Location, Location, Location! Another choice women have today in breast augmentation is the placement of the implant. The options for breast implant placement are either in front or behind the Pectoralis Major muscle. In both instances the implant is placed behind the breast tissue. This ensures that the architecture of the milk ducts, blood vessels, and nerves from the breast tissue to the nipple and areola remains intact.
After the breast incision is made the tissue is dissected to the breast tissue – Pectoralis muscle junction. At this point the surgeon creates a space or pocket either in front of the muscle or behind the muscle to place the breast implant.
Sub Pectoral Implant Placement (behind the muscle)
Placement of the breast implant behind the muscle provides additional soft tissue coverage and allows for more of a breast slope. In women with very little breast tissue, placing the implant under the muscle reduces the risk of implant rippling or implant wrinkling. The pressure of the top portion of the muscle on the breast implant allows it to take on a more sloping appearance. It is also easier to image the breast tissue during mammograms. Studies have shown that placing implants behind the muscle are much less likely to form a capsular contracture, or hardening and distortion of the breast, from excessive scar tissue formation. The submuscular implant does have some disadvantages as well. Implant distortion may develop when the Pectoralis muscle is flexed. This tightening of the muscle can cause the implant to move superiorly.
- Less likely to ripple
- Lower risk of capsular contracture
- Easier to read mammograms
- Implant distortion when the Pectoralis muscle is flexed
Pre Pectoral Implant Placement (in front of the muscle)
Placement of the breast implant in front of the muscle offers some distinct advantages as well as some disadvantages when compared to submuscular placement. As the muscle does not cover the implant, there is less tissue between the implant and the skin so rippling or wrinkling is more noticeable. For that reason I usually recommend using silicone implants when using a pre pectoral approach. Since there is no muscle coverage, implants placed in front of the muscle have a rounder shape. Also, the implant will not become distorted if the pectoralis muscle is flexed. In women with some breast drop, placing the implant in front of the muscle may prevent the need for a breast lift. Higher risk of capsular contracture occurs in women who have implants placed in front of the muscle.
- No implant distortion with muscle flexion
- May prevent the need for a breast lift in women with breast droop
- More likely to ripple
- Higher incidence of capsular contracture
As with all options for breast augmentation there are no right or wrong choices. These options exist to give the optimum results that the patient desires.