Options for Breast Implant Placement

02 Aug Options for Breast Implant Placement

What Is the Right Placement for Breast Implants?

Are you thinking about getting breast implants? There’s more to it than just choosing the size. One of the crucial decisions you’ll need to make is where the implants should go. But with options like “under”, “over”, or “dual plane”, it might feel a bit confusing. In this blog we will break everything down in simple words and explain what each placement option means. This way, you’ll be well-informed and ready to make the right choice for yourself regarding breast implant placement.

Perth Specialist Plastic Surgeon Dr. Watts is committed to helping his patients make the right decisions regarding breast implants to get optimal results after Breast Implant/Breast Augmentation surgery.

What are Breast Implants?

Breast implants are special devices that surgeons use to make breasts bigger or to increase the volume of the breasts, to restore fullness and create symmetry in disproportionately shaped breasts. When it comes to breast implants, you have different choices in terms of size, shape, texture and placement.

Breast Anatomy and Implant Placement

The breast is primarily composed of fatty tissue, glandular tissue, and connective tissue, which are essential for milk production and delivery during breastfeeding.

Breast Anatomy

• Fatty Tissue: This forms the bulk of the breast and its size varies depending on the woman’s overall body fat. It provides shape to the breast and can change due to factors like age, hormonal changes, and weight fluctuations
• Glandular Tissue: This is the functional tissue of the breast, which consists of lobules (milk-producing glands) and ducts (tubes that carry milk from the lobules to the nipple)
• Connective Tissue: This type of tissue surrounds and supports the glandular and fatty tissue. It helps maintain the shape and structure of the breasts
• Muscles: Underneath the breast tissue and on the chest wall are muscles – the pectoralis major and minor, which are important considerations in breast implant surgery
• Skin and Nipples: The skin covers the breast tissue, and the nipple is in the centre of the areola, which is a darker area of skin on the breast

Determining Implant placement

Understanding the breast anatomy is crucial for determining the right implant placement options. This knowledge helps Dr. Watts predict how implants will interact with the existing breast tissue and muscles. Here’s why:

• Pectoral Muscles: The pectoralis major muscle is a key consideration in implant placement. Placing the implant below this muscle (submuscular placement) may provide a more natural look and feel, while placing it above the muscle (subglandular placement) can make the surgery and recovery time shorter
• Existing Breast Tissue: The amount and firmness of the existing breast tissue can influence the appearance and feel of implants. For instance, women with less natural breast tissue may choose submuscular placement to better camouflage the implant
• Body Type: The patient’s overall body type, including factors like height, weight, and chest wall shape, can influence the best implant placement decision

Breast Implant Placement Options

When it comes to Breast Augmentation, there are three main types of implant placement options to consider: submuscular placement, subglandular placement, and dual plane placement. Each has its unique set of advantages and potential drawbacks, and the choice among them depends on a variety of factors including the patient’s anatomy, lifestyle, and aesthetic goals.

1. Submuscular Placement: Under the Muscle

Submuscular placement, also referred to as “under the muscle,” involves positioning the breast implant beneath the pectoralis major muscle. This muscle is found on the chest wall, underneath the breast tissue.

The submuscular placement may provide a more natural appearance, especially in women with thinner breast tissue, as the muscle layer can help to camouflage the implant. Additionally, it’s thought to have a lower risk of certain complications like capsular contracture and implant rippling. However, the surgery can be more invasive, which may lead to a longer recovery period.

Procedure

Submuscular placement refers to positioning the breast implant beneath the pectoralis major muscle, which is the large muscle in the chest area.

The surgical procedure for submuscular placement usually follows these steps:

• Anaesthesia: The patient is put under general anaesthesia to ensure comfort and painlessness during the procedure
• Incision: Dr Watts makes an incision, usually in the inframammary fold (the crease under the breast), around the areola, or in the armpit. The location of the incision depends on various factors, including the type and size of the implant and the patient’s anatomy
• Creating the Pocket: Dr Watts creates a pocket beneath the pectoralis major muscle to accommodate the implant
• Inserting the Implant: Dr Watts inserts the breast implant into the pocket
• Closure: Dr Watts closes the incisions with sutures, skin adhesive, or surgical tape

The procedure usually takes between one to two hours and can be performed on an outpatient basis, meaning the patient can go home the same day.

Who Are Suitable Candidates for Submuscular Placement?

Submuscular placement can be a suitable option for various types of patients. It may be particularly appropriate for:

• Women with Thin Breast Tissue: Submuscular placement can help camouflage the implant in women who have little natural breast tissue
• Non-Athletic Women: Women who do not participate in strenuous physical activities involving the chest muscles may be good candidates, as there’s less chance of the implant being affected by exaggerated muscle movement
• Appearance: Because the muscle helps to soften the transition between the upper chest and the start of the breast mound, submuscular placement can provide a more natural slope, which some women prefer
• Women Concerned about Breastfeeding or Mammography: Submuscular placement may cause less interference with mammography and breastfeeding

Benefits of Submuscular Placement

• Appearance: Since the implant is placed under the muscle, it can create a smoother, more natural transition between the chest wall and the breast, especially in women with little natural breast tissue
• Reduced Risk of Rippling: Submuscular placement may reduce the risk of visible or palpable rippling, as the muscle provides an extra layer of tissue over the implant
• Lower Capsular Contracture Risk: Capsular contracture, a condition where the scar tissue capsule around an implant thickens and hardens, is less likely with submuscular placement according to some studies
• Less Interference with Mammograms: Placing implants under the muscle may result in less interference during mammograms, making breast cancer screening easier

Drawbacks or Potential Issues

• Longer Recovery Time: As the procedure involves cutting through muscle tissue, recovery may take longer compared to subglandular placement. Patients may experience more postoperative discomfort
• Animation Deformity: This refers to the distortion of the breast shape during muscle movement, such as flexing the chest muscles. This can occur because the implant is placed beneath the muscle

2. Subglandular Placement: Over the Muscle

Subglandular placement, or “over the muscle,” means the breast implant is positioned directly behind the breast tissue, but above the pectoralis major muscle. This placement can make the surgery and recovery time shorter, and it can provide a higher, more pronounced breast profile.

However, subglandular placement may not be suitable for women with minimal breast tissue, as the implant may be more visible or palpable. Also, it may have a higher risk of complications such as capsular contracture compared to submuscular placement.

Procedure

Subglandular placement, also known as “over the muscle” placement, involves positioning the breast implant directly behind the breast tissue but above the pectoralis major muscle. Here’s a general overview of the surgical process:

• Anaesthesia: The patient is put under general anaesthesia
• Incision: Dr Watts makes an incision, typically in the inframammary fold (the crease under the breast), around the areola, or in the armpit
• Creating the Pocket: Dr Watts creates a pocket above the muscle but behind the breast tissue. This is where the implant will be inserted
• Inserting the Implant: Dr Watts inserts the breast implant into the pocket
• Closure: The incisions are closed with sutures, skin adhesive, or surgical tape

Who Are Suitable Candidates for Subglandular Placement?

Subglandular placement may be suitable for:

• Women with Adequate Breast Tissue: Women who have a moderate amount of natural breast tissue my benefit from this placement, as the existing tissue can help to camouflage the implant
• Women Seeking a More Pronounced Profile: Subglandular placement can create a high and rounded breast profile, which some women may prefer
• Athletic Women: For women who engage in rigorous physical activities, especially those that involve the upper body, placing the implant above the muscle may reduce the risk of the implant being affected by muscle movement

The final decision on suitability should be made in consultation with Dr. Watts, considering the individual’s anatomy, lifestyle, and aesthetic goals

Benefits of Subglandular Placement

• Recovery Time: As the muscle isn’t manipulated during surgery, recovery is often less complex and less painful compared to submuscular placement
• No Animation Deformity: Since the implant is not under the muscle, the risk of animation deformity, a distortion that can occur when the chest muscles are flexed, is avoided
• More Pronounced Profile: Subglandular placement can create a high and rounded breast profile, providing an “augmented” or “enhanced” look

Drawbacks or Potential Issues

• Higher Risk of Rippling: As there’s less tissue to cover the implant, the risk of visible or palpable rippling may be higher, especially in women with thin breast tissue
• Higher Risk of Capsular Contracture: Some studies suggest that subglandular placement may carry a slightly higher risk of capsular contracture
• Potential Interference with Mammograms: Implants placed over the muscle can sometimes make it harder to interpret mammogram images, which could potentially affect breast cancer detection
• Potential for a Less Natural Look: Depending on the patient’s existing breast tissue, the result might look less natural compared to submuscular placement

3. Dual Plane Placement

Dual plane placement is a hybrid approach, combining aspects of both submuscular and subglandular placements. In this technique, the implant is placed partially beneath the pectoralis major muscle and partially behind the breast tissue.

Dual plane placement can offer the benefits of both submuscular and subglandular placements. It may provide a natural appearance and feel while also allowing for a more pronounced breast profile. It’s often used when there is a small amount of excess skin, as it can give a slight lifting effect.

Procedure

Dual plane placement is a hybrid approach that combines the benefits of both submuscular and subglandular placements. Here’s a general overview of the surgical process:

• Anaesthesia: The patient is placed under general anaesthesia
• Incision: Dr Watts makes an incision, in the inframammary fold (the crease under the breast), around the areola, or in the armpit
• Creating the Pocket: Dr Watts creates a pocket where the upper part of the implant is placed beneath the pectoralis major muscle and the lower part is positioned behind the breast tissue
• Inserting the Implant: Dr Watts inserts the breast implant into the pocket
• Closure: Dr Watts closes the incisions with sutures, skin adhesive, or surgical tape

Who Are Suitable Candidates for Dual Plane Placement?

Dual plane placement may be suitable for:

• Women with Mild to Moderate Breast ptosis (sagging): Dual plane placement can give a slight lifting effect, making it suitable for those experiencing some degree of breast ptosis
• Women with Minimal Breast Tissue: The dual plane approach provides additional coverage over the implant, making it a good option for women with less natural breast tissue
• Women Seeking a Natural Look: Dual plane placement combines the benefits of both submuscular and subglandular placements, often resulting in a natural appearance and feel

Benefits of Dual Plane Placement

• Natural Appearance: By placing part of the implant under the muscle and part under the glandular tissue, dual plane placement often results in a very natural-looking augmentation
• Reduced Risk of Rippling: The dual plane method provides extra coverage over the implant, which can help to reduce the risk of visible or palpable rippling
• Suitable for Mild Ptosis: Dual plane placement can provide a slight lifting effect, making it a good option for those with mild to moderate breast ptosis (sagging)

Drawbacks or Potential Issues

• More Complex Procedure: Because dual plane placement involves manipulating both the breast tissue and the muscle, the procedure can be more complex than straightforward submuscular or subglandular placements
• Longer Recovery Time: Given the complexity of the procedure, recovery might take longer compared to subglandular placement
• Potential for Animation Deformity: Similar to submuscular placement, dual plane placement could result in animation deformity due to the part of the implant being under the muscle
• Risk of Double Bubble: There’s a small risk of a “double bubble” effect, where a bulge or line appears in the lower part of the breast. This can occur if the implant drops down behind the breast tissue but the breast tissue and skin remain in their original position

FAQs about Breast Implant Placement Options

How do I choose the best implant placement option for me?

• The best implant placement for you depends on various factors, including your body type, the amount of natural breast tissue you have, your lifestyle, and your aesthetic goals.
• Dr. Watts can guide you through the decision-making process, considering all these factors.

Does implant placement affect the ability to breastfeed?

• Submuscular and dual plane placements have less impact on breastfeeding compared to subglandular placement, as they involve less manipulation of the breast tissue. However, any breast surgery can potentially affect breastfeeding.

Will implant placement affect mammograms?

• Implants can make mammograms a bit more challenging, regardless of the placement.
• Submuscular and dual-plane placements are usually less likely to interfere with mammogram images than subglandular placement.
• Always inform your radiologist about your implants before a mammogram.

Does implant placement influence the risk of capsular contracture?

• Capsular contracture is a condition where the scar tissue that naturally forms around the implant thickens and hardens. Some studies suggest that submuscular and dual plane placements may have a lower risk of capsular contracture compared to subglandular placement, though more research is needed in this area.

Further Reading about Breast Surgery with Dr. Watts

• Read Dr Watts’ Breast Reshaping with Fat Grafting
• See Dr Watts’ Breast Reduction and Lift Gallery
• See Dr Watts’ Breast Lift and Implants Gallery
• Read Dr Watts’ Blog About What causes Sagging Breasts
• Read Dr Watts’ Blog About History of Breast Implants

Medical References about Breast Implants

• Placement of breast implants – Mayo Clinic
• Where will your breast implants be placed? | ASPS
• Breast Implants: Types, Surgery, Recovery & Risks