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By Jeffrey Donaldson, MD |

Which Breast Implant Placement Is Best?

The Benefits Of Each Standard Placement Technique

Which Breast Implant Placement Is Best?

Breast implant placement plays a crucial role in your final look, your recovery experience and how your results age over time. There are three standard options: over the muscle, under the muscle and dual-plane. Each method offers its own distinct advantages based on your anatomy and aesthetic goals.

We discuss best use cases and the technique details of each to help you answer the question “Which breast implant placement is best” for yourself. 

Our Preferred Method: The Dual-Plane Breast Augmentation

In a dual-plane augmentation, the implant is positioned so that the upper portion is covered by the pectoral muscle, while the lower portion sits directly beneath the natural breast tissue. This hybrid placement is highly customizable, allowing your surgeon to adjust the degree of muscle release based on your tissue characteristics, degree of ptosis (sagging), and desired aesthetic.

During the procedure, your surgeon releases the tissue in the subglandular plane above the muscle, typically just below the areolar border. The submuscular tissue is released, including the origin of the pectoral muscle at the rib. This causes the muscle to “window shade” upward, creating space for the implant to settle naturally into the lower breast pole.

Updated diagram that shows the Dual-Plane Breast Augmentation

This technique was refined and popularized by the late John Tebbetts, MD, a renowned plastic surgeon who emphasized precise anatomical tailoring to optimize both form and function.

More About The Dual-Plane Method

Ideal For:

  • Patients with mild sagging (pseudoptosis), thinner breast tissue
  • Those seeking a natural-looking slope with enhanced lower-pole fullness

Greatest Benefits:

  • Natural upper contour
  • Customizable to existing anatomic structure
  • Enhanced implant coverage
  • Lower risk of implant visibility or rippling
  • Balanced projection and long-term stability

Potential Negatives:

  • More technical surgery
  • Slightly longer recovery period

“The dual-plane method is great for patients who want to accentuate the lower pole fullness in addition to enhancing the upper pole fullness. It really is the best of both worlds.”

– Dr. Jeffrey Donaldson

 

Diagram that shows the implant placement with a Subglandular Breast Augmentation

Above The Muscle (The Subglandular Breast Augmentation)

Subglandular placement means the implant is placed above the pectoral muscle and directly beneath the breast tissue. This method is typically accessed via an inframammary (under the breast) or periareolar (around the nipple) incision.

Ideal For:

  • Patients with abundant natural breast tissue who want to avoid muscle involvement

Greatest Benefits:

  • Faster recovery time
  • No implant movement with muscle flexing
  • Easy surgical access

Potential Negatives:

  • Increased risk of capsular contracture
  • Less natural appearance in leaner patients
  • More visible edges or rippling in low-tissue coverage cases

“To mirror breast tissue, the implant sits within or just behind the breast tissue without involving the muscular level. For most patients — especially those who are a little more petite or have a smaller breast size — it’s helpful to have that extra anatomic layer covering the implant, disguising it from the outside world.”

– Dr. Jeffrey Donaldson

Under The Muscle (The Submuscular Breast Augmentation)

In this method, the implant is placed entirely beneath the pectoral muscle. It’s less commonly used in modern cosmetic breast augmentation surgery but remains an option in unique anatomical situations or reconstructive cases. Access is usually via an inframammary incision.

Diagram that shows the implant placement of a submuscular breast augmentation

Ideal For:

  • Patients with extremely low breast tissue volume
  • Patients undergoing post-mastectomy reconstruction.

Greatest Benefits:

  • Excellent soft-tissue coverage
  • Low risk of visible implant edges
  • Reduced capsular contracture risk

Potential Negatives:

  • More discomfort post-op
  • Potential for implant movement with muscle activation (animation deformity)
  • Longer recovery time

“It’s very rare that I place an implant just exclusively under the muscle. It’s often too limiting for the natural movement & position we’re aiming to achieve.”

– Dr. Jeffrey Donaldson

Refined Surgical Skill & Experience Are Vital 

A smooth, safe and comfortable recovery is often the result of your surgeon’s technique, judgment, staff, pre-op planning and post-op support. The body responds better when advanced methods are used and delicate tissue is treated responsibly. Surgical team consistency reduces operation time, and a reduction in operation time minimizes the risk of complications and improves healing times in plastic surgery patients.

An experienced surgeon understands what your anatomy is capable of. They also know when to say no, and how to redirect with safer, more effective options.

A Surgeon’s Expertise Should Never Limit Your Options

Choosing the right implant placement depends on your body, lifestyle and personal taste. That means every solution should be on the table for you, so long as it is safe and appropriate. At Donaldson, our team evaluates your existing natural tissue, your goals and your activity level to recommend a placement that prioritizes safety, aesthetics and longevity.

The most successful procedures are collaborative, and we’re here to ensure you feel informed, supported and confident every step of the way.

schedule a consultation with our experts

About The Author

Jeffrey Donaldson, MD, is a board-certified plastic surgeon based in Columbus, Ohio, known for his refined approach to all three standard breast augmentation techniques. He continuously refines his methods to reflect the latest surgical advancements while curating each treatment plan to suit the needs and anatomy of the individual patient. Dr. Donaldson prioritizes education as a foundational aspect of care, believing that informed patients make empowered decisions and that consultations should leave people feeling seen, supported and confident.

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