Breast Affairs – Augmentation with Implants: Incision and Placement.

Now that we already discussed the type, shape and even size of breast implants, you might now be interested in knowing more about how and where the implants are placed inside your natural breast. For something not new, let’s start for saying that the place of incision and the placement of the implant depends on your body characteristics, the surgeons technique and professional preferences (as the specialist he is), and his evaluation of your particular case. Once again, the final choice should be a compromise between your personal preferences and your surgeon’s professional advise, after a no doubt frank discussion. The Incision Incisions are made in areas which would conceal minimal visible scars. There are 3 main common areas for incision that vary according to the type and size of implant or even the intended placement of the implant. Inframammary Incision – The incision is made in the crease under the breast, slightly above where the breast meets the chest (called the infra-mammary fold), to better conceal the surgical scar that can result slightly thick. Still is the cut that better provides access to the breast tissue and pectoralis muscle interface. Periareolar Incision – This incision is made in the inferior-half border limit of the nipple areola, in a half circle shape. It’s a common incision for cases of simultaneous aerola reduction and specific types of breast lift. This results in a smaller, lighter and therefore, usually less visible scar. This approach can cause a change in the nipple sensation, that is a normally temporary effect, but  it’s also believed to create difficulties for breast feeding since the milk ducts are connected to the nipple and may sometimes be cut during incision. Transaxillary Incision – This incision is made in the armpit, where the surgeon creates a tunnel through the subcutaneous fat to create the pocket behind the breast, helped endoscopically. It is primarily used for saline breast implants. Some surgeons consider this the best incision for sub-muscular placement (check below) and it does not leave scar in the breast itself, although the resulting scar in the arm pit can be quite prominent. Other two less common incisions can be used, on specific situations: the transumbilical and the transabdominal. On the first, the implant is placed literally through the navel. With the use of a fine tube, a tunnel is created from the umbilicus till the bust and the implant is placed threw a small hollow tube with endoscopic visual assistance. Obviously this technique is not used for pre-filled silicone implants (which do not allow compression), but for the saline solution implants, that are filled when already placed. Apart from this limitation and from being technically more difficult, this type of placement results in no visible scars, definitely, a big positive point. The transabdominal approach is made when the patient is, simultaneously, undergoing an abdominoplasty (the commonly known Tummy Tuck). During the procedure, a tunnel is made from the abdominal incision already made, till the implant pockets and the implants are placed through that created channel. Again, with no scar for the breast and with no need of extra surgery. Whatever the approach selected, when the procedure is completed, incisions are sutured in the several layers of breast tissue and skin (medical adhesive or surgical tape can also be used to close the skin) and they will fade with time. Using a silicone gel based ointment proper for surgical scars helps to fade the scar. Placement of the Implant The quantity and quality of your breast tissue and skin, the actual shape of your breast, the degree of enlargement intended and even your lifestyle will be considered by your surgeon when deciding where to place the chosen implant for the best expected results.

For a better understanding of the Breast Anatomy.  Image from A.D.A.M  medical encyclopedia

Sub-glandular placement (also called submammary placement): The implant is placed directly behind the breast tissue (the glands), in the so called retro-mammary space, over the pectoralis major muscle (muscle that covers the upper chest). Although the implants might be more visible and easier to feel through the skin and with some more risk of capsular contracture, many surgeons believe it’s the more natural location for the implant as an extension of the natural breast tissue. Besides, this technique reduces time of surgery and recovery, with less pain and discomfort for the patient and representing less trauma for the body. Submuscular placement: The implant is placed under the pectoralis muscle. Although it provides the best coverage for the implant creating a more natural appearance and feel, the muscle movement constrains the implant which can lead to implant displacement and distortion, so a technique believed not the best for extensive exercise lovers. Recovery might be longer and more difficult for the patient, but on the other hand, this placement registers fewer occurrences of capsular contracture and provides better mammogram imaging. Dual Plane Placement: This placement is becoming more and more popular by the day. Surgeons believe it provides a better accuracy of implant placement and a better, more balanced and fuller shape of the inferior part of the breast, combining advantages of both subglandular and submuscular approaches. It’s a variation of the sub-muscular placement, where the implant is placed totally under the muscle. Here,  the surgeon releases only the inferior part of the muscle (muscle-splitting technique) and the upper pole of the implant is inserted under it leaving the lower half directly under the glandular tissue, in a dual plane location that seems to fit better the big range of anatomical variations of the patients. This technique reduces the effects of the muscle contraction on the look of the breast (distortion) and presents no rippling, lateral displacement or double-bubble deformity, being seen as resulting in a more natural overall appearance of the breast. Subfascial Placement: It does not have many supporters nowadays, but still an existing method, the implant is placed beneath the fascia (the membrane that covers the muscle). It is still between the breast tissue and the muscle, as a variant of the subglandular placement, but some surgeons believe this placement provides greater implant coverage to better sustain its position in the pocket.

From left to right: Sub-glandular placement, submuscular placement, dual plane placement and subfascial placement. Image from http://www.plastic-surgery-sydney.com.au

Read the Breast Augmentation Guide by BWMC here Have a question? Ask here