Teardrop implants: under the muscle?
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Doctor Answers 8
Teardrop Implants Under the Muscle?
You'd think teardrops are great in front - but they're not!
Since teardrop implants (specifically the Allergan 410) rarely ripple, and since their tapered edges blend well into the natural breast surrounding the implant, it seemed logical to conclude that they would do well in front of the muscle.
The implant was first used in Sweden in 1993 and most of the first cases were in front of the muscle. Rippling was not an issue. Early results were great. But after a year or two they were noticing that the tissue over the implant was thinning from the pressure of the implant and that the edges were gradually becoming more obvious.
For that reason they soon switched to behind the muscle and that is the standard way that it has been taught since US clinical trials began in 2001. I've done thousands of these over these past 15 years and with few exceptions have placed them behind the muscle.
The purported disadvantages of going behind the muscle are illusory: there is not any more pain, cleavage can be created, and any amount of fullness in the upper breast is possible. The only notable trade-off is that when you contract your pectorals muscles you will see some movement of the implant and even some traction on the skin in the lower inner breast in thin patients. You need to be aware of this, but it is well worth the tradeoff in most situations.
More specifically the current way to place implants behind the muscle is "dual-plane." That means the surgeon decides exactly where and how much muscle coverage will best suit a particular patient and precisely performs the surgery to control the muscle in that position. "Half over/half under" are commonly used misnomers and have no basis in anatomy.
Teardrop implants: under the muscle?
Subglandular implant benefits:
A shorter recovery time.
Less discomfort initially.
No distortion of the breast when the pectoralis muscle flexes.
Mild preoperative sagging can be improved, especially if no breast lifting procedure is performed.
Easier surgical procedure.
Larger implants can be placed.
Subglandular implant disadvantages:
The implant may be more visible.
More visible rippling, especially in patients with a small amount of natural breast tissue.
Generally, saline implants do not produce a good result in front of the muscle.
Higher incidence of capsular contraction.
“Bottoming out” in some patients.
Some radiologists have more problems reading a mammogram with an implant in front of the muscle.
Submuscular implant benefits:
Usually results in a better appearance for naturally small breasted women
Less tendency for seeing ripples of the implant.
A more natural feel to the breast especially in slender women who don’t have much of their own breast tissue.
Less interference with mammograms, although most radiologists take additional views no matter where the implants are placed.
Lower rate of capsular contraction.
Less of a chance of “bottoming out” where the implant bulges at the lower aspect of the breast and the nipple and areolas tend to appear excessively elevated.
Submuscular implant disadvantages:
Recovery usually takes a little longer and is more uncomfortable initially.
There may be an “animation deformity”, which is a temporary distortion of the breasts when the pectoralis muscle is flexed. Body builders and weight lifters generally prefer implants in front of the muscle.
It is harder to achieve cleavage in women who have widely spaced breasts.
The implants often ride higher on the chest.
Actually, most patients who have breast augmentations today have breast implants placed in a combination or “dual plane” position. This approach has the same benefits and disadvantages of a total “submuscular implant”, but with a lesser tendency to ride high on the chest wall. The disadvantage as compared to a total “submuscular implant” is a higher tendency for bottoming out.
The ideal placement in any particular patient depends on their particular anatomy and understanding of the pros and cons of each approach and desired outcome.
Keep in mind, that following the advice from a surgeon on this or any other website who proposes to tell you what to do based on two dimensional photos without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure may not be in your best interest. I would suggest that your plastic surgeon be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.
Robert Singer, MD FACS
La Jolla, California
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Despite the overwhelming negative sentiment of most of my colleagues, these implants have a lower overall complication rate compared to round smooth implants. Fears of implant rotation are overblown, and your risk in the hands of an expert are 2%. These implants can be placed above or below the muscle, but what is right for you should be discussed with your surgeon. Dr. Singer does a nice job summarizing.
Best of luck!
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.