I am having augmentation next week . I am 52 and have some sagging- moderate. My doctor is placing the implant over the muscle to fill the space I have lost. She said I have good breast tissue.I realize later I may still need a lift. I am anxious about mammograms. But she reassured me that is may take more work on the radiologist side but that they can still preform mammograms on women with implants over muscle. Advise?
Is breast augmentation over the muscle ok?
Doctor Answers 17
Breast implants above the muscle
Anatomic cohesive gel implants and biplanar placement is better
There is more wrinkling and rippling. Capsular contracture rates are higher. The breast can stretch out.
An anatomic cohesive gel implant can help with mild droop. Also biplanar placement can allow the implant to be placed to fill more of the droop but still have superior pole cover for the advantages of muscle cover.
An above the muscle implant in a 52 year old can look very fake as well.
If the droop is more advanced a mini or peri areolar lift can also be considered. A slightly larger implant will also correct more droop.
But avoid above the muscle implants if you can. Although they look fine at first, later the results are not as good.
Avoid over the muscle implants
Gary Horndeski, M.D.
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Over the muscle, pre-pectoral implants
Is breast augmentation over the muscle ok?
Dual plane breast augmentation refers to breast implant positioning in the sub muscular ( pectoralis major) positioned superiorly and the sub glandular position inferiorly. This is the breast implant position used by the majority of plastic surgeons today and what I would suggest in your case.
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).
However, as you may know, sub muscular (dual plane) breast implant positioning does have the potential downside of “animation deformity” ( movement/ distortion of the breast implants seen with flexion of the pectoralis major muscle.
Again, I think the advantages of sub muscular (dual plane) breast implant placement far outweigh the potential disadvantages associated with breast implant placement in the glandular position.I hope this, and the attached link, helps.
Breast implant over the muscle?
There are pros and cons to the placement of breast implants in the “submuscular” position or the “subglandular” position, in which the implant is place behind the breast tissue, but in front of the pectoralis muscle. Either approach may produce a good cosmetic result in the appropriate patient. The following are the advantages and disadvantages of the various positions:
“Submuscular implant” benefits:
o Usually results in a better appearance for naturally small breasted women
o Less tendency for seeing ripples of the implant.
o A more natural feel to the breast especially in slender women who don’t have much of their own breast tissue.
o Less interference with mammograms, although most radiologists take additional views no matter where the implants are placed.
o Lower rate of capsular contraction.
o Less of a chance of “bottoming out” where the implant bulges inferiorly and the nipple and areolas tend to appear excessively elevated.
Drawbacks of “submuscular implants”:
o Recovery usually takes a little longer and is more uncomfortable initially.
o 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.
o It is harder to achieve cleavage in women who have widely spaced breasts.
o The implants often ride higher on the chest.
“Subglandular implant” benefits:
o A shorter recovery time.
o Less discomfort initially.
o No distortion of the breast when the pectoralis muscle flexes.
o Mild preoperative sagging can be improved, especially if no breast lifting procedure is performed.
o Easier surgical procedure.
o Larger implants can be placed.
“Subglandular implant” disadvantages:
o The implant may be more visible.
o More visible rippling, especially in patients with a small amount of natural breast tissue.
o Generally, saline implants do not produce a good result in front of the muscle.
o Higher incidence of capsular contraction.
o “Bottoming out” in some patients.
o Some radiologists have more problems reading a mammogram with an implant in front of the muscle.
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. Discuss your concerns with a Plastic Surgeon who is Board Certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery.
Robert Singer, MD FACS
La Jolla, California
Over the muscle is OK
Over the muscle (sub-glandular) implant placement has been around since the very beginning of breast implant surgery. Your plastic surgeon, after examination and discussion with you, can offer you implant selection and placement options.
Sub-glandular implant placement is less painful and is used with gel implants (textured and smooth) in selected patients to obtain good cosmetic results. With saline implants, an acceptable result can be obtained if the patient has adequate breast to start with. Over the muscle implants are also less susceptible to displacement in patients with very well developed pec. major muscles. Later breast lifting may be of benefit if the breasts fall beyond what you find attrative.
Mammograms require additional views with breast implants...
Wishing you a pleasing result next week....
Implants can be placed over the muscle.
The pendulum is beginning to swing back to sub glandular. The game changers are the new anatomical shaped cohesive gel implants. In Europe, which had these implants over a decade, many if not most implants are placed above the muscle with excellent results. We in the US are relearning the lessons of sub glandular implant placement. One size and one approach does not fit all. Dogma takes a long time to resolve. Talk to your plastic surgeon; ask about the pros and the cons. Good luck to you!
Implants above the muscle
Breast Implant Placement
Dr. Rai's answer would make sense if breast implants were made out of breast tissue. They're not, however. There is a lot known about short and long term effects of implants placed over the muscle including implant palpability, visibility, increased tissue stretch and subsequent sagging, higher risk of capsular contracture, and impairment of mammograms. On the other hand, subpectorally placed implants enjoy lower risks of the aforementioned problems, but have additional 'dynamic mobility' issues when contracting the pectoralis muscle, something that most women don't mind or even notice.
Contrary to Dr. Stoeckel's assertion that no consensus can be achieved, the annual Breast and Body Symposium in Santa Fe, run jointly by the ASPS and the ASAPS, poll surgeons about breast augmentation preferences. Typically, 90% plus surgeons place breast implants under the pectoralis major muscle, with the majority of them doing so exclusively. Less than 5% of surgeons share Dr. Rai's views.
A common error is the concept that subglandular implants can lift a sagging breast. The improvement is always temporary, and typically the tissue stretch and implant settling increases breast sagging. Breast sagging is not treated with breast implants or their placement. Breast sagging is treated with breast lifts.
You should be evaluated by a surgeon that performs all aspects of cosmetic breast surgery, including lifts, reductions, revision breast surgery, and not just implants. The minimum requisite credentials should be certification by the ABPS, and membership with the ASAPS.
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.