Main Points
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Is there a particular shape you want to achieve? Is there one you want
to avoid?
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Does ease of ability to feel the implant bother you at all?
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Remember "Rippling" from the last topic? How do you feel about rippling?
Subglandular placement:
The implant is placed beneath the breast tissue and skin over the Pectoral
musclature..
Submuscular Placement:
The implant is placed beneath the Pectoralis major muscle as well as breast
tissue and skin. This is commonly called "Under The Muscle."
A Subglandular Placement Example:
This image shows the result of a mid-sized implant placed in the Subglandular
position. The young lady presented to my office one year after her
first breast augmentation operation using saline implants (by another
surgeon). As she was displeased following the surgery, she went back to
the original surgeon four months following the surgery. He responded by
making the implants even larger and leaving them "Over The Muscle." Let
us analyze the aesthetic problems here:
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The implant's margins are very visible here especially toward the cleavage.
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Even though the patient is only one year from surgery, the breast "mound"
has already descended objectionably leaving the nipple and areola positioned
"too high" on the mound. This is far more commonly seen in subglandular
implants as the Pectoralis major muscle (in the Submuscular case) supports
the implants to an extent retarding extreme descent.
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The cleavage is poorly-developed even though the patient is displeased
that the implants are too large. Usually larger implants develop the cleavage
better.
Here is the same patient ten weeks later. The old implants were removed
from the subglandular pockets and replaced with smaller saline implants,
which were placed beneath the Pectoralis major muscles. A modified breast
lift was performed to reposition the nipple and areola correctly on the
new breast mound. The patient's breast look more natural and the cleavage
is better developed. This was a fair bit of work leaving the patient looking
almost as nicely as she would have if a submuscluar placement had been
performed at the first operation.
Summation
On the topic of rippling, saline-filled implants can ripple because of
the "thinness" of water. Rippling is more apparent where the implant is
covered by little tissue. The more tissue covering the implant in any region,
the less the tendency for rippling to be visible through the skin. Even
with Submuscular augmentation, rippling can show underneath the implant
and/or at the sides of the chest where the tissue covering is the least
abundant. With Subglandular placement, rippling can be apparent over the
entire chest including the cleavage probably the worst potential place
for it to show. This patient had rippling toward the cleavage prior
to surgery when she walked. This was improved following corrective surgery
(above).
To date, no patient with sub-muscular implants has requested that her implants be replaced in the subglandular position. There are several patients like the one above that requested the opposite.
BREAST SURGERY MAIN
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PROCEDURES INDEX | FEES and FINANCING
©1996-2005 John Di Saia, MD... an Orange County
California Plastic Surgeon
1300 Ave Vista Hermosa, Suite 230 * San Clemente California * (949) 369-5932
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Please note that this resource is offered freely to individuals considering cosmetic breast surgery. No rights are granted and it is not to be reprinted or copied without the author's prior written consent. Understand that some of the information presented may be a matter of professional opinion. Although efforts have been made to assure accuracy, no guarantees are expressed or implied.
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