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Where is the Best Placement of Implant when Dealing with Constricted Breasts? (photo)

asked 8 months ago by Houston3058
Latest answer by Joseph M. Perlman, MD
Question viewed 570 times
Tags: constricted, placement

Was told I have contricted breasts. I have 2in of tissue under my areolas and told it would be best if silicone implant was placed over the muscle (subgladular) and my lower breasts would be scored. I'm really worried about capsular contracture. Am I doomed to have Capsular Contracture because of the position of the implant & would scoring also increase my chances? Is it possible to go under the muscle and still have good results? Does scoring incr chances of bottoming out? Am I headed for compl

19 answers to Where is the Best Placement of Implant when Dealing with Constricted Breasts? (photo)

Ptotic / Constricted Breast

I would recommend a modified V-O/Q lift with subpectoral silicone implants. You may need to stage the procedure and all of the arreola pigment may not be able to be removed and some may remain along the verticle incision. This may be able to be removed at a later date if needed. Doing implants only above or below the muscle will most likely lead to an unsatisfactory result requiring revisional surgery. Do your homework and obtain a few consults from board certified... more

Lawrence Shaw, MD
Scottsdale Plastic Surgeon

Augmentation and constricted breast tissue

Hello, It is important to note that not all constricted breast syndrome cases are the same. Each patient and each set of breasts require different treatment based on the surrounding tissue as well as the goal that is desired. One of the more important decisions that you should make is which surgeon to go to as not all plastic surgeons have equal experience with constricted breast tissue. Subglandular or subfascial breast augmentation does not necessarily expose you to... more

Remus Repta, MD
Phoenix Plastic Surgeon

www.aaaplasticsurgery.com

Treatment of Constricted Breast

You have a fairly mild form of a constricted breast in that the problem is mostly a tight lower pole of your breast with a small amount of sagging (based on these photos). I think you would do well with silicone breast implants placed in a partially sub-muscular pocket (dual plane approach) while lowering the breast fold by 1- 2 cm. You would not need extensive scoring, just release of any horizontal constricting bands just above the breast fold. Also, don't pick an implant with a base... more

Joseph Fata, M.D.
Indianapolis Plastic Surgeon

www.breastsurgeryindianapolis.com

Tuberous Breasts and Breast Augmentation

Hello Houston3058, You have mild to moderate constriction of the lower pole of your breasts, a lesser form of 'tuberous breasts'. Regardless, it does present with some difficulties in breast augmentation. Here is a line of reasoning to follow: Like any sagging breast, subglandular placement of the implants does not help, therefore should be avoided and subpectoral placement performed. That will eliminate much of the risk of capsular contracture. Your breasts... more

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon

Implant Placement and the Constricted Breast

Thank you for sharing your photos. I would concur with you that you indeed have a mildly constricted breast. This does make your case a bit more challenging. However, do not worry - I think you still can achieve a very nice result! To give you formal recommendations would require a formal physical exam so I could actually assess the distribution of your tissue, your skin quality, and actual degree of ptosis (sagging if any). Most likely, I would recommend... more

C. Bob Basu, MD
Houston Plastic Surgeon

Pocket placement for constricted breasts

There is no question that constricted breasts are more of a challenge when considering augmentation mammaplasty. That does not mean, however that you are destined for complications. Scoring of the breast tissue to spread it out does no increase your risk for capsular contracture. I prefer to use a dual plane for breast augmentation which keeps the muscle over the upper portion of the implants and you keep the advantages of implants under the muscle. This technique... more

James McMahan, MD
Columbus Plastic Surgeon

Constricted (Tuberous) Breasts

Thank you for the question and pictures. Constricted (tuberous breasts) generally have a very narrow base, a short distance from areola to inframammary fold, a tight (constricted) lower pole of the breasts, a relatively wide space between the breasts, a "puffy" and areola and some degree of ptosis (drooping). Generally, the procedure involves breast augmentation with areola reduction / mastopexy procedure. I prefer the dual plane (... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

www.poustiplasticsurgery.com

Pocket selection and constricted breasts

There is still some controversy in regards to which is the best pocket to use when treating patients with constricted breasts. Traditionally only subglandular (above muscle) pockets were recommended along with inferior pole scoring with or without a mastopexy. Many surgeons are now getting excellent results with subpectoral pockets as well. Pocket selection is probably not near as important as adequate inferior pole scoring. Scoring does not increase one's chances of developing capsular... more

Kelly Gallego, MD
Sioux City Plastic Surgeon

Breast augmentation in constricted breast

Your breasts are constricted, which means that the lower breast is shorter and tighter than normal. In order to provide you with a satisfactory result, the loer pole must be released and lowered. I would actually place the implant under the muscle, releasing the lower edge of the muscle so that the implant can fill the lower pole. I would make cuts in the tissue if it remained tight once streteched by the implant. One has to be careful not to release the inferior fold of the breast too musch... more

Karen Vaniver, MD
Seattle Plastic Surgeon

Above or below muscle placement of implants for constricted breasts?

Constricted breasts do present challenges for breast augmentation. The short "constricted" distance from areola to the inframammary fold must be increased or, since the bottom of the implant lies at this fold, the nipple will reside too close to the bottom of the breast mound and point down. The only way of increasing this distance is to lower the fold, and then one must release the constricting bands holding the breast tissue too narrow and too tight and try to obliterate the old fold so... more

Robert M. Grenley, MD
Seattle Plastic Surgeon

www.seattleplasticsurgery.com

I have placed implants both sub glandular and sub muscular

My experience with constricted breasts or tuberous breasts has taught me that there are many different types and ways to treat the problem. If there is satisfactory breast tissue in the upper half of the breast, I prefer the sub glandular approach place in the implant on top of the muscle. If there's not enough tissue then I go sub muscular and use the dual plane approach. Some patients require scoring or cutting of the base of the breast glands in order to spread it. All my patients... more

Joseph M. Perlman, MD
Houston Plastic Surgeon

Implant placement in constricted breasts

I would generally agree with Drs. Fata, Grenley, and Johnson. It doesn't really matter what it's called. I would call it a deficient lower pole of the breast rather than a constricted breast and there is pseudoptosis because of the deficient lower pole but it doesn't look like a lift/mastopexy is needed. The issue of above or below the muscle is irrelevant to the problem. The implant needs to be under the pectoralis muscle in the upper half of the breast to pad, protect, and... more

Scott L. Replogle, MD
Denver Plastic Surgeon

Implant placement for constricted breasts

Based on your photographs, you do have constricted breasts. The procedure you need can be done with saline or silicone gel implants either sub-glandular or sub-muscular. First, find a board certified plastic surgeon who has experience with this procedure. Most of the time, the fold needs to be lowered, and a small areolar reduction or lift procedure will need to be done.

Donna Rich, MD
Houston Plastic Surgeon

Constricrted breasts

You look to have a very mild form of constricted breasts. In all likelihood you will not need scoring, and a circumareola lift will most likely necessary. Without a formal exam it is hard to say for sure.

Steven Wallach, MD
Manhattan Plastic Surgeon

The complication rate will be higher

The concerns in your case are constricted breast,nipple position, wide space in between breast,lack of breast volume and limited skin and tissue in lower pole. The use of breast implant will help the breast volume but will create other issues like thinning out in lower pole, breast tissue sagging off the implant and wide gap in the middle. I would recommend mastopexy with or without fat grafting first and then implants later on.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon

Constricted Breast Augmentation Surgery

We all concur that Breast Augmentation for patients that have constricted breasts is more challenging than the usual breast augmentation surgery. Traditionally, the implant was placed in the subglandular pocket. Good results are achieved in the submuscular approach. Most submuscular approaches release the muscle, where the muscle covers the upper portion of the implant whereas the lower pole is subglandular. The important maneuver for patients with a constricted... more

Jonathan Berman, MD
Palm Beach Plastic Surgeon

www.drberman.com

Implant position with constricted breast

Usually I place the implant for a contricted breast above the muscle along with scoring of the breast tissue to allow it to release. These are usually done with a circumareola mastopexy to decrease areola size. Use of a small implant will help decrease your complication. Donald R. Nunn MD Atlanta Plastic Surgeon.

Donald Nunn, MD, DDS
Atlanta Plastic Surgeon

Breast implants for a constricted breast

A constricted breast has a tightness in the fold, and a very short distance from the nipple to the breast fold. As an implant must center on the nipple, the fold must be pushed down and the lower breast expanded. Under the muscle placement provides muscle coverage over the upper half of the implant only with the lower half under the gland of the breast, and should work out well for your augmentation. Best of luck, peterejohnsonmd.com

Peter E. Johnson, MD
Chicago Plastic Surgeon

www.peterejohnsonmd.com

Constricted and tuberous breasts, there is a solution

I would strongly recommend subfascial placement to get beautiful shape. When I treat tuberous or constricted breasts I use a modification of subfascial placement that I call 'cold-subfascial augmentation.' I use the fascia to give a n appropriately designed teardrop shape to the breasts and stabilize the implants in an aesthetic position. I perform an areolar reduction and subtle lift with hidden scars and score in the subdermal plane. Using these techniques I... more