During breast implant surgery, there are two choices regarding the position in which the implants can be placed:
Subglandular placement:
The implant is placed beneath the breast tissue and skin, but 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." The aesthetic problems:
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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 called "Bottoming Out." and is far more commonly seen
with 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 breasts 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 Submuscular placement had been
performed at the first operation. She required no further breast surgery.
Summation
(1) Bottoming Out Corrected.
(2) Breast Contour Appears More Natural.
In over ten years of plastic surgery practice, no patient with submuscular implants has requested that her implants be replaced in the subglandular position. There are many patients like the one above who requested the opposite.
BREAST MAIN | SITE MAIN
© John Di Saia, MD... an Orange County
California Plastic Surgeon
Serving Southern California since 1997 * (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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