I'm a mother of 2 who breastfed so I do have some ptosis. My current size is a 36B but am looking to only go maybe to a large C at most. I have been to a plastic surgeon for a consultation and he suggested placing the breast implants subglandular. I was wondering if his opinion would change since I'm still losing weight. Also, I'm leaning towards saline implants instead of silicone now. How many consultations should I get before proceeding with the procedure?
Is Subglandular Breast Implant Placement Right for Me?
Doctor Answers (7)
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Subglandular placement is acceptable if you have at least 2cm of tissue pinch in the upper pole.
That being said, the most important factor that keeps the breast looking natural over hte long term is tissue coverage, and that is greater when it is behind the muscle.
But the notion of thinking that there are just two choices - in front and behind the muscle - is obsolete thinking. Today we do "dual-plane" augmentation, in which there is muscle over the implant towards the center and upper part of the implant, where coverage is most needed, yet there is no muscle over the lower pole of the breast, where direct appostion of the implant against the lax breast envelope helps fill out a droopy envelope.
In fact, there is little if any advantage of subglandular over dual plane, other than some possible minor animation deformity when strongly contracting the muscle.
The one thing you mentioned that I strongly disagree with is using saline implants in the subglandular position in a ptotic breast. Many surgeons have observed that saline implants tend to cause greater stretch in the droopy breast, possibly as a result of their greater weight and of a "water-hammer" effecte of the sloshing of hte contents. Furtermore, silicone implants lesser tendency to ripple and fold give them the advantage in the reduced coverage environment in front of the muscle.
Finally, you must be sure that you don't need a lift. One of the most frequent reasons women have unsatisfactory results after augmentation is the post lactation/weight loss atrophy/ptosis patient who gets a large subglandular implant instead of getting a lift with an appropriately sized implant behind the muscle. Is your nipple to inframammary fold distance >10cm? Be sure it isn't, or you may need a lift.
The breast implants have to go subglandular unless you also want a lift.
Of course, you should get another opinion, but I agree with your surgeon. Even if you are going to lose weight, breast implants should be placed subglandular if you have any sagging.
In New York City, we have quite a few women with subglandular saline inplants who look and feel just fine. But in general, we would recommend smooth walled silicone implants.
Subglandular Breast Augmentation
I would certainly recommend that you not do any surgery until your weight has lstabilized and your are comfortable. With a mild degree of ptosis a simple augmentation may be enough, but for moderate ptosis you may require a short scar mastopexy or more. If the skin and fat above the nipple in the upper poles of the chest are adequate then a suglandular placement with silicone implant would probably give you the most natural look and feel. You should anticipate recurrent ptosis over the years and a simple skin procedure can be done to "adjust" this.
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Sublandular Breast Augmentation for mild sagging
Subglandular breast augmentation can be a good choice for a woman such as yourself with mild ptosis (sagging) due to childbirth. If you lose additional weight, however, the ptosis may get worse. If that happens, you may need to consider doing a mastopexy, or lift, along with the implants. The disadvantage of the mastopexy is the additional scarring, however with time (a year or two), the scars do fade quite a bit. The advantage of the mastopexy is that you can have the implants placed under the muscle instead of in a subglandular position. If you do choose to have a subglandular implant, you may want to seriously consider using the new cohesive gel implants. Saline implants have a tendency to ripple over time (even when over-filled), but if the implant is positioned under the muscle the rippling is less evident. Either way, it's a good idea to finish losing most of your post-baby weight and to have at least one other consultation before making any final decisions.
Breast Implant Position?
Thank you for the question.
In general, I think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” sub muscular position. This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).
The submuscular positioning also tends to interfere with mammography less so than in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.
The type of implant used may determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have. If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants. If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result. On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference. Patients may need an MRI to diagnose a silicone gel rupture. Saline implants are also less expensive than the silicone gel implants. Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants. On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational. As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.
I hope this helps.
Breast implant placment depends
The answer here depends upon how much ptosis you have and whether or not you want a lift. I am not crazy about saline-filled implants in the sub-glandular position as they tend to ripple especially with weight loss. Maybe you can split the difference and go for a mini lift with placement of the implants in the sub-muscular position. It is hard to tell without examining you.
You will get different opinions
I am personally not a believer that above the muscle implants are the best way treat laxity of the breast tissue. With your goal being to lose weight you run the risk of visible rippling and wrinkling especially in the area of the upper and inner breast.
You should chose the plastic surgeon to care for you that you are most comfortable with and you agree with the plan. Do not hesitate to ask questions about your concerns as well. Best of luck.
Web reference: http://www.medwardsmd.com/plasticsurgery_questions1.html
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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