Dr. Gary Lawton Advocates for Dual-Plane over Subglandular Breast Augmentation

Yale-trained San Antonio plastic surgeon says corporate marketing does not overturn decades of anatomic and clinical evidence SAN ANTONIO , Aug. 14, 2026 /PRNewswire/ -- As national cosmetic surgery companies and new breast implant manufacturers promote above-the-muscle breast augmentation, Yale-trained, board-certified plastic surgeon Dr. Gary Lawton challenges the premise that a newly introduced implant and a forceful corporate marketing campaign transforms subglandular breast augmentation into a new or more advanced operation. Breast Augmentation in San Antonio Subglandular breast augmentation is not new. It places the implant immediately behind the breast gland and dates to the earliest era of breast implant surgery. "A procedure does not become advanced because it has been repackaged with a new implant or corporate medical messaging," Dr. Lawton said. "The relevant question is whether the anatomy, biology, and long-term evidence justify moving the implant out from beneath muscle coverage." Breast Augmentation Frequently Asked Questions Rapid Recovery Is Not an Implant Plane National cosmetic surgery organizations predominantly known for awake liposuction are now marketing awake, over-the-muscle breast augmentation. Similar national campaigns describe preservation of native breast tissue as an innovation, although preservation of healthy native tissue has always been a fundamental objective of breast augmentation. Minimal-Scar Breast Augmentation in San Antonio Dr. Lawton believes this questionable marketing strategy risks conflating two fundamentally different questions: How quickly does the patient recover, and where should the implant be placed to provide the strongest long-term anatomical result? "Rapid recovery should come from reducing unnecessary surgical trauma," Dr. Lawton said. "Precise dissection, efficient surgery, controlled tissue handling, proper anesthesia, and postoperative management all affect recovery." Transaxillary Breast Augmentation in San Antonio The Case for Muscle Coverage The distinction is not merely philosophical. Capsular contracture rates are 6.85% with subglandular placement and 1.99% with dual-plane placement . Muscle coverage also provides an additional layer of living tissue over the implant, which reduces visible implant edges and rippling, particularly in patients with limited native breast tissue. Submuscular dual-plane surgery is technically more demanding, but technical difficulty does not negate the anatomical advantages. "The appropriate response to a technically more demanding operation is to become better at performing it," Dr. Lawton said. "It is not to automatically return to an anatomically simplistic operation from more than 60 years ago." A New Implant Does Not Make an Old Plane New New textured implants recently introduced into the United States have generated considerable advertising, mostly for the benefit of the manufacturer. Dr. Lawton cautions against interpreting favorable implant trials as evidence that subglandular placement has overcome its historical disadvantages. The distinction is fundamental: implant technology and implant position are separate variables. A different textured shell surface or new delivery system may alter certain characteristics of the surgery. It does not negate the importance of tissue thickness, gravity, mechanical loading, pocket anatomy, or the biological response to an implanted device. Refine the Operation, Not the Anatomy For more than 25 years, Dr. Lawton has focused on refining endoscopic transaxillary dual-plane breast augmentation rather than abandoning muscle coverage to accelerate recovery. His approach uses direct endoscopic visualization, controlled dissection, meticulous hemostasis, and precise pocket construction to minimize unnecessary tissue injury while maintaining dual-plane coverage. The objective is to solve the recovery problem through surgical refinement. "Patients experience recovery for days or weeks," Dr. Lawton s...