Results of subglandular versus subpectoral augmentation over time: one surgeon's observations.

BACKGROUND: Advocates of subglandular and subpectoral augmentations, respectively, each feel that the benefits of their method outweigh any drawbacks.

OBJECTIVE: A comparative analysis of subglandular and subpectoral augmentation results was undertaken over a decade to compare long-term results.

METHODS: Data were collected from 100 patients who underwent subglandular augmentation and 100 who underwent subpectoral augmentation between 1993 and 2002. An initial satisfactory result by evaluation or patient declaration was a prerequisite for inclusion. Patients with any early implant displacement were excluded. Patients were examined both in the relaxed position and with chest muscles contracted. All patients were evaluated for malposition, distortion, asymmetry, contour deformity, and scarring.

RESULTS: Subglandular augmentations exhibited various degrees of capsular contracture, implant palpability, and visible rippling, depending on implant type and breast tissue volume. Subpectoral augmentations were associated with varying degrees of muscle contraction-induced deformities, including malposition, distortion, asymmetry, and contour deformity. These problems were directly related to muscle strength and inversely related to the amount of breast tissue present. Subpectoral augmentations were also associated with a high incidence of initially high implant placement, and a 94% upward migration rate at 7-year follow-up after initially appropriate placement. Rippling over the superior pole of the breasts, but not over the inferior portion, was observed to be less in subpectoral augmentations than in subglandular augmentations.

CONCLUSIONS: Subpectoral augmentation provided better concealment of upper pole rippling than subglandular augmentation, but at the price of higher rates of muscle contraction-induced deformities and implant displacement. Capsular contracture can occur after augmentation in either plane, but because the processes of capsule formation are qualitatively different in each case, a direct comparison of contracture rates would be misleading.