Breast Implant Placement
Submuscular vs. Subglandular
With the development of fiber optic technology the transaxillary approach (placement through the under arm incision) has become a technically more precise procedure. The endoscope (a fiber optic camera) allows the implant pocket to be well defined and easily visualized which insures a more accurate placement of the implant. The endoscopic technique also lends itself to placing the implant in a submuscular (under the pectoral muscle) versus a subglandular (under the breast gland) position.
For our breast augmentation patients from Panama City, Pensacola, Destin, placing breast implants beneath the pectoral muscles (submuscular placement) offers the following 3 major advantages:
- Decreased rate of capsule contracture
- More tissue to cover the implant to prevent the implant from being easily seen or felt
- Support of the breast gland by the underlying muscle to diminish future droop
This patient underwent a subglandular (above the muscle) augmentation and several subsequent revisions by an outside surgeon prior to presenting to Destin Plastic Surgery. At Destin Plastic Surgery, she underwent an endoscopic implant exchange from over the muscle to under the muscle to revise the previous surgeons work. See the tremendous improvement in the shape and contour of her breast in the bottom photos when the implant is under the muscle.
Capsular Contracture and Rippling
Capsule contracture is the term used to describe the formation of scar tissue around the implant which, when thickened, can make the implant feel hard and round. Although the implant itself remains soft, the scar tissue "squeezes" the implant, which makes the implant itself feel hard. In the submuscular position, the rate of capsule contracture is decreased in general from 15% to 3%. That's a significant difference.
"Rippling" occurs when the implant shell is easily felt beneath the skin. With subglandular augmentation, the possibility of this occurring is greater than with the submuscular position. Large studies have shown that the chance of "rippling" is 3 times greater with subglandular augmentation than with submuscular augmentation. Additionally, when implants are placed in the submuscular position "there is the important added advantage of improved mammography."
Separating the breast gland from the underlying muscle removes one of the breast "supports." This can lead to accelerated breast droop. Also, by removing the blood supply from the undersurface of the breast, a future breast lift will be more difficult if needed.
The disadvantage of the subglandular placement versus submuscular placement in breast augmentation near Pensacola is that the postoperative recovery is lengthened and the patient may experience more postoperative discomfort. In addition, there may be more motion of the implant with forceful pectoral contracture.
All things considered, the submuscular placement of an implant is the least at risk for the complications of capsule contracture, "rippling" and breast droop.
Dr. William Burden
An internationally renowned plastic surgeon who draws patients from near and far.
Dr. L. Scott Ennis
A renowned plastic surgeon devoted to achieving the optimal outcome for every patient.