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Breast Implant Position

Breast implants can be placed in a number of different positions under the breast. Your wishes will determine which is the best option. In this article I will give my opinion regarding the pros and cons of each breast implant position to hopefully shed some light on this complex area.

Breast Implant Position

There are three main positions, or planes, that plastic surgeons talk about when discussing breast augmentation. The first is the sub glandular position, placing the breast implant directly under the breast gland. The second position is the submuscular plane, placing the breast augment under the pectoralis muscle. The dual plane is a combination of both of these approaches.

Subglandular Plane

Only breast tissue and skin covers the breast implant in the subglandular plane. Creating this pocket to place the implant into is a relatively straight forward surgical dissection. With out lifting the underlying muscle, there is less discomfort and swelling.

Some breast deformities demand a subglandular plane approach. An example of this is in the severe tuberous breast. The tight constricted breast base of the tuberous breast needs maximal breast implant contact to expand the deformed gland.

The thinner covering over the breast implant makes the augment easier to feel and see. This is less of a problem if the patient already has a large amount of breast tissue to camouflage the augment.  A sub glandular placement can also provide a more obvious augmented look.

The other issue with a purely subglandular implant is that the added weight behind the skin and gland can stretch the breast. Over time this can lead to a droopy looking breast, much like placing a rock in a sock. Using a smaller implant and wearing a bra as much as possible post operatively, generally minimises these problems.


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Submuscular Plane

In the submuscular plane the breast implant is entirely hidden under the pectoralis major muscle. Lifting the pectoralis muscle causes more discomfort for the patient partly due to the associated increased swelling. Both of these factors increase recovery time.  There is also has a slightly higher rate of postoperative hematoma due to the larger blood vessels encountered intra-operatively supplying the muscle.

With an implant under the muscle the breast will animate (move) with contraction of the muscle. This means if doing an exercise such as a push up, the muscle will squeeze the implant moving the breast slightly to the side. Most patients are not concerned with this as long as they are aware of it prior to surgery.

The advantages to the submuscular placement is that the implant has an extra layer over it. This greatly reduces palpability and can help make the implant look more natural, especially at the top of the breast. Muscle helps support the implant so that its weight is not entirely taken by the breast gland and skin. This consequently should reduce the amount of droop that the breast undergoes.

A major disadvantage of the implant being placed entirely under the muscle is that the implant is unable to interact with the breast gland. As a result the implant is unable to fully expand the breast. Two deformities can result from this. A ‘double bubble deformity’, where the gland is higher than the implant, or a ‘waterfall deformity’ where the implant is higher than the gland.

Dual Plane

In an attempt to harness the best parts of both of the planes, the dual plane was developed. This technique involves two stages. The first part of the operation involves elevating the breast off the lower part of the of the muscle. The second lifts the muscle off the chest wall. The final result therefore has the implant tightly held under the muscle in the upper part of the breast, with expansion of just gland in the lower part.

While being a more demanding operation to perform, the benefits are significant.

A layer of muscle holds the implant in the upper part of the breast. This smooths the point at which the breast starts to lift off the chest wall, generally creating a more natural feel and appearance in the upper pole. The muscle also supports the implant reducing the amount of breast droop.

Only breast tissue and skin cover the implant in the lower part of the breast. Planned correctly this allows the implant to maximally expand the breast minimising double bubble and waterfall deformity mentioned above.

A fully expanded lower pole with a smooth upper pole take off creates a youthful natural shape, which is the aim of most of the patients we see. 

Plastic Surgery Perth

Always make sure your surgeon is a fully qualified Plastic And Reconstructive surgeon with a special interest in Aesthetic surgery (Australasian Society of Aesthetic Plastic Surgeons.) You should be comfortable discussing all you options and feel you really understand all of the risks and complications that surgery can involve. If you aren’t 100% happy always seek a second opinion.

Look out for our next blog post looking into some of the common complications which can occur with breast augmentation.

Feel free to email any questions you might have through the contact page or message via instagram.




2018-04-25T13:27:11+00:00April 25th, 2018|

Breast Augmentation Incision

The breast augmentation incision is the first part of your breast surgery. The placement of that scar has many implications in terms of visibility and safety. This is why  you should understand the factors that go into the decision to help you engage with your surgeon.

Types of incisions

There are many different types of breast augmentation incisions. They range from the traditional breast fold incision to the more controversial belly button incision. The three commonest incisions I see in my practise are the infra mammary fold incision (IMF), the axillary fold incision and the periareolar incision. I will explain where each is and then expand on my favourite.

Periareolar Scar

This breast augmentation incision is placed around the lower half of the areolar of the breast. Areolar is the pink/brown coloured skin surrounding the nipple. The perceived advantages of this scar is that it is difficult to see and maintains the lower fold of the breast intact.

The disadvantages of the periareolar incision is the surgeon is cutting through some of the breast ducts. Firstly this can this interfere with future breast feeding. Secondly it exposes the breast implant to naturally occurring bacteria which live in the ducts. Dr Sam Cunneen works tirelessly to avoid any exposure to bacteria so his preference is to avoid this incision. 

Finally the periareolar scar is also quite obvious when going topless. This is a tell tale sign of a breast augmentation.

Axillary Incision

This breast augmentation incision is made in the line of the armpit. The advantage of this incision is that it forms a well hidden scar.

The disadvantages are that the incision is a long way from the final position of the breast implant. Hence it is very difficult for the surgeon to see exactly where they are placing the implant. Consequently it is impossible to accurately control how the breast tissue slides over the muscle to interact with the implant.

The final point to make regarding the scar is that while the scar is quite hidden, even when topless, it is visible when a patient raises her arms.

Infra mammary fold (IMF)

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IMF incision 3 months post

Probably the most commonly used incision to place a breast implant is the IMF. The aim of the incision is to put the final scar right in the lower breast crease where the breast comes out from the chest. There are three reasons this is the preferred incision of Dr Sam Cunneen at Breast Augmentation Perth.

Hidden scar

A well placed IMF incision is very hard to see with your bra removed. This is because the breast implant folds the scar into the chest, obscuring the incision from view. To see your scar someone can either crouch down to look up or you can lift up your breast to show it off!

Surgical vision

To give you the best looking breasts he possibly can, accurate implant placement is critical. No other incision provides as good access as the IMF incision to allow this to occur. Using an IMF incision Dr Sam Cunneen can release as much breast gland as required off the underlying muscle to craft these lovely breast shapes.


Besides trying to create the most spectacular breasts possible we are constantly striving to avoid any complications from the surgery. One of the most concerning complications, although rare, is infection. As the breast ducts harbour naturally occurring bacteria, Dr Sam Cunneen is able to avoid all of these with an IMF incision. Bacteria are disastrous if they stick onto a breast implant. The IMF incision, by going below the breast gland, maintains all the breast ducts intact reducing the risks of infection.


More News Posts From Breast Augmentation Perth

As you can see there is a lot to think about. Make sure you choose a surgeon who is appropriately qualified to answer all of your questions (ASPS and ASAPS). Please email if you have any other questions. The next blog post will have a discussion about the different positions an implant can be placed. Until then keep the Questions coming! Sam

2018-04-25T13:41:04+00:00October 8th, 2017|

Continuing education

Dr Cunneen is committed to his ongoing surgical education and this weekend attended the 39th Annual ASAPS Conference. The annual conference hosted by the Australasian Society of Aesthetic Plastic Surgeons is the premier event of it’s kind in Australasia, and this year’s meeting held on the Gold Coast had a twin focus on Breast & Body, plus Facial Rejuvenation. Sam also used the opportunity to catch up with plastic surgery colleagues including Dr Nicholas Moncreiff (Newcastle), and Dr Michael Miroshnik (Sydney).


2017-04-16T12:21:38+00:00October 19th, 2016|