Breast Augmentation Characteristics
The seven characteristics that go into breast augmentation
Now on to number four: whether to place breast implants above the muscle or below the muscle. Above the muscle is also referred to as subglandular, or under the breast. Our anatomy is such that the pectoralis muscle is not very long. In fact, the pectoralis muscle only goes down over the rib cage equal to as far as the bottom of the areola around the nipple. This means that when the muscle is lifted up and implants are placed beneath the muscle, the muscle covers about two thirds to three quarters of the implant, or conversely, the entire pectoralis muscle is over the implant. I hope your following this.
The importance of this is that submuscular breast augmentation requires more skill. Implants placed under the muscle tend to last longer and have fewer complications particularly regarding capsular contracture. Additionally, patients with subglandular implants tend to have more implant rippling and more implant palpability. A little appreciated phenomenon of saline filled implants placed in the subglandular position is pressure atrophy of fat over time. This tends to thin out overlying breast which creates premature sag and increases rippling as well.
Also and very important is that breast cancer surveillance by diagnostic imaging, (mammography and ultrasound) may be compromised by subglandular implant placement. Diagnostic intervention such as core biopsy could damage the implants in this location. Sub muscular placed implants, however, should not interfere with imaging or intervention. In fact, in my practice I have never had a patient, radiologist, or gynecologist complain that any implant case I’ve done interfered with imaging or intervention!!
So overall, there is really no place for subglandular augmentation. It still unfortunately accounts for nearly half of all breast implant augmentations. It is untrue that you can’t work out with implants under muscle. I have countless patients who are personal trainers, fitness experts, triathletes and the like with implants under muscle.
Finally, from an aesthetic standpoint, submuscular implants done well look and feel far superior to subglandular implants. It is also untrue that they can be placed close together to get cleavage when done under muscle. See my web site to see what I mean!
So categorically, I recommend only sub muscular placement of breast implants!!