Answer:
I. Bostwick says always below muscle unless...
A. considerable breast ptosis when a subglandular implant placement can be useful to minimize the elevated appearance of an implant that is positioned too high, or...
B. considered for patients with
- fuller ptotic breasts with good potential cover for the implants
- patients who are active body builders and want to avoid any distortion of the implant from muscular contractions.
II. Below muscle...
A. Advantages
- lower incidence of capsular contracture
- improved breast contour b/c edges are blunted by muscle
- less exposure of the prosthesis to bacterial contaminants from glandular tissue
- a plane of dissection that is less vascular than in retroglandular implant placement
- maximal preservation of nipple sensation
B. Disadvantages
- need to be careful to avoid irregularities in inframammary fold
- tend to shift upward and laterally with time