Submuscular placement of breast implants
Breast implants can be positioned either in front of or behind the pectoralis major muscle, or in a joint position called the “dual plane.” Of course, a breast augmentation procedure with implants is tailored to fit each patient’s needs, so there is no standard technique to be used in all cases.
The choice of positioning the implants during a breast augmentation surgery largely depends on the thickness of the existing breast tissue (mammary gland and fat), the desired volume of the breasts to be achieved, the existence of breast ptosis, as well as other aspects such as the patient’s lifestyle and so on.
Each breast implant placement has its advantages and disadvantages. However, positioning the breast implants under the pectoralis muscle has many benefits. This article will help you understand why this position, called the submuscular position, is most preferred by plastic surgeons.
A natural touch
Placing the implant behind the pectoral muscle allows better palpability of the breasts and a natural feel, especially on an intimate level. The benefit is even more accentuated if the patient has a thin tegument (small mammary gland and not a lot of adipose tissue). If the implant’s volume is reasonable and placed under the pectoral muscle, the breast implant is almost imperceptible to the touch.
Better wound healing and incision protection
When the implants are placed on a flat or small chest, their position behind the pectoral muscle can also help achieve the desired size of the breasts (the thickness of the muscle will add to the thickness of the mammary gland). This also allows better protection to the incision site which might be fragile, especially if the volume of the implant is big and the breast coverage of the patient is not sufficient.
The goal of breast augmentation is to get the most natural results possible, and thus we aim to hide the contours of the breast implant. The choice to position the implant behind the pectoral muscle helps soften the edges of the implant, especially on its upper level, at the neckline.
Positioning the implant beneath the muscle allows for the better retention of the implant, particularly when the augmentation is associated with a breast sagging correction (mastopexy). This is explained by an effect of an anatomical bra conferred by the muscle at the lower part of the implant (the implant will be maintained at its lower base by the muscle), which will prevent a possible subsequent sagging of the breasts.
If there is a case of mild to moderate breast ptosis (sagging) that the patient does not want to correct to avoid the creation of scars, it is best to have the implant positioned above the pectoral muscle to compensate for the sagging of the breasts. In the case of a submuscular placement for sagging breasts, it might curb the implant and prevent it from descending into the skin envelope.
The position of the breast implant before the muscle can sometimes offer good results if the thickness of the gland is sufficient to cover the contours of the implants. In this case, subglandular implantation (behind the mammary gland and in front of the muscle) is preferred. Still, you must keep in mind that the thickness of the mammary gland decreases with age and can be influenced by factors such as menopause, pregnancy, and weight loss.
Postoperatively, the submuscular position is associated with more pain than a subglandular implantation, but the pain is easily managed with prescribed analgesics.
In many cases, if the patient is a professional athlete, submuscular placement is not recommended. Muscle contractions can increase the risk of implant displacement, particularly during the first few months after surgery. For athletes, placing the implants before the pectoral muscle is advised.
The Dual Plane Technique
The dual plane technique positions the lower half of the breast implant between the muscle and the mammary gland and the upper half of the implant behind the pectoral muscle. This way, the implant is situated in an ideal place in the envelope of the breasts and not constrained by the pectoral muscle in the lower pole. At the same time, the neckline looks natural with a nice, soft slope, as the top of the implant is masked by the pectoral muscle. This technique is generally used for relatively thin patients or patients desiring a large volume implant while trying to avoid the bulging aspect that will make the breasts look unnatural and obvious.
In most cases, the plastic surgeon will recommend the placement of the implant under the pectoral muscle. Some patients want the implants under the mammary gland for less pain during the recovery period. However, while a submuscular placement may cause more pain as it will cut through the muscle to create a pocket for the implant, it is the best way to avoid implant visibility, especially if there is not enough breast tissue coverage. Keep in mind that the most suitable technique for you will be determined after careful examination of the existing breast tissue, as well as after considering your desires and expectations from the surgery.
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