Understanding Cosmetic Breast Enhancement

Breast Augmentation – Placement Options

Numerous breast implants (e.g. silicone implants, saline implants, various profiles, etc.) and methods of placement (e.g. over the breast vs submuscular) are available. The final choice is generally based upon a number of factors including: intended purpose, desired result, body-type, age, health, etc. The type of breast implant to use and the method of placement will be carefully considered and discussed during your Complimentary Consultation with Dr. Marcus.

 Submuscular Implant Placement

With this method, the top two-thirds of the breast implant is behind the pectoral muscles and the lower one-third is behind the fascia or connective tissue. The implants can be placed with either a periareolar, or inframammary fold incision approach.

Advantages

• This method conceals the breast implant most effectively, reducing the chances of visible signs of rippling.
• The facia or connective tissues assists in supporting the breast implant, unlike in the over the muscle placement, where the implant is supported by skin tissue only.
• Less risk of capsular contracture or where the natural healing process can tend to squeeze and distort the implant.
• Less risk of “bottoming out” or the implant descending to a lower position, since it is supported by the fascia.
• Mammogram readings are generally better due to the fact visibility of the breast tissue is not obstructed.

Disadvantages

• Post-operative discomfort is likely to be higher since an incision into the muscle tissue is necessary for placement of the implant – as opposed to simply a skin incision for over the muscle or “subglandular” placement.
• The breasts tend to be higher until the muscles have had time to heal and relax.
• Slight distortion may occur during physical activity (e.g. weight-lifting), when the pectoral muscles are contracted.

Over the Muscle Implant Placement

With this approach, the breast implant is placed behind the breast tissue and over or in front of the muscle.

Advantages

• The placement of the breast implants is relatively easy to perform.
• Recovery time is faster and post-operative discomfort is generally less severe since muscle tissues remains in tact.
• Larger breast implants can generally be placed using this approach.
• In some cases a breast lift can be delayed or even avoided by placing a breast implant.
• Women athletes tend to prefer over the muscle placement, due to the fact that less distortion occurs when the pectoral area is flexed or contracted during activity.

Disadvantages

• Rippling effect or indications a breast implant is present is more likely due to the fact there is less tissue covering the implant.
• Implant descent or “bottoming out” can occur when the implant moves downward out of the incision pocket.
• This approach has a tendency to lend a more “rounded” look to the breast – especially in cases where there is little breast tissue present to begin with. Of course, this is a matter of personal preference.

In order to access your individual requirements and which breast implant approach may be best suited for you, please scedule a Complimentary Consultation with Dr. Marcus at his Cosmetic Surgery and Laser Center in Santa Rosa, CA.

Breast Augmentation Incisions

Various approches to placing the breast implant are available. Incision placement is generally a matter of personal preference, but can also depend upon the type of implant (e.g. pre-filled implants or inflatable saline implants) being used. Pre-filled implants often times require a slightly longer incision, which may influence the point of incision. However, a skilled surgeon such as Dr. Marcus, can generally place a pre-filled implant through a very small incision.

The four incisions available for breast implant placement, as well as the pros and cons to each approach will be explained in detail by Dr. Marcus suggests during your Complimetary Consultation.

Incision Options

• Periareolar or Areolar Incision: One of the most widely used methods of placement is accomplished via the areolar incision where over the muscle, submuscular and partial submuscular implants can be placed. With this method, the incision is made just beyond the areola (the darker area of skin surrounding the nipple), which also aids in visible signs of scarring being lessened. The areolar incision is used for breast lift or “mastopexy” procedures.
• Inframammary Incision: Another very widely used method to place breast implants of all types. The incision is made in the inframammary fold a.k.a. the crease, and when done properly, the scar should not be visible. This method affords working in close proximity to the breast and the implant does not pass through the breast ducts. The inframammary incision is generally preferred for dealing with revisions as well.
• Transaxillary Incision: This incision is made in the natural folds of the skin in the armpit area – leaving no visible scars on the breast. Over the muscle, submuscular and partial submuscular implants can be placed with through the transaxillary incision, however, in cases where a removal is required, it is likely an inframammary or areolar incision will be necessary, as removal via the armpit is difficult or not possible.
• TUBA Incision: Trans-Umbilical Breast Augmentation requires an incision at the rim of the naval. Over the muscle and submuscular implants can be placed with this approach. The TUBA method of implant placement affords the quickest recovery time and the least amount of post-operative discomfort, due to the fact that it is the least invasive of the available incision types. Scarring is minimal and in most cases, almost undetectable.