In San Diego, breast augmentation is one of the most popular cosmetic surgical procedures I perform. San Diego and Southern California have sunshine most all year long, and I commonly see people on the beach through Thanksgiving! As a result, I wanted to help educate patients about breast augmentation and their options through a series of blog posts about different aspects of the procedure.
Above or Below the Muscle
Initial breast augmentation surgeries were exclusively performed with the implant being placed under the breast tissue alone. The initial implants were silicone, very soft and thin walled and, thus, almost imperceptible. Unfortunately, since the implant wall was so thin there was a higher incidence of rupture and breakage. As the implants became thicker and stronger to be more resilient, they were more noticeable through the skin.
Additionally, women requesting a breast augmentation normally have little breast tissue, and the breast implant is a significant percentage of the overall breast. Thus, with less breast tissue to cover a saline or silicone implant we need additional tissue to help camouflage the underlying implant. This is where the chest muscle can be very helpful in breast augmentation. The upper half of the breast implant sits beneath the chest muscles which helps soften and hide the implant – giving a more natural look. Most women have less breast tissue on the upper half of the breast and thus, the muscle is critical in its location.
Other benefits of placement beneath the muscle are several. The incidence of capsular contracture has been shown to be slightly less in this location as well as breast cancer surveillance is improved, as there is a distinct barrier between the implant and the breast tissue. Thus, it makes it easier for radiologists to distinguish each distinct layer of tissue.
Subglandular (under the breast only, or over the muscle) remains a good option for the properly selected patient. If women have larger breasts (C or D) cup, the need to “hide” or camouflage the breast implant is less necessary as there is enough breast tissue to do the work of the chest muscle. The recovery is faster and there is no risk to have movement of the implants with contraction of the chest. Also, since the implant is directly underneath the breast, there is more of a “breast lift” effect with the placement beneath the breast tissue.
In summary, 80-90% of women who undergo a breast augmentation will likely have the implant placed beneath the muscle. It is a great operation and one with some very happy patients. Stay tuned for the next installment – incisions.