Breast implants can be placed in a number of different positions under the breast. Your wishes will determine which is the best option. In this article I will give my opinion regarding the pros and cons of each breast implant position to hopefully shed some light on this complex area.
Breast Implant Position
There are three main positions, or planes, that plastic surgeons talk about when discussing breast augmentation. The first is the sub glandular position, placing the breast implant directly under the breast gland. The second position is the submuscular plane, placing the breast augment under the pectoralis muscle. The dual plane is a combination of both of these approaches.
Only breast tissue and skin covers the breast implant in the subglandular plane. Creating this pocket to place the implant into is a relatively straight forward surgical dissection. With out lifting the underlying muscle, there is less discomfort and swelling.
Some breast deformities demand a subglandular plane approach. An example of this is in the severe tuberous breast. The tight constricted breast base of the tuberous breast needs maximal breast implant contact to expand the deformed gland.
The thinner covering over the breast implant makes the augment easier to feel and see. This is less of a problem if the patient already has a large amount of breast tissue to camouflage the augment. A sub glandular placement can also provide a more obvious augmented look.
The other issue with a purely subglandular implant is that the added weight behind the skin and gland can stretch the breast. Over time this can lead to a droopy looking breast, much like placing a rock in a sock. Using a smaller implant and wearing a bra as much as possible post operatively, generally minimises these problems.
In the submuscular plane the breast implant is entirely hidden under the pectoralis major muscle. Lifting the pectoralis muscle causes more discomfort for the patient partly due to the associated increased swelling. Both of these factors increase recovery time. There is also has a slightly higher rate of postoperative hematoma due to the larger blood vessels encountered intra-operatively supplying the muscle.
With an implant under the muscle the breast will animate (move) with contraction of the muscle. This means if doing an exercise such as a push up, the muscle will squeeze the implant moving the breast slightly to the side. Most patients are not concerned with this as long as they are aware of it prior to surgery.
The advantages to the submuscular placement is that the implant has an extra layer over it. This greatly reduces palpability and can help make the implant look more natural, especially at the top of the breast. Muscle helps support the implant so that its weight is not entirely taken by the breast gland and skin. This consequently should reduce the amount of droop that the breast undergoes.
A major disadvantage of the implant being placed entirely under the muscle is that the implant is unable to interact with the breast gland. As a result the implant is unable to fully expand the breast. Two deformities can result from this. A ‘double bubble deformity’, where the gland is higher than the implant, or a ‘waterfall deformity’ where the implant is higher than the gland.
In an attempt to harness the best parts of both of the planes, the dual plane was developed. This technique involves two stages. The first part of the operation involves elevating the breast off the lower part of the of the muscle. The second lifts the muscle off the chest wall. The final result therefore has the implant tightly held under the muscle in the upper part of the breast, with expansion of just gland in the lower part.
While being a more demanding operation to perform, the benefits are significant.
A layer of muscle holds the implant in the upper part of the breast. This smooths the point at which the breast starts to lift off the chest wall, generally creating a more natural feel and appearance in the upper pole. The muscle also supports the implant reducing the amount of breast droop.
Only breast tissue and skin cover the implant in the lower part of the breast. Planned correctly this allows the implant to maximally expand the breast minimising double bubble and waterfall deformity mentioned above.
A fully expanded lower pole with a smooth upper pole take off creates a youthful natural shape, which is the aim of most of the patients we see.
Plastic Surgery Perth
Always make sure your surgeon is a fully qualified Plastic And Reconstructive surgeon with a special interest in Aesthetic surgery (Australasian Society of Aesthetic Plastic Surgeons.) You should be comfortable discussing all you options and feel you really understand all of the risks and complications that surgery can involve. If you aren’t 100% happy always seek a second opinion.
Look out for our next blog post looking into some of the common complications which can occur with breast augmentation.