Virginia Breast Implants Placement & Technique

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Breast Implant Placement Options

What breast implant position will create the best results for me? Many women wonder this question when considering breast implants. However, there isn’t a single ‘right’ answer that will be the best for every woman.

There are a couple options. Breast implants can be placed right below the breast tissue, but above the chest muscle. Another option would be to place the implant below the muscle. There are pros and cons to each option. The final look will depend not only on the placement, but also on:

The information below will give some info on the pros and cons to each placement. Talk to the plastic surgeon about which option might be best for you.

Cross section breast anatomy diagram

Cross section breast anatomy diagram

Cross section breast anatomy diagram with implant

Cross section breast anatomy diagram with implant

Placement Above the Muscle

Placing the implant below the breast tissue but above the muscle is often referred to as ‘sub-glandular.’ This is because it is just below the breast glands. You may also hear this described in ways like:

  • Over the muscle.
  • Above the muscle.
  • Above the pectoral muscle.
  • Under the breast.
  • Below the gland.
  • Between the breast and the muscle.

These are all describing the same placement: below the glandular tissue, but sitting on top of the chest muscles. There are several pros and cons to this placement.

Pros:

  • The surgery is simpler.
  • There may be less pain as it heals.
  • The recovery is quicker since the surgery does not involve moving the muscle.
  • Larger implants can be used, if desired.
  • Use of the chest muscles during exercise will not interfere with the implant in the future. This may be helpful for athletic women.

Cons:

  • Sometimes the implant can be felt or even seen through the skin. This happens more for women with thin skin or breast tissue, low body fat, and/or less natural breast tissue.
  • There is a higher risk of some types of problems after the surgery. These include capsular contracture, changed nipple sensation, and infection.
  • This placement may affect the ability to read future mammograms.
  • Sometimes wrinkles and ripples in the implant may be visible.
  • The implant can move downward over time and change the look of the breast. In other words, it may droop or sag.

For many women, this placement results in a more rounded final look. Whether this is a pro or con is a matter of preference. Women with plenty of natural breast tissue may be able to avoid some of the cons on this list. The natural tissue will lessen the chance of seeing implant ripples or wrinkles. The natural tissue will also help to hold the implant in place (and avoid the implant sagging too low) over time.

Placement Partially or Fully Below the Muscle

In this option, the surgeon places the implant either within the muscle (below the surface) or below the muscle.

When placing the implant below the pectoral muscle surface, the bottom of the implant will extend below the muscle. This placement involves separating a portion of the muscle to allow the implant to be placed under a portion of it. This results in the muscle then enveloping the implant. The majority of implant surgeries use this method. This may also be described as:

  • Sub-fascial or sub-pectoral (because it is below the ‘fascia’ of the pectoral muscle)
  • Partial sub-muscular
  • Dual-pane placement

Placing the implant completely below the muscle surface is similar, but the implant is placed under the muscle itself. The muscle fully covers the implant. This is also called:

  • Sub-muscular
  • Between the pectoral muscle and the ribs
  • Under the muscle or below the muscle

As with placing the implant above the muscle, there are several pros and cons.

Pros:

  • This placement may hold the implant in position better over time. It has more support, especially for women without ample natural breast tissue. With placement completely below the muscle, there is less likelihood of the implant dropping downward. (This is less true when placed only partially below the muscle; in that case the implant can still drop over time since there is not muscle below it to support it.)
  • Since the implant is behind muscle, it does not cause as much problem reading future mammograms.
  • The risks of capsule contracture are lower.
  • Implant ripples or wrinkles are less likely to be seen at the skin surface.

Cons:

  • In partial sub-muscular placement, the bottom of the implant is not held by the muscle, so the implants can still drop downward over time.
  • The surgery has a longer recovery period.
  • There is more pain during the healing process.
  • There is also more swelling. The swelling may last weeks or even months. This also means it will take longer before the final results can be seen. The area at the top of the breasts can be quite swollen.
  • When flexing the chest muscle, the breast shape may look distorted. This can happen during exercise.

Which option is best for you? The answer depends on many factors. Your anatomy and the desired result should be taken into account. Talk with the surgeon to determine what option will achieve the best result for you.

Breast Augmentation Surgery Technique

Step 1

This first 3-D illustration depicts a woman lying on the operating table with a pre-operative mark around her breast crease or inframammary fold. This mark serves as a reference and aides precision during her cosmetic breast augmentation surgery.

Step 2

This 3-D illustration depicts the cosmetic breast augmentation surgery incision along the breast crease or inframammary fold. This exact placement of this incision depends on the woman’s breast tissue characteristics and how large of a breast implant she desires. The incision is placed in such a fashion so that after the breast augmentation implant surgery is complete, it is hidden the crease of the breast. It is measured and is only 3 centimeters in length. This is slightly longer than one inch. A small retractor is holding up the skin to expose the breast fat and breast gland.

Step 3

For illustration purposes the surgery incision in this 3-D illustration has been extended to show more of what the cosmetic breast augmentation surgery involves. In real breast augmentation surgery, this is more difficult to see than these next few illustrations. A larger retractor is placed and the subcutaneous fat and breast fat have been divided to expose the underlying pectoral muscle. It is this muscle that will be raised or lifted to allow the breast implant to be placed ‘under the muscle’.

Step 4

At this point in the breast augmentation surgery, the pectoral muscle has been divided to a required amount and a pocket or space has been created ‘under the muscle’. The pectoral muscle is in the upper aspect of this wound, below the retractor. The muscle that is along the bottom part is the muscle that is in between the ribs.

Step 5

This image is showing that the breast implant has been prepared and is rolled up and is being placed ‘under the muscle’ for her cosmetic breast augmentation.

Step 6

The breast implant is now under the muscle and is ready to be filled with saline. The tube connects to the breast implant and fills the saline. If these were silicone gel breast implants, there would be no tube and the breast implants are prefilled.

Step 7

The breast implant has been filled and the fill tube has been removed from the implant. At this point in the augmentation surgery, the implant position is confirmed by feeling the edge of the implant and then the other side has the implant placed in the same fashion. Then both breast implants are checked for breast symmetry and the wounds are closed with dissolvable stitches in three different tissue layers.

Step 8

This final surgery illustration depicts the wound closed from her breast augmentation surgery. The plastic surgery stitch that is seen will be pulled out on the first post operative visit usually by the plastic surgeon. This type of plastic surgery wound closure leaves no dots around the thin line scar this has been positioned in the breast crease.