When considering breast augmentation, patients often focus on the size and type of implant. But one of the most important decisions your plastic surgeon will make is where to place the implant—above or below the muscle—and how that affects scarring, recovery, and long-term results.
Understanding your options can help you make a more informed decision about your surgery and set realistic expectations for your results and recovery. In this blog, we’ll explore how implant placement impacts scarring, the different types of incisions used in breast augmentation, and how to minimize visible scars after surgery. Female board certified plastic surgeon, Dr. Kristi Hustak, provides breast augmentation to patients in Houston, Texas and surrounding areas.
Subglandular vs. Submuscular Implant Placement
Breast implants can be placed in one of two main locations:
-
Subglandular (over the muscle): The implant is placed between the breast tissue and the chest muscle (pectoralis major).
-
Submuscular (under the muscle): The implant is placed beneath the pectoral muscle.
Each option has its pros and cons, and the choice depends on your anatomy, lifestyle, and cosmetic goals.
Subglandular Placement (Over the Muscle)
Pros:
- Shorter recovery time
- Less postoperative pain
- Easier surgical technique
Cons:
- More visible implant edges (especially in patients with less breast tissue)
- Higher risk of capsular contracture
- More noticeable rippling
Scarring: Subglandular placement doesn’t affect the external scar location, but it can impact how well the implant is concealed under the skin, potentially making rippling or edge visibility more noticeable—especially in thinner patients.
Submuscular Placement (Under the Muscle)
Pros:
- More natural look and feel in leaner patients
- Less visible implant edges
- Lower risk of capsular contracture
Cons:
- Slightly longer recovery time
- More discomfort initially
- Animation deformity in active patients
Scarring: Scars may be better concealed with submuscular placement, particularly when using inframammary or periareolar incisions, because the muscle offers more coverage.
Types of Breast Augmentation Incisions
Regardless of implant placement, the incision type and location will have the most direct impact on visible scarring. There are three primary incision options:
Inframammary Incision (Under the Breast)
- Most common approach
- Incision is placed in the natural breast fold
- Provides excellent surgical access and control
- Scar is well-hidden under the breast
Best for: Patients concerned about visible scars; often used for both submuscular and subglandular placement.
Periareolar Incision (Around the Nipple)
- Incision made along the lower edge of the areola
- Scar blends with the pigment change between areola and skin
- Offers direct access to the implant pocket
Best for: Women with larger areolas who want minimal visible scarring; may be less ideal for those planning to breastfeed.
Transaxillary Incision (In the Armpit)
- Hidden scar in the natural crease of the armpit
- No scar on the breast itself
- Technically more challenging, may limit implant types
Best for: Patients who want no scarring on the breast, though the armpit scar may be visible in tank tops or swimwear.
How Implant Placement Affects Scarring Over Time
While incisions leave scars, the visibility and long-term appearance of those scars can vary based on:
- Implant size and weight
- Skin quality and elasticity
- How well the incision is supported
- Post-operative healing and scar care
Submuscular placement offers more support to the implant, which may reduce tension on the incision and improve scar healing. In contrast, subglandular placement may put more pressure on the incision, especially in larger implants, which can lead to wider or more visible scars over time.
Tips for Minimizing Breast Augmentation Scars
No matter the incision or placement, there are proven ways to help minimize scarring:
- Follow your surgeon’s aftercare instructions carefully.
- Use silicone sheets or gels once the incision is closed.
- Avoid sun exposure on healing scars for at least a year.
- Stay hydrated and maintain good nutrition for optimal healing.
- Massage the scar if recommended by your surgeon.
Some patients may also benefit from laser treatments, microneedling, or steroid injections to improve scar texture or pigment after the healing process.
What’s the Best Option for You?
Every patient is unique, and the best breast implant placement and incision approach will depend on:
- Your body type and breast anatomy
- Desired size and shape
- Lifestyle and activity level
- Skin quality and healing tendency
During your consultation, your board-certified plastic surgeon will evaluate your anatomy and goals, then recommend the most appropriate implant placement and incision type to balance results and minimize scarring.
Balancing Aesthetics and Scarring
Breast augmentation is a highly customizable procedure, and implant placement plays a major role in the final outcome—both in terms of appearance and potential scarring. Understanding the pros and cons of subglandular vs. submuscular placement, as well as the different incision techniques, can help you approach your procedure with confidence.
With the right surgeon and a personalized surgical plan, you can enjoy beautiful, natural-looking results with scars that fade gracefully over time.
Considering Breast Augmentation?
Contact us today to schedule a consultation and discuss your options for implant placement, incision location, and scar management with a board-certified plastic surgeon.
For more information on procedures and treatments provided by board-certified female plastic surgeon Dr. Kristi Hustak please call us to schedule a consultation at 713.322.7265 or click here. Offices in Houston, Texas.
Serving Houston, TX, The Woodlands, Sugar Land, Katy, Friendswood, Pearland, League City, Richmond, Spring, Humble, Kingwood, Stafford, Cypress, Fulshear, Missouri City, River Oaks, Piney Point, Hunters Creek, Memorial Close In, Bunker Hill, Southside Place, Afton Oaks, Tanglewood, Crestwoods and all other surrounding Greater Houston, Texas communities and more.