BACKGROUND: Subpectoral and prepectoral planes have commonly been used in implant-based breast augmentation. The effect of implant plane on complication rate was still unclear. This meta-analysis demonstrated current evidence with regard to comparison of complication rates between subpectoral and prepectoral breast augmentation. METHODS: Pubmed, EMBASE and Cochrane library were searched to December 2018. The results of selected studies were meta-analyzed to obtain a pooled odds ratio of the effect of subpectoral versus prepectoral breast augmentation on rates of complications. RESULTS: There were significantly lower rates of capsular contracture and hematoma but higher rates of implant displacement and animation deformity in the subpectoral group compared with the prepectoral group. There was no significant difference with regard to rates of reoperation, seroma, rippling, infection and implant rupture between these two groups. CONCLUSIONS: Subpectoral and subglandular breast augmentations both have their merits and demerits with regard to complications. The pros and cons of each procedure should be fully explained to patients and selection of implant plane should be considered more comprehensively. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .