Split Muscle vs Dual Plane? (Photo)
Doctor Answers 7
Split Muscle versus Dual Plane?
Animation deformity can significantly vary according to the type, size, and style of implant, the type of implant surface, the way in which the surgery is done, and probably most important, your specific muscle anatomy. So some individuals are much more predisposed to have this problem than others, in particular patients who have a muscle origin that is located higher on the chest wall will tend to develop a more severe deformity. A smooth surface round large or high profile saline implant on someone with a high muscle position would be a situation in which that person would develop a more severe form of this problem. This is because the smooth surface implant slides around easily on the chest wall and the less compressible high profile implant is more prone to displacement by the muscle. On the other hand, a lower profile, smaller, silicone gel implant with a textured surface will be much less predisposed to the muscular displacement known as animation deformity.
Given that you tissues are quite thin, you would also be a good candidate for an anatomic or teardrop shaped implant which would give you a more natural appearing result. All shaped implants have a textured surface so that they adhere to your tissues to prevent rotation of the implant, but this also has the additional benefit of limiting motion of the implant which minimizes animation deformity. Also, the gradual slope of the upper portion of the implant will be less predisposed to the mechanical forces of muscle contraction again minimizing animation problems. I have found that the Sientra teardrop shaped gel implants are an excellent choice for minimizing the problem of animation changes and allow one to avoid the more radical surgical approaches like the split muscle technique. I would not use a smooth surface implant in your situation because it will predispose you to a more severe expression of animation deformity, and very careful dissection of the implant pocket must be done to preserve as much as possible the lower and more medial attachments of the muscle.
The notion that an endoscopic approach is technologically more advanced is complete nonsense. An endoscope is simply another tool with which to perform surgery. The outcome of the operation has far more to do with the skill, experience, thoughtful planning, and technical execution of the procedure rather than any particular type of instrument that is used. A transaxillary approach will not prevent the problem, and I personally find that an inframmary incision provides the best visualization and access for performing the careful and precise dissection of the implant pocket required in this type of situation.
I suppose you will receive a lot of different answers. See the answer two down by Dr. Rigano, as I agree also you would benefit from a dual plane. Thanks also for your photo. I believe you will find the references below to be helpful. All the best, Dr. Joe
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Semantics can be confusing...
There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”. I will try to outline some of the differences here; you may find the attached link helpful as well.
I think it is in the best interests of most patients (including you based on your picture) seeking breast augmentation surgery to have implants placed in the “dual plane” or 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 breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.
On the other hand (as you mentioned), sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants seen with flexion of the pectoralis major muscle) they can be seen with breast implants placed in the sub muscular position.
Best wishes for an outcome you will be pleased with.
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.