Placement of Breast Implants the Beverly Hills Style
Posted On: April 11, 2019 Author: The Office of Dr. Stuart Linder Posted In: Breast Implants
Saline or silicone implants may be placed in one or two planes, either subglandular retromammary, the dual plane technique, or subpectoral, two-thirds under the muscle and one-third over. We prefer the majority of our patients undergoing primary breast augmentation to select the dual plane technique, placing the implant behind the muscle along the medial two-thirds and behind the glandular tissue on the lateral outer-third. However, patients who have an endomorphic build such as barrel chest deformity or severe pectus excavatum with thick breast tissue may do well with implants placed in the subglandular pocket.
Dual Plane Placement of Breast Implants
Advantages of the dual plane technique include decreased visibility and palpability, reduced scar tissue contracture or ease for mammography for a radiologist. Disadvantages of the subpectoral pocket include more pain, stiffness, and sometimes flexion deformities when the parasternal attachments of the pectoralis major muscle are not released.
Subglandular Placement of Breast Implants
Advantages of the subglandular approach include easy placement and less pain post-operation; however, many disadvantages including increased risk of scar tissue contracture, difficulty reading mammograms, more visibility, palpability of the bag, and a less natural appearance.
There are cases of placing an implant above the muscle. Sometimes if a patient has very thick tissue and an endomorphic or a barrel chest, they may do better with the breast implants above the muscle so that the fullness of the bag can be more appreciated and it won’t be as flat or blunted. Thick tissue and endomorphic or a barrel chest is common in a lot of Eskimo or Latin American patients with very thick chest walls. For the majority of our patients, however, we prefer the subpectoral method (behind the muscle).
Subpectoral Placement of Breast Implants
Now, what does subpectoral mean? Patients ask me every single day, “How much of the breast implant is covered by muscle?” Specifically, we use the dual plane technique, meaning that the muscle covers anywhere between one-half and three-quarters of the implant from the middle of the chest towards lateral. The lateral third of the bag is usually only covered by breast tissue. So the dual plane technique or submuscular really means about three-quarters of the bag at most is covered by the pectoralis major muscle.
There is no such thing as total muscle coverage unless the serratus anterior muscle on the side of the chest is pulled up laterally, which is not performed in elective cosmetic breast augmentation surgery. The serratus muscle should be spared for women who require breast reconstruction for cancer reconstructive surgical purposes. Therefore, when a patient says, “How much of the breast implant is actually being covered by muscle,” in the dual plane technique, two-thirds or three-quarters at most is the correct answer.
The most natural looking breast in the world has implants placed in the dual plane with some muscle coverage. This reduces the fullness in the upper pole and allows for a more natural shape and is especially important in patients who are found in the Entertainment Industry.