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How are breast implants installed? Breast augmentation with modern implants

Breast augmentation surgeries are by far the most popular and sought-after surgical interventions in aesthetic surgery. Installing an implant helps solve many problems: increase the size, tighten the skin, correct the shape and make a woman’s breasts much more attractive. Plastic surgeons have to modify thousands of women's breasts, but few people know that the doctor prepares for each such operation individually. The choice of implant installation method depends on many factors that must be taken into account in each individual case. Quite often, surgeons prefer the method of installing an implant under the muscle. Read about the features of this breast augmentation technique on estet-portla.com.

Features of installing a breast implant under the muscle

Placing an implant under the muscle is called the submuscular implant placement technique.

It is possible to achieve maximum aesthetic effect with minimal complications by partially placing the implant under the muscle - approximately 2/3.

Complete submuscular placement of the implant results in an unnatural appearance of the breast in the lower part due to the placement of the implant above the lower fold of the gland. In addition, the volume and height of the operated breast are poorly expressed due to the density of the pectoral muscle. Full installation of an implant under the muscle is especially not recommended for women who are actively involved in sports.

Installing an implant under the muscle:

basic methods of installing breast implants during mammoplasty;
benefits of installing a breast implant under the muscle;
what the surgeon needs to consider when installing an implant under the muscle.

Basic methods of installing breast implants during mammoplasty

At the stage of preparation for mammoplasty, the surgeon must determine a large number of factors that decide which implant installation option is optimal. There are three main methods for installing breast implants:

subglandular location of the implant: can be used if the mammary gland is sufficiently dense and pronounced in volume, when it is sufficient to uniformly cover the entire implant;
full muscular coverage of the implant implies the formation of a single coating, which allows not to destroy the pectoralis major muscle and preserves all lines of fascia, including the axillary one;
installation of an implant under the muscle and under the gland: also used for those patients whose mammary gland is quite well defined, otherwise the result of the operation threatens to be short-lived.

Benefits of having a breast implant placed under the muscle

The main advantages of installing a breast implant under the muscle include:

natural appearance of the upper chest, due to the fact that the pectoral muscle hides the upper edge of the implant;
minimal risk of capsular contracture, which spoils the appearance of the operated breast and causes pain in the patient;
minimal risk of “waves” and “ripples” on the breast skin after implant installation;
almost complete impossibility of palpating the implant after its installation;
the ability to take clear images of the breast when performing mammography.

What the surgeon needs to consider when installing an implant under the muscle

There are some important points that a plastic surgeon must take into account when performing mammoplasty with the installation of a breast implant under the muscle:

the technique can be used in cases where the patient has intact pectoralis major muscles;
the method does not eliminate mastoptosis, and therefore is recommended for patients only in combination with a breast lift;
installing an implant under the muscle implies a longer rehabilitation period than with other methods of mammoplasty;
The use of anatomical drop-shaped implants for installation under the muscle is not recommended;
The use of polyurethane or acrotextured fixation implants is strictly prohibited.

Installing an implant under the muscle is an effective method of breast enlargement and improving its shape and appearance.

Careful and strictly individual selection of mammoplasty techniques will allow you to achieve maximum results with which the patient will be satisfied.

The most popular aesthetic surgery today is breast replacement, which is usually called breast augmentation. The safest option for changing breast size today is to enlarge it using silicone endoprostheses, or implants. Because, firstly, they have been tested for a long time, have a sufficient service life, positive statistics, have been used for a long time and already have long-term results. Sometimes it becomes necessary to remove the implant if it is damaged by the sharp edge of a broken rib after some kind of injury or accident.

A modern implant contains a highly adhesive gel that does not leak. The implant and shell can be removed and placed.

In most surgical societies in the world, including France, Switzerland, Brazil, except for Russian society, the implantation of shellless implants is strictly prohibited. What is a shellless implant? This is the same gel that is used for lip augmentation, but in larger quantities for breast augmentation. Therefore, in some countries it is still allowed. We do not have a clear prohibition on this operation. But there are side effects. And the society of plastic surgeons, including Russian ones, does not recommend the use of such implants.

The second option that exists in breast augmentation is resizing using your own fat. The technique is, in fact, absolutely not new. It's called breast lipofilling. It’s just that after a certain period of time, each time they add something to the technique (sampling method, vacuum suction cups, etc.) and try to implement it as know-how. Essentially, breast lipofilling is a change in its size using your own fat tissue.

Hence all the consequences of this technique, starting with fat resorption, because free fat is taken from the body. There should be sufficient quantity of good quality fat. When it is taken, it is deprived of a source of blood supply, that is, it does not feed, and when it is planted in a new place, part of it takes root, and part of it is necessarily destroyed.

Fat can be destroyed in the following way. It can simply dissolve, or it can form fibrosis, like bumps on the buttocks after injections. In the future, these fibrosis may frighten mammologists during examinations and may look like some kind of neoplasm. Moreover, this resorption occurs unevenly on the right and left, sometimes requiring repeated injection and correction. If aseptic (without suppuration) necrosis occurs - tissue destruction, then it is not a fact that it will be possible to remove this fat well, which does not have a clear shell and is found in all tissues of the gland.

Breast implants are constantly being improved. If earlier there were smooth implants, then they appeared with liquid gel - soft to the touch. There were also saline implants, which were filled with water through a valve, and gel implants. In saline solutions, water could leak through the valve in the shell over time. The implants were harmless, but did not last long and required periodic replacement. In addition, if air entered through the valve during installation, a “gurgling” effect occurred, like a bag of water, i.e. when they said that “implants gurgle,” they meant saline ones. It is precisely because of the use of these implants that the myth that implants burst on airplanes was probably born. Apparently, some girl’s implant started leaking, for example, on an airplane, and when it finally leaked, she concluded that it had burst. Then the yellow press picked it up, and a myth was born, which, unfortunately, became very popular.

About the gel. Previously, injections of polyacrylamide gel were used, which is still used in some neighboring countries. This substance could cause necrosis, dissolution, inflammatory changes in the tissues of the mammary gland, and spread from the mammary glands down to the back and stomach. Over time, they tried to replace polyacrylamide with a hyaluronidase-based gel based on hyaluronic acid. Over time, it resolves, but the introduction of large volumes into the thickness of the mammary gland has shown a negative effect, and most countries, clinics, and surgeons have abandoned this procedure and do not recommend it, and in many countries they also prohibit the shell-free administration of these gels.

The third option that the manufacturer tried was to fill the implant with carboxymethylcellulose, which is essentially a harmless substance, as an alternative to hydrogel. If it ruptures and subsequently migrates into tissue, carboxymethylcellulose dissolves into the tissue. However, with such an implant it is impossible to make an anatomical shape - they hold their shape worse and can be felt and palpated. Such implants are still sold, but their manufacturers are mainly switching to production with silicone filler.

In order to reliably, well, safely enlarge the mammary gland, there is nothing better in the world than silicone breast implants in a shell with a filler in the form of a highly adhesive gel.

Requirements for breast implants

Since breast implants are medical devices, there are great demands placed on them. They should be as similar as possible to their own tissues and safe for the wearer, even if the integrity of the wall is damaged. There must also be biocompatibility, that is, the absence of inflammatory processes inside the breast, and a minimal risk of product rejection.

Any implant, in essence, is a foreign body around which the body forms a shell - a capsule. Accordingly, a very important requirement is that the capsule must be minimal to ensure only the stability of the implant in a certain place. Why am I talking about this requirement? Because if it is not performed, the capsule can grow larger and thicker, causing compression, breast deformation and possible complications.

In addition, if the implant is made of too soft materials, subsequent changes in its dimensions and surface tension structure are possible due to corrugation effects. This phenomenon is often observed in lower anatomical areas where there is insufficient muscular support for the organ. Too soft - can be tactilely felt in the transition of the chest to the chest, in the lower and outer lateral sections. The softer the implanted material, the higher the risk of fibrocapsular contracture in the chest. This is the formation of a denser, thicker and tougher shell around the implant, which causes deformation to the point that the breast becomes stone-like. This is facilitated by installation under the gland, an implant that is too soft or of poor quality.

There are basically two forms. Some implants are round, depending on the diameter and projection. They can be with low, medium, high projection in the same diameter. The second option is an anatomical implant. Its essence is that the upper maximum point of the projection is shifted down; when viewed from the side, a more triangular breast shape is obtained. Despite this, with the same width of the implant, the height, that is, the distance from the bottom point to the top, can be either less or almost equally equal to the width or even longer than the width, that is, a more elongated or shorter implant. In this case, the projection changes accordingly.

Some manufacturers have such an option as a drop-shaped implant, which has at its base the diameter and shape of a round implant, but at the same time has a projection that is maximally shifted downward, which from the side more closely resembles a triangular shape, like anatomical implants. Objectively, the outer diameter of the implant should not be the same throughout its entire length. This condition must be met in the vast majority of cases in order to prevent loss of the static position of the implant in the event of unsuccessful implantation into the parenchyma of the organ. Free movement of the object will change the visible shape of the breast and disrupt the functionality of the surrounding tissue.

There are three options for installing an implant - under the gland, under the fascia and under the pectoralis major muscle, which is usually called axillary installation, although in fact only the upper part, that is, half or even a third of the implant, is under the muscle.

The method of installation under the gland is still used, but it has long been proven that the risk of developing contracture in this case is very high. This method can only be done for women who have a large volume of their own tissue that extends to the chest. If a woman is somewhat overweight, then installation under the gland is possible. If this is a thin patient who has little tissue of her own, especially in the lower parts, then it should definitely be installed only under the armpit. And since there are no muscles in the lower sections, the implant can protrude somewhere and be palpated - this is its design feature, but in the décolleté area and above, the muscle will create a smoother transition and prevent the implant from standing out too much.

In certain cases where the fascia is prominent, installation under the fascia is possible. Fascia is a large membrane that covers a muscle. For example, roughly speaking, if you bought meat in a store, there is a white film on it that you peel off. This film can be weak, or thick. There is such a feature in people - more pronounced connective tissues, then you can install an implant and there is a chance that it will last 8 years. From one personal observation - childbirth occurred within 8 years, no changes, the implant was not even reinstalled.

There are many options on how to choose. Each surgeon comes up with different techniques, different manufacturers are also trying to come up with them, but there are basic points that need to be taken into account.

The first is each woman’s own anatomical characteristics. They include the shape of the chest, which can be keel-shaped, barrel-shaped or funnel-shaped, and have different angles of convergence of the ribs. That is, this is a bone skeleton that the surgeon cannot influence, but the implant will lie precisely on the bone, which, as a solid base, will determine its position. That is, either the chest will be larger - the ribs will push the implant forward, or slightly to the side, which is more often the case, by 45 degrees, because over time a person’s ribs can change their bend, moving the chest even more to the sides. As for getting as close to the center as possible, which some patients request, this depends more on well-chosen lingerie.

The second point is anatomical. How is your pectoralis major muscle located and what shape is it, at what level is it attached. It's no secret that if every woman goes to the mirror and starts measuring and examining her breasts, she will see that one is a little higher. On one side the nipple is slightly higher, one is slightly wider, the volume is slightly different, because there is no symmetry in the human body. The pectoral muscle may be located slightly differently, slightly stronger or weaker on one side or the other. The thickness, elasticity and density of the muscle cannot be understood by any preliminary studies, only during surgery. And it is important to determine this, since the shape of the breast and the service life of the implant greatly depend on it.

The third point is the structure of your tissues, that is, in particular, how much glandular and fatty tissue there is. If there are more fatty ones, then they can decrease in volume, if there are more glandular ones, then to a lesser extent, but the breasts may not be completely smooth to the touch. In addition, if there is not enough native tissue, then in the lower parts of the chest and in the outer lateral sections, where there is no pectoralis major muscle, the implant can be felt more by palpation and even visually. This is a feature of the implant, so a lot depends on how much of your own tissue you have and how they are distributed.

In addition, one more point - it is always better to determine the so-called base of the mammary gland and breasts. What is it? This is essentially the width of your breasts that you currently have that will cover the implant. When asked to make the size as large as possible, we surgeons have to break these boundaries, go beyond the breast. Then there is a more real sensation of the implant, there may be downward displacements, short-lived service of such a breast, and the appearance of waviness in the outer sections of the ribs, especially when tilted. Therefore, installing a larger volume, a larger base has its own characteristics.

The second point is that there is such a formation as the inframammary fold. In African tribes, women go without a bra; their breasts may sag, but this inframammary fold is there. Many classical surgical techniques involve breaking this fold. The second school that exists recommends leaving this fold, because if we maintain it, then the breasts will not sag anywhere. If we put in more volume than necessary and destroy this fold, then we have a double contour of the lower breast (“double bubble”), and the contours of the implant may be noticeable.

One more thing. When a woman asks to move her breasts to the center as much as possible, i.e. to reduce the interthoracic distance, this can only be done if a certain location of the muscle, which is attached right at the edge of the sternum - these are the bones between the chest - and the beginning of the ribs, allows. If they ask you to bring the implants as close as possible, you need to cut the muscle high, then our installation turns into almost subglandular. The implant may jump out from under the muscle, and then on the inside the contours of the mammary gland may appear wavy when bending over and when moving. Let's just say that some surgeons offer to tell from a photograph what the volume of the implant can be placed. But this can only be determined approximately, and in order to determine it accurately, you need to take into account a lot of factors. Therefore, without a personal examination, planning an operation based on a photograph is stupid.

The condition of the skin also plays a role - how dense, with stretch marks, turgor (elasticity). Another important point is the height and proportions of the figure. What does this mean? If we take some kind of implant with a volume of approximately 320 ml and place it on a girl with a height of 1.57-1.60 m, her breasts may look like a third size, proportionally. And if we place the same implant on a girl with a height of 1.80 m, then she will already have the second size or the changes will not be particularly noticeable at all. In addition, it is also very important to correctly calculate how much of your own tissue you have. Therefore, there is no clear concept that such and such an implant gives such and such a size. But on average, the surgeon still believes that from 130 to 150 ml gives plus one breast size.

As for volume, various options are possible due to a combination of implants and various techniques. In what way? With a certain width of the chest, you can take an implant with a different projection and, depending on this, the volume will be different. Here we need to remember only one rule when we say that we want maximum naturalness or we want maximum volume, because these parameters are inversely proportional to each other. It doesn’t happen that they made the most natural size 5 breasts without anyone seeing. If you received a size five, but was a size one, then this will immediately become noticeable. Even if there was a bad mark, and you got a fifth, then the same thing. If there is a lot of tissue, especially in the lower part, then there is practically no difference between a round and an anatomical implant; they look the same. When there is absolutely no excess tissue - a flat chest, let's say - then anatomical implants have an advantageous position compared to round ones. These points need to be remembered. Still, the anatomical shape comes down more to marketing. They are called contour-profile implants, but one should not assume that if the word “anatomy” is used, then the breasts are more natural. Basically, more round implants are being placed in the world. In addition, the differences between a round and anatomical implant are fundamental. For the second, the issue of ingrowth and clear formation of the pocket is fundamental, because if you sleep on your stomach, if you have a pregnancy, childbirth, if you change weight, for example, lose weight after surgery, if there is some kind of traumatic sport (for example, alpine skiing, deep sea diving, parachute jumping), then there is always a risk of displacement, rotation of the anatomical implant, after which the shape of the breast may change. With a round breast, these questions disappear, because if ingrowth does not occur and the implant rotates, then the shape of the breast will not change.

Until 1992, smooth implants were produced, which are still produced - they are filled with water and are used most often in the USA. We use this type of implant very rarely, but they are filled not with water, but with gel. When smooth shell implants first came out, no one thought about the structure, they were just round and smooth. Over time, when capsular contracture occurred, that is, tissue compaction around the implant, when the body tried to separate the foreign body, they realized that, firstly, these contractures more often occur when the implant is installed under the mammary gland. If there is little tissue around it, it is better to place it under the muscle. And secondly, we tried implants with a textured surface. The engraftment of an implant depends on the pores on its surface - sometimes the implant grows in, sometimes it doesn’t. If we take the same manufacturer - the implant is smooth and textured - with the texture, the fibers of fibrous tissue that are distributed around the implant become more chaotic. And therefore the risk of developing contracture is reduced, this is their main advantage. The second point is the size of this relief - it varies differently for all companies. When the pores are larger, the likelihood of good implant ingrowth is higher, that is, it is the tissues that grow into the surface shell, which prevents its displacement and rotation. This point is very relevant when we talk to you about such implants as anatomical ones, because we don’t need a reversal there.

Implant manufacturers

In the modern world, the first manufacturers who began making implants were Americans. There were two companies here - McGhan and Mentor, which are now called Natrelle and Mentor, respectively. One is Allergan Corporation, the other is Johnson & Johnson, which are competitors. They have the most experience in the production of implants and, accordingly, have authority and good reviews from surgeons and patients. There are a number of other companies that also produce implants. Of these, we can highlight the Brazilian SILIMED - this is the only non-American company that has licensed its products in the USA. There, at one time, there was strict control due to the silicone boom. In addition, there are also French manufacturers - EUROSILICONE, ARION, SEBBIN; German - POLYTECH, English - NAGOR.

There was one French company PIP, which produced implants of worse quality than American, French and European ones, but they were cheaper. For the last approximately one and a half to two years before its closure, this company, in order to save money and try to earn more money, began to pour technical gel into implants instead of medical gel, and therefore problems began to arise for patients. And women with such problems are now appearing all over the world, since the technical gel simply eats away the implant shell.

Guarantee for implants and surgery

Unfortunately, there is a bit of dishonesty in terms of management. When they tell you that there is a lifetime guarantee for the operation, then this is a substitution of concepts. Many manufacturers have begun to provide a lifetime warranty on their products. What does this mean? If it suddenly breaks during your life (not contracture), then they are ready to replace it for you free of charge. But what will this mean? You will have to remove the implant, respectively, pay for the operation and anesthesia, because there is no guarantee for this. The removed implant is sent to Europe or the USA, and after two months a conclusion is issued. If the manufacturer admits its guilt, then a pair of implants will be sent to you free of charge.

Believe me, you will not walk for two or three months with one breast, because where the implant was removed, a pronounced scar process will form in two or three months and it will be uncomfortable to walk, constantly putting in some kind of external breast substitute, as after oncology. Sometimes it happens that a pronounced scar process in the breast will not allow you to create exactly the same breast, so when replacing it, it is better to immediately place an implant, immediately restore the shape when it first broke, so that tissue changes do not begin in the breast and you do not have to re-form the pocket, because it is technically more difficult.

The second point is that you cannot give a guarantee for the operation. You know, more and more low-quality Chinese implants are appearing on the market, and the manufacturing company can only exist for a year, while giving a lifetime guarantee. Another question is that there are more serious, older manufacturers - with experience, seniority and reputation. Their guarantee and the guarantee of a company that has existed for a year, two, three are completely different concepts.

Regarding the lifetime guarantee for the operation, one can say this - this is only possible if the operation is done perfectly and you are frozen after it. You don’t walk, you don’t give birth, you don’t gain weight, you don’t lose weight, and, most importantly, you don’t grow old, that is, you just lie immobilized. Only in this case, the operation can be given a lifetime guarantee. Since almost all of the above happens to us, and the breast is the first to react to everything - weight gain, weight loss, and childbirth, then it will change accordingly. The implant may not break, but the shape of the breast will change, so a lifetime guarantee cannot be given for the operation; this is just a trick to drag the patient in.

Since we discussed the guarantee and all the technical features, in addition to the hands of the surgeon, the quality of the implant is also important, how the tissue is sutured, how the technology works, and what is also important is how the body itself reacts, individual characteristics. A very significant point is the issue of rehabilitation, which, unfortunately, most surgeons and many patients I meet in life do not understand or know. People do not appreciate how important it is to pay attention to rehabilitation. It depends on it, especially in the first two to three months and up to six months, how well and long your new breasts will serve you. Therefore, in surgery there is no one hundred percent guarantee. This is an inexact science; risk reduction is only possible due to the quality of the operations performed, the medications and implants used, the quality of rehabilitation and individual characteristics.

Look for decent plastic surgeons with experience and reputation - we have them in Russia. Choose several doctors who have been working for a long time and have successful experience, and go to them for consultations, because personal communication with a surgeon reveals a lot of things. In comparison, you will understand which doctor is better to entrust your health to.

Service life

Regarding the service life of breast implants. If a woman is nulliparous and her tissues are very small, then, as a rule, after childbirth they react less to hormonal changes and require less correction. But if your tissues had sufficient volume, that is, there is an implant or not, regardless of this, some changes will occur with the gland. And here the question is - how are your ligaments structured, what is the percentage of adipose tissue, what is the glandular tissue, there is milk - there is no milk, we wear a bra during pregnancy - we do not. The breast may react differently, and in such a situation, correction may be required.

Correction is carried out using different methods. One option - with normal preservation of the implant - is to tighten or even reduce the tissue above the implant. Situations arise when we can place a larger implant and thereby lift and enlarge the breast, straighten the tissue, and make it more elastic. But if we take a situation where a woman has already given birth and we have placed implants, everything again depends on the amount of tissue. But in this case, after the first or second pregnancy, the fat component is practically gone, the milk ducts are already formed, as far as the tissues could stretch, they have already stretched, and when operating on such patients, a longer lasting result is obtained, because the breasts react less to any changes that await a nulliparous woman .

On average, manufacturers say that the service life is 10-20 years, because during this period something still happens to you. There is a risk of developing contracture, you can gain weight, give birth again, get injured, and so on. Unfortunately, as we age, wrinkles appear on the face, in the eye area, on the chest, but we don’t see them, because these wrinkles straighten out due to the fact that the chest goes down. In this case, correction may also be required. If 10 or 15 years have passed, even though everything is fine with the implant, if you need to carry out some kind of correction and give anesthesia, in such a situation any competent surgeon will advise replacing the implant with a more recent one, so as not to think about how long it will last - 15 or 20 years, and start counting the life of the implant again. In addition, over 10-15 years, some changes still occur in the texture of the shell layers of the implanted components, in the density, and in the quality of the gel. They are gradually being improved and are more and more in line with the wishes of patients.

Removal of implants

What to do next in the future? From experience I will tell you that at the age of 65 a woman had her breasts done, and at the age of 61 another patient had a buttock augmentation. Therefore, here, in terms of restrictions on surgery, there are only severe concomitant diseases, such as systemic connective tissue diseases, diabetes mellitus, and cardiopulmonary failure. This can limit operations. What to do if you had breast augmentation at the age of twenty? After giving birth, they corrected it, replaced the implant, and you don’t think about what will happen in 20-30 years. Firstly, when you think what will happen in many years, this is already a philosophical question, since no one can predict this. There are two points. If you have a preserved body, not poisoned by nicotine, alcohol, unhealthy diet, and no diseases, then you can make a correction and continue to live with such breasts. If, say, at 60-70 years old you don’t want to have implants, they can be removed and you will be left with the situation that would have been without breast augmentation. The only difference is that from the age of 20, 30, you walked for 10, 15, 20 years - this is a significant part of your life - with a sufficient volume of the mammary gland that satisfied you, or you walked all this time, dissatisfied with the shape and volume of your mammary gland glands, but did not undergo surgery. The choice is yours. Operations are carried out everywhere in the world, if you decide to do it, you consciously go for it and in the future you can either correct it or simply remove the implants, returning to the original natural volumes.

Popular questions about breast implants

- What is the cause of contracture?

This is approximately 3 to 5% of cases. What is the reason? Installation under the gland, installation of smooth implants, individual characteristics, manufacturer. The better the company, the lower the risk of complications. The technique of the operation is also important. If there are extensive hematomas, long-term seromas, or infection of the tissues around the implant, then the risk of contracture is higher.

- Is it possible to develop an allergy to silicone? How do you know if you are allergic to silicone?

An allergy to silicone is unlikely, because silicone is present in many places in our lives. In all antiperspirants, deodorants, in soap, for example. If you have a severe polyvalent allergy to everything, then the risk of developing rejection is very high. In other cases it is less likely. There are situations when the surgical technique was performed incorrectly: they did not leave tissue, they damaged too much, formed an extensive hematoma, and drainage was left in place for a long time. There are other reasons for complications here, not implant rejection.

- The most frequently asked question: does having an implant affect breastfeeding later?

No. The presence of an implant has long been proven to not affect the possibility of feeding in the future. The only thing is that there is such a feature as access. The most popular approach is along the lower edge of the areola. With this access, according to statistics, it is believed that in 30% of cases there is a risk of disruption of the feeding process. But very often girls come who have already given birth, and who, despite the normal volume of their gland, initially did not have the opportunity to feed. If this girl had been given an implant initially, they would have said that because of the implant or because of the access, a situation arose where she could not feed. In fact, 30% is an average figure; it depends on the qualifications of the surgeon, the school, and the technique. Because with such an installation, the gland tissue is often damaged when the surgeon does not operate very competently. For the most part, the qualifications of most surgeons are sufficient to ensure that patients do not have problems with feeding.

Position of the implant in relation to the pectoralis major muscle

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Location breast implants may vary depending on whether it is installed above or below the pectoral muscle. The advantages of installing an implant over the pectoral muscle include less discomfort after surgery and less swelling in the postoperative period.

It is worth remembering that the risk of the breasts moving during upper body movements is higher in women who have an implant installed under the muscle. This is very important and applies to those women who lead an active lifestyle. Sometimes (but not always) such breast movements can cause significant discomfort. Other benefits of having breast implants placed under the pectoral muscle include that there is less interference with mammograms (breast x-rays) if needed.

In addition, implants that are placed under the pectoral muscle do not shrink. Women with small breasts are more suited to having implants placed under the pectoral muscle. For women who lead an active lifestyle, it is better to choose the method of installing the implant above the pectoral muscle.

The location of the implant in relation to the pectoralis major muscle can be:

Subglandular or subglandular location – buzzy implants are installed between the breast tissue and above the pectoralis major muscle. This placement of the implant has the most aesthetic results. Subglandular placement of implants in patients with thin breast tissue is fraught with the appearance of breast shrinkage. In addition, in this case, the risk of capsular contracture is slightly higher, so patients at risk of such a complication (smokers or have had multiple breast surgeries) are not recommended to have an implant placed under the breast tissue
Subfascial – breast implants are also installed under the gland tissue and above the muscle, but under the fascia of the pectoral muscle. The benefits of this method of implant placement remain controversial, however, its proponents believe that this can improve the fixation of the implant in the breast.
Subpectoral or submuscular – breast implants are installed under the pectoralis major muscle after cutting its lower part. Therefore, the implant appears to be half under the muscle and half under the mammary gland. This method of implant installation is most popular in the USA.
Axillary – breast implants are installed under the pectoralis major muscle, while its lower part is not cut.

Subfascial breast augmentation is one of the methods of installing implants, widely used along with others in modern aesthetic surgery. The method involves installing an endoprosthesis under the fascia of the pectoralis major muscle. Fascia is an additional soft tissue layer consisting of a superficial and deep layer. A superficial layer of fascia covers the outer surface of the pectoral muscle, separating it from the mammary gland. A deep layer of fascia is located in the middle between the pectoral muscles.

The method of installing the implant under the fascia of the pectoralis major muscle is also notable for the absence of the risk of possible deformations of the mammary glands during contractile processes of the pectoral muscle. In addition, installing an implant under the fascia minimizes all complications during the recovery period.

If a woman wants to get natural, attractive breasts of a new shape, but is afraid that the edges of the implant may be contoured through the skin. The method of installation under the fascia of the pectoral muscle completely eliminates this undesirable defect.
If the patient does not have enough soft tissue in the breast, which is used by the surgeon during the operation to cover the implant.
If the patient would like to avoid changes in breast shape when contracting the pectoral muscle.

How is the implant placed under the fascia?

The implant can be installed through a transaxillary approach (in the armpit), a periareolar approach (an incision along the lower edge of the areola) or an inframammary approach (in the crease in the area under the breast). The access is selected in accordance with the anatomical characteristics of the patient and her wishes.

As a rule, the endoscopic method is chosen for those with initially small breasts. The method allows you to avoid visible scars. Through access in the fold under the breast, it is possible to install implants under the fascia, even of significant volume. If there is no breast ptosis yet, access through the areola is acceptable.

The result of subfascial breast enlargement

Installing breast implants under the fascia is an opportunity to create firm, attractive breasts without the risk of contouring the implants. Soft tissues completely cover the endoprosthesis, so its edges cannot be felt at all and cannot be noticeable. The operation makes it possible to install implants of any size, from minimal to maximum, as well as any shape, from teardrop-shaped to round.

Advantages of installing an implant under the fascia

There is no risk of visualizing the edge of the installed implant.
Increasing the elasticity of the integumentary tissues of the breast and a slight tightening effect.
Possibility of combining surgery with lifting.
Minimal risk of developing fibrous capsular contracture after breast augmentation surgery.
Preserving nipple sensitivity.
Elimination of damage to the endoprosthesis during contractile processes of the pectoralis major muscle, since the fascia protects it.
The ability to create a better breast contour that will look natural.

Disadvantages of installing an implant under the fascia

The fascia tends to gradually thin out under the influence of age-related changes, which can lead to some deformations and even displacement of the implant.
If you install an implant along the fascia, it will not be palpable, but it can create incorrect contours if the shape and size are chosen incorrectly.

The appearance of the breast depending on the placement of the implant above or below the pectoral muscle

Obviously, if the patient has enough natural breast tissue to completely hide the implant and avoid contouring and rippling at the edges, placing the implant under the gland will give the most natural result.
This is understandable, since in this case the implant only adds volume to the gland, which imitates breast enlargement in a natural way, adding volume to it, and not lifting it.

Women with a sufficient or large volume of their own breast tissue, who have an implant placed under the muscle, often complain that, for example, when playing sports, their breasts in movement after implantation look unnatural - like a two-story tower, the second floor of which is displaced relative to the first.

But women with moderate or insignificant breast volume will definitely benefit from having an implant placed under the muscle. Implants placed above the muscle (subglandular) in such patients will look frankly artificial and fake, since they are close to the surface.

Placement of the implant under the mammary gland, but above the pectoral muscle.
Technically, all implants are located under the breast, since implants placed under the muscle are also under the breast.

However, “sub-glandular implant placement” refers specifically to placing the implant between the mammary gland and the pectoral muscle.

The placement of the implant partially under the muscle is very often, apparently for brevity, simply called “under the muscle.”
Which is not entirely correct.

With subpectoral placement, the implant is placed under the pectoral (pectoral) muscle only partially due to the characteristics of this pectoral muscle. With this approach, the lower part of the implant is not covered by muscle.

And although, when the patient says “under the muscle,” most likely, she means partial, subpectoral placement, there is also a technique when the implant is actually located completely under the muscle layer.

This technique implies that the implant will be covered from above by the pectoral muscle, and from below and on the sides by muscles adjacent to the lower part of the implant.

This is another option, along with placing an implant “under the gland,” “under the muscle,” and “partially under the muscle.”
Fascia is a thin layer of tissue covering the pectoral muscle. The surgeon separates the fascia from the muscle and places an implant underneath it.

And although the technique was fashionable several years ago, and many doctors practiced it, time has shown that placing an implant under the fascia does not provide any additional advantages.

Risk of capsular contracture

Many surgeons cite statistics from clinical studies showing that the risk of capsular contracture is lower when the implant is placed partially or completely under the muscle than when it is placed under the gland.

However, other surgeons cite statistics indicating quite the opposite.

In fact, there is no single consensus on this matter today.

One option that has been proposed to prevent capsular contracture is a textured implant surface.
Although there are some debates here too. For example, some surgeons believe that a textured surface makes the ripples more noticeable than a smooth surface.

Ripple and implant competition

Patients with a small volume of breast tissue benefits when placing an implant under the muscle.
In this case, this approach reduces contouring and ripples along the edges of the implant, since in addition to the breast tissue, it is also covered by the pectoral muscle.

Mammography

And although technology is moving forward and placing an implant under the gland is not such a problem for breast imaging today as before, it is nevertheless clear that placing an implant under the muscle does not in any way interfere with proper mammography imaging, unlike the option when the implant lies under the mammary gland.

Ptosis (sagging) of the implanted breast

Many surgeons claim that placing an implant under the muscle provides additional support to the breast. As a result, in the long term, the risk of breast sagging is less than when placing an implant under the gland.

Unfortunately, mammoplasty does not stop the aging process of the breast in the future.

Regardless of the method used to place the implant - under the muscle or above the muscle, age-related sagging will not add aesthetics to the shape of the breast. However, the same as for breasts without implants.

Another important issue that is taken into account when choosing a particular implant location is the question of whether the patient plans to become pregnant in the future.

And although the implant placement technique today allows you to feed the child in both cases, the risk of damage to the mammary gland during surgery or due to possible complications after is higher when placing the implant under the gland than when placing the implant under the muscle.

Therefore, be sure to discuss this issue with your surgeon, as it may have an impact on the choice of where to place the implants.