Breast Implant Position - Part 2

Plastic Surgery Cincinnati from The Loftus Plastic Surgery Center

Breast Implant Position Part II

by Dr. Michael D. Vennemeyer |

Subglandular Breast Augmentation

Placing the breast implants over the muscle is also called subglandular because the implant is directly beneath the glandular tissue of the breast.  Positioning the implant over the muscle leads to a faster recovery.  There is less pain and swelling.  Also, the shape of the breast can be improved easily because the implant is in direct contact with the breast tissue which is draped over it.  Sometimes surgeons describe this as the implant “molding” the shape of the breast.  This is not entirely accurate.  As we discussed in “The battle for final breast shape” the interaction between the implant and breast tissue results in the final shape.  This change is variable.  However, in most patients this can help improve the shape of the breast.  The improvement results from the increase in volume filling the skin and the shaping effect that the implant has on the breast tissue.  The breast implant can exert this effect best in a subglandular augmentation because it is in direct contact with the breast tissue.  This effect is not as pronounced with the implant positioned under the muscle.

Subglandular Breast Augmentation Disadvantages

The down side of placing the implant over the muscle is that you may see and feel more of the implant than you would like.  Think of it this way.  The more of you (your breast tissue) that covers an implant, the less you feel the implant and the more you feel you.  Your breast will feel more natural and look more natural the more of you that covers the implant.  If there is less breast tissue covering the implant you are more likely to see rippling and you will feel the implant more when you touch your breasts.  Another disadvantage- there is a higher rate of capsular contracture when the implant is placed in a subglandular position.  Finally, there is more interference with mammography when the implant is subglandular.

So who benefits from placing an implant over the muscle?  Classically, it is women with ample breast tissue where there is enough soft tissue coverage to minimize the risk of rippling and implant visibility.  You’re probably thinking, “If I had ample breast tissue I wouldn’t need an augmentation in the first place.”  We completely understand if you feel that way.  Most women seeking breast augmentation don’t have much breast tissue and want another option.  In “Part III:  Under the Muscle” we will tackle that option to see if it works for you.

 

Breast Implant Position Part I

Plastic Surgery Cincinnati from The Loftus Plastic Surgery Center

Breast Implant Position

Women considering breast augmentation frequently ask, “Should I have my implants placed over or under the muscle?”  Answering this intimidating question is easier than you might think, once you have the right knowledge.  Although this blog will probably give you a good idea what the right choice is for you, the best way to make that decision is during your consultation.   After considering your goals and performing an examination, we can help you discover what implant position will work best for you in the long term.  First, it is important to understand how your breasts get their final shape from a breast augmentation.  Then, you will be able to better understand the advantages and disadvantages of various implant positions, which we will discuss in parts II-IV.

Implant vs. Breast:  The Battle for Your Final Breast Shape

Before we discuss implant position, it is important to understand how you arrive at your final breast shape after an augmentation.  Your breasts have a certain shape to them.  An implant has a certain shape.  They both have variable stretchy characteristics.  They both have variable degrees of softness.

Breast Skin Elasticity

Your breasts are covered with skin that has elasticity.  Usually your skin gets less elastic as time (and pregnancies) go by. The amount of skin and elastic quality of that skin, the amount of breast tissue inside the skin and the distribution of that breast tissue all add up to determine your breast shape.  More skin, less elasticity and less breast tissue filling results in a breast that looks deflated and ptotic (saggy ).  More breast tissue and less, tighter skin result in a perkier breast.

Breast Implant Effects on Breast Shape

The implant is designed to have a particular shape, volume, and projection.  Implants have different levels of softness and change differently with compression, depending on what they are filled with.  (See Breast Blogs Saline vs. Silicone I, II, and III)  There are all sorts of implants that vary in these characteristics.  Implants can have the same volume, but the degree of projection can vary and result in different shaped breasts.  The degree of projection is often referred to as “profile” (for example:  High profile, moderate profile, etc.)

Breast Interacts with Implant

So, now we have your breasts on one side, and the implants on the other.  In the operating room we bring them together and they interact.  The breast pushes on the implant, and the implant pushes on the breast.  All of these characteristics we have discussed intermingle to give your final, unique shape.  The shape that results is not solely determined by the implant or the breast, but somewhere in between.  Perhaps this sounds like complete chaos.  Rest assured.  With training and experience a plastic surgeon knows how to predictably combine these factors to get the result you want.  That’s why we ask about your goals during your consultation, so we can help you make the right decisions.  Now that you understand the interaction between implant and breast, we can discuss how different implant positions affect shape and a few other things.   In the next blog, we will discuss placing the implant over the muscle.



Plastic Surgery Cincinnati from The Loftus Plastic Surgery Center

2139 Auburn Avenue, Suite #201
Christ Hospital Medical Office Building,
Cincinnati - Ohio
(513) 793-4000


View Larger Map