Breast Augmentation - Implant Position and Surface

from plastic surgery

Implants can be placed in one of two positions: between the breast and the pectoralis muscle, or between the pectoralis muscle and the ribs. Either way, they are centered under each breast and nipple. The outside of an implant can be either smooth or textured. The surface of the implant is indiscemible following surgery.

Implant Position - Above the Muscle

Position of the implant above the pectoralis muscle is known as subglandular placement and offers several advantages. This operation involves less discomfort and faster recovery because the pectoralis muscle itself is not disturbed. Your breasts immedi¬ately appear attractive because swelling is minimal. In athletic muscular women, it causes less distortion of the breast when the pectoralis muscle is flexed.

Women with ample breast tissue might be more likely to select subglandular placement than women with very modest breasts, as larger breasts offer more of a cushion between the implant and the skin.

Disadvantages include a higher risk of capsular contracture and greater interference with mammog¬raphy than subpectoral placement. Women with thin skin, low body fat, or petite breasts are very likely to feel the implants through the skin and are more likely to have rippling and wrinkling. Large implants are more likely to displace downward, and the risk of nipple numbness is slightly higher.

Implant Position - Below the Muscle

Implant position below the muscle, also known as submuscular or subpectoral placement, offers the advantages of a lower rate of capsular con¬tracture, less interference with mammography, lower rate of rippling, and less likelihood of downward displacement. Thin women with petite breasts may obtain the best cosmetic result with the implant placed under the muscle, which provides more padding between the implant and the skin.

Disadvantages include greater postoperative pain, greater swelling, and a longer recovery period. Swelling can be profound and may persist for weeks to months. During this time, the upper portion of the breast appears unnaturally full. And after swelling subsides, flexing the pectoralis muscles, such as during exercise, may cause the breasts to move and look distorted.

Implant surface - Textured

Textured implants have a surface that feels like dull sandpaper. They were developed because they were thought to impose a lower risk of capsular contracture. This has not turned out to be true. Textured implants are more prone to rippling than smooth implants and are also more likely to cause seromas, or fluid collec¬tions, around the implant. For these reasons, very few surgeons use textured saline implants.

One situation in which textured implants might be important, however, is in the selection of teardrop-shaped silicone gel implants, although these implants were not approved by the FDA as of 2007, plastic sur¬geons are working with the FDA to achieve approval. Teardrop-shaped silicone gel implants are filled with silicone gel that is stiffer than that in round silicone gel implants. They offer the benefits of maintaining their shape while feeling soft and natural. Because they are filled with stiffer silicone gel, their likelihood of rippling is significantly reduced in spite of being textured. All teardrop implants are textured to help prevent rotation of the implant sideways or upside down. Hence, if teardrop silicone implants are selected, a textured surface is the only option.

Smooth

Smooth implants offer the advantage of a lower rate of rippling and fluid accumulation. Most plastic surgeons use smooth implants for these reasons.