Breast augmentation with an implant under the muscle. What is the best way to place the implant: under the muscle or under the gland? Ripple and implant competition

There are many factors to consider when deciding how to place an implant. Depending on your breast size, as well as the result you want to achieve. The implant can be installed under the mammary gland or under the pectoral muscle. Each method has its own advantages and disadvantages.

The implant is located under the mammary gland above the pectoral muscle. This allows the use of larger implants and shortens the recovery period, since muscles are not injured.

However, this method has its disadvantages:
– the implant is easily identified by touch;
– it is difficult to achieve a clear image during mammography;
– the breasts after surgery do not look entirely natural;
– there is a high risk of fibrocapsular contracture – the formation of dense fibrous tissue around the implant.

Implant under the pectoral muscle

The implant is partially located under the pectoral muscle - approximately 2/3. Part of the implant is covered by muscle, part by connective tissue. This arrangement allows you to achieve the most natural look, since the pectoral muscle hides the edge of the implant. The implant does not interfere with taking clear images during mammography. Minimal risk of capsular contracture.

The disadvantages include an increase in the recovery period.
All questions related to implants should be discussed with your doctor. The placement of the implants may depend on your body type, preferences and/or lifestyle. Most women want their breasts to look natural, so they choose submuscular implants.

Breast Implant Revision: Problem Solving

Implant revision solves problems that arise after breast augmentation surgery. It corrects size, location, surface or asymmetry.

It is believed that breast augmentation is an easy procedure to perform, but this is not true. Correctly chosen methodology and attention to detail are the key to a good result. But this is often neglected, which leads to complications. As with any other cosmetic procedure, when installing implants, the main thing is an individual approach.

Why do women want to have an implant revision?
Most often there are three reasons:
– don’t like the size;
– I don’t like the feeling in my chest;
– breasts look unnatural.

These problems can be avoided thanks to the attentive attitude of the doctor.

Publications on the topic:

Submuscular location of the implant (partially under...
Subglandular placement of the implant (in front...
Changes in breast enlargement before, during and after...

Breasts do not change their volume and shape throughout life, only in a small number of women. You can try to preserve the beauty of the mammary gland on your own, starting from youth. But, despite all the attempts and efforts, its shape still changes, even if the gland is small. Every woman cannot escape this. Therefore, you have to make a decision about breast surgery (mammoplasty). It should be noted that among the patients of aesthetic surgeons who decided to resort to mammoplasty, there are many young girls who want to increase the volume and shape of their breasts. The surgeon should strive to ensure that it looks as natural as possible, both to the touch and to the eye. Experts, having conducted a series of studies, have found that most often women between the ages of eighteen and thirty-thirty-five prefer to undergo mammoplasty.

When you come for a consultation with a surgeon, you need to find out in detail about the mammoplasty procedure. He, in turn, will take into account all the wishes of the patient, which will allow us to jointly choose the method of surgical access, the type and shape of the implant. All patients must be photographed before undergoing mammoplasty.

The most common augmentation mammoplasty is performed using periareolar access (an incision is made along the areola), submammary (under the mammary gland) and axillary (least used).

Areola mammoplasty

Mammoplasty using periareolar access - this method is also called sutureless mammoplasty. During this operation, the tissues are not cut with a scalpel (except for the skin incision), but are moved away. At the same time, the integrity of the vessels and milk ducts is preserved, which makes it possible for women who have not given birth to resort to lactation in the future without problems. In the latter, the axillary approach is more often used to place the prosthesis under the muscle, because injury to the nipple during periareolar access can lead to the development of mastitis.

So, by making an incision around the areola of the nipple, the doctor, bypassing the breast tissue, can place the implant under the pectoralis major muscle. The scar running along the border of the nipple, where the light and pigmented skin is located, remains invisible (the wound is not stitched, but glued together with special glue). An implant can be placed under the muscle when sufficient tissue is observed.

The advantages of this method of placing an implant during mammoplasty include:

for those who have too small breasts, the contours of the implant will not be visible;
the duration of the mammoplasty operation takes much less time;
Capsular contracture will be less noticeable as the muscle covers the implant.

The disadvantages of this method include:

frequent damage to nerve fibers;
frequent damage to gland tissue;
inability to install some implants;
Over time, the implant may move;
during mammoplasty surgery with such an implant installation, there is less control over how the gland is formed;
quite painful and long rehabilitation period.

It also happens that during this mammoplasty, the prosthesis may be installed incorrectly under the muscle, which subsequently leads to thinning of its fibers, and the shape of the breast is deformed. Sometimes the size of the areola is too small to perform such mammoplasty, so the submammary method is used.

Mammoplasty under the gland

Submammary access in mammoplasty allows for more precise and symmetrical formation of a pocket for the implant and makes it possible to better control bleeding. In this case, a pocket will be formed in the interfascial space, which is limited by the fascia of the mammary gland and the fascia of the pectoralis major muscle. The implant in such a pocket will be located on the surface of the muscle and covered by the gland itself. The muscles are not damaged when performing this access during mammoplasty. The incision line with this access is located directly along the submammary fold, and its length does not exceed five centimeters.

The advantages of this method of installing a prosthesis include:

the formation of breast volumes is better;
local anesthesia is used in combination with intravenous sedation;
easy and short rehabilitation period;
a more natural appearance of the gland is formed;
when ptosis (breast drooping) occurs, this technique makes it less noticeable;
the risk of postoperative bleeding is reduced;

The disadvantages of installing an implant under the gland when performing augmentation mammoplasty include:

Mammography will be difficult to perform in the future;
the risk of capsular contracture increases;
the breasts after such mammoplasty will look unnatural.

Mammoplasty under the muscle

There is also a two-plane placement of the implant during augmentation mammoplasty. So, the lower part of the prosthesis will be under the gland tissue, and the upper part under the muscle. The positive aspects of this method are that the breasts look quite natural.

The disadvantages of this method are:

development of earlier ptosis of the gland;
long-term rehabilitation;
possible distortion of the breast shape.

A rare method of placing an implant is to insert it under the fascia of the pectoralis major muscle, but in principle, this method is practically no different from placing it under the gland and only some surgeons use it.

Choosing implants for mammoplasty

When performing augmentation mammoplasty, the choice of implants is very important. Indeed, depending on the type of prosthesis - anatomical or spherical - its location may also depend. Spherical high-profile implants are used for those women who have severe breast ptosis. With mammoplasty in this situation, the prosthesis is placed under the pectoralis major muscle. When the prosthesis is located under the major muscle of the chest, to prevent displacement of the implant, mammoplasty is completed by cutting off the muscle from the place of its attachment to the ribs and sternum.

An anatomically shaped prosthesis during mammoplasty will ultimately create a more real breast and is usually installed submammary (under the gland).

Plastic surgery encourages you to remember that no matter what method of placing an implant is chosen: under a muscle or under a gland, breast augmentation surgery, namely mammoplasty, can easily recreate an aesthetically beautiful breast shape and will always help you stay on top.

We welcome to our website readers who are interested in mammoplasty, the advantages of implanting a prosthesis under various structures in the breast area (muscle, gland, fascia), and the implants that are preferably used for this type of operation. Today we will talk about what mammoplasty under the arm is, the advantages and disadvantages of the procedure.

Opinions among plastic surgeons regarding the preferred method of installation are mixed:

Some of them consider the best option to install them under the muscle, when the tissue covers almost the entire prosthesis, with the exception of its lower edge;
other surgeons prefer a mixed method of implanting the prosthesis: partly under the muscle, partly under the gland;
Still others consider the submammary (subglandular) location of the endoinsert to be optimal.

But implants are installed under the fascia extremely rarely. And few surgeons choose this method of endoprosthetics.

Which method to use, whether it is better to install an implant under a muscle, combined or under a gland, will depend on a whole set of factors.

Submuscular implantation of a breast prosthesis: main nuances for small breasts

The choice of implantation method and location of the prosthesis is dictated not only by the surgical school or the personal preferences of the doctor. To a greater extent, it is justified by the anatomical features of the patient:

the size of her own breasts;
amount of tissue (muscle, glandular, fat);
the distance between the submammary fold and the nipple.

There are two theoretical possibilities for installing a submammary prosthesis:

cutting the pectoralis major muscle;
and without cutting it.

With small breasts, it is almost impossible to do without dissection. The femoral gland is attached in the region of the ribs slightly higher than the subglandular fold. This means that if a fairly large implant is placed in a pocket of a naturally small breast without cutting the muscle, then under muscle force it will eventually move upward, and the nipple will “look” down. Agree - this is not very beautiful.

Therefore, surgeons more often resort to dissecting the femoral bone. This is especially necessary for hypomastia. In this case they have to:

dissect the femoral bone, which lengthens the rehabilitation period;
increase the nipple-submammary fold distance, which, according to natural data, is very small.

The latter is achieved by forming a new inframammary fold. Lower than it was intended by nature. This allows you to avoid “jumping of the prosthesis” and lowering of the nipple. But during healing, the muscles, even when cut, “jump” (i.e., contract).

Therefore, there remains a part at the bottom of the implant that is not covered by muscles.

Over time, this area may become more exposed, and patients or their partners will be able to feel the prosthesis under the subcutaneous fat. The smaller the prosthesis, the more it is covered with muscles, and the more natural the breast will be when palpated.

Nevertheless, even small ones can be carried out using this method. And the results, at least visually, are very good. Judging by the pictures before and after the procedure. Although you shouldn’t believe that the surgeon will be able to “hide” the entire implant under the muscle.

This operation is good for women with developed and intact pectoral muscles and medium-sized busts. It is used when glandular tissue has involuted due to postpartum or age-related atrophy.

Submuscular mammoplasty: advantages and disadvantages

The main advantages of this placement of the endoprosthesis are:

good filling of the upper part of the chest, its beautiful natural shape;
tight “fixation” of the implant with muscle, which minimizes the risk of its displacement, ripples, formation of “waves”, and, consequently, the risk of re-intervention;
implants can only be felt in patients with hypomastia and only in the lower part of the bust;
endoinserts do not overlap the mammary gland and allow it to be clearly visualized during examination.

The disadvantages include:

insufficient filling of the lower chest;
weak expression of bust height due to the density of muscle tissue;
inability to correct sagging breasts, needs to be combined (with a lift);
longer recovery period;
It is highly undesirable to install;
It is not recommended to implant acrotextured prostheses and a polyurethane version of end inserts under the muscle.

When choosing a method, it is important to combine the surgeon’s skills in performing a particular correction method, his preferences and the patient’s anatomy. Then the result with any method will be stunning.

Recovery period after implantation of a prosthesis under the muscle

(of any type) the process is quite lengthy, and requires the woman to strictly follow the surgeon’s recommendations. In total, your tissues will regenerate for about a year. But this does not mean that during this entire period you will be bedridden and look like a mummy.

During the normal course of the operation, you may only need bed rest for the first day, and then you will go home to recover. Although the “savings regime” will need to be observed in the first month. There is no point in describing the recovery period by day. But we will highlight the main stages:

early postoperative period (until the patient recovers from anesthesia);
period of suture removal (this process normally takes place on the 5th or 7th day);
after 20-25 days you will say goodbye to swelling;
after 60 days, the pockets for your implants will be fully formed, and you will be able to evaluate the preliminary results of your and the doctor’s efforts;
after 90 days you will be able to enjoy the final version of your bust;
after 183 days you will already be leading your usual lifestyle, all feelings of discomfort will leave you and you will begin to forget that your breasts have additional foreign inserts;
after 365 days, complete recovery will occur, and you can think about procreation, if this topic is relevant to you, the sea breeze and a full-fledged sports rhythm of life.

Under a muscle or a gland? This question arises in every patient, and with this she comes to the doctor. Each of these methods has its own advantages and disadvantages.

Installation of an implant under the gland

When the implant is placed under the gland, it is placed in the space between the gland and the pectoralis major muscle.

In this case, the implant is covered only by skin, subcutaneous tissue and gland tissue. In this case, the muscle is not touched. The implant is installed under the gland, and only the gland tissue and subcutaneous fat cover it on top.

What are the advantages of this method?? The next day, the patient calmly goes home, there is practically no pain, and the use of painkillers is not even required. Heals quite quickly, well.

What are the disadvantages? For thin patients, this method is unacceptable; the thickness of the soft tissue is very small and the implant can be felt in some places. If the patient is ready to take such a risk, then an implant can be placed under the gland; if she is not ready, then another method must be used.

Installation of an implant under the muscle

When the implant is placed under the pectoralis major muscle. In this case, everything looks a little different. In Fig.2. The implant is covered by the pectoralis major muscle, on top of the gland. In this case, in addition to the fact that the implant is covered by gland tissue, the pectoralis major muscle almost completely covers it.

This is essential coverage that minimizes the risks of contouring top and bottom. The likelihood of implant contouring is reduced to a minimum.

What are the disadvantages of this method?? It's quite painful. Installing an implant under the muscle causes it to stretch, and this, in turn, causes severe pain. Here you can no longer do without painkillers.

Let's ask a question: if you place an implant under the gland, will the breast look more natural?

This is not entirely true. Let's look at patients who are suitable for a submammary implant location and those who are suitable for a placement strictly under the pectoral muscle.

If the patient is thin, there is not so much soft tissue, so if you place an implant under the gland, there is a high probability that after six months or a year the implant may begin to contour in the upper part and on the sides, that is, its edge will simply be noticeable.

If the patient has a fairly large mammary gland, a dense build with good tissue elasticity, but there is ptosis (drooping) of the mammary gland, in this case it is necessary to install an implant under the mammary gland, it will fill it well, and the thickness of the soft tissue will not allow the implant to be contoured.

When choosing a method for installing an implant, you must remember that everyone’s idea of what beautiful breasts are is different.

Breast augmentation standards in the world

For example, in Brazil and the USA, they prefer to install implants under the mammary gland; Americans and Latin Americans love fairly pronounced breasts, voluminous, with an upper pole, and they often say that they do not place implants less than 500, but only larger ones.

Breast augmentation in Russia

In Russia and Eastern Europe, patients ask for the volume to be reasonable, so that it looks quite natural, the breast size should fit the figure. And in this case, installation under the gland will not be suitable; it will be necessary to place it under the muscle so that the implant is not visualized and the breast has the most natural shape possible.

There is also the opinion of patients, and even doctors, that installing implants under the muscle does not give anything at all. Because by installing an implant under the muscle, the surgeon damages the muscle: when an incision is made into the pectoralis major muscle, for example, from below, the muscle goes upward, i.e. rises to a fairly large distance. Thus, muscle function is lost, or at least impaired.

How is breast augmentation surgery performed?

It all depends on how to lift this muscle. The muscle fibers are attached from above the clavicle from the inside to the sternum and from below to the costal arch. The implant should be located under the pectoralis major muscle. The implant is inserted through a small hole under the breast. If a muscle is roughly cut off, of course, it can contract and rise, and this is extremely undesirable.

But if the muscle fibers are carefully separated from below, an implantation pocket is formed under the pectoralis major muscle, and then the muscle actually remains in its place, without moving anywhere. In this case, the mobilization of the pectoralis major muscle is carried out correctly.

What are the methods for installing implants?

Many have heard that there is a method implant installation in two planes. In fact, this method is no different from installing implants under the pectoralis major muscle, the only difference is that the pocket is made in this way: first, an incision is made under the mammary gland and the gland tissue is separated above the pectoral muscle, thus forming a pocket in the first plane (under the gland). The level of this pocket, depending on the degree of ptosis of the gland, can be from 2-3 cm above the inframammary fold to the upper edge of the areola. Then a full-fledged pocket is formed in the second plane under the pectoralis major muscle. That’s why the method of creating an implantation pocket in two planes is called.

In fact, this is the same submuscular implant placement discussed above. The only difference is that the gland is mobilized slightly higher, not just 2-3 cm away from the submammary fold, but up to the level of the areola. This is done so that the surgeon has the opportunity to move the tissue, both the pectoralis major muscle and the gland, relative to the implant. This allows you to achieve maximum natural breasts after surgery. This is a more advanced method.

I think the opinion that with the two-plane implantation method the pectoralis major muscle is cut off almost to the middle, and only the upper part is covered by the muscle, is at least not entirely true.

conclusions

Now you know the main methods of installing breast implants, each of which has its own pros and cons, each has its own indications and contraindications.

To decide on the option of installing implants, you need to come for a consultation, weigh the pros and cons, tell the surgeon about your wishes and make a decision based on this.

The decision to undergo mammoplasty for most women is motivated primarily by the desire to increase breast size. An important point is the choice of one form or another of the mammary gland. But the shape of the future breast depends not only on the type of implant, but also on the method of its installation.

How does the shape of implants affect the appearance of the breasts?

To understand this, you need to know that a woman’s breasts and implants interact with each other and press on each other. The mammary glands already have their own specific shape, and the degree of natural softness and elasticity varies with the same characteristics in breast implants. All these indicators affect the appearance of enlarged breasts. However, not only the type of implant and the natural shape of a woman’s breast determine the future result. The choice of implant installation method also plays an important role: above the pectoral muscle, above the mammary gland. Only experienced surgeons can put all these factors together and predict the final appearance of the operated breast.

Implant installation methods

Submuscular (installation of implants under the pectoral muscle);
Subglandular (installation of implants under the mammary gland);
Subfascial (installation of implants under the fascia of the pectoralis major muscle).

Let's look at the features of each implant location.

Method of installation under the mammary gland

The recovery period when installed under the gland is easier and faster

This method is not very suitable for women with small breast volume. The implant will be palpable and may be visible visually. But the main disadvantage of this method is the possibility of complications in the form of fibrous capsular contracture and loss of nipple sensitivity. But in addition to the disadvantages, this method also has advantages.

Advantages:

The pectoralis major muscle is not affected, resulting in a shorter recovery period, which passes with little or no pain. Swelling is also minimal, the mammary glands take their final shape in a short time;
During physical activity, an implant installed in this way does not deform or move;
The subglandular method makes the breasts appear fuller.

Flaws:

Capsular contracture is possible;
If a woman's breast skin is thin, there is little fatty tissue, and there is a lack of breast tissue, the implants may be visible and palpable;
The skin around the implant may develop irregularities in the form of ripples and waves;
Due to the lack of muscle support, large implants can stretch the skin and make the breasts sag;
The risk of infection and loss of sensitivity is higher;
The appearance of stretch marks on the chest;
Difficult blood supply;
Breast asymmetry may appear.

Installation of implants under the gland is well suited for trained women

Plastic surgeons do not often choose the over-the-muscle method, but it may be ideal for women who have enough breast volume to cover the implants, have ptosis but do not want a lift, have scarring or degeneration of the pectoral muscle, or have strong muscles from weightlifting. or bodybuilding (trained pectoral muscles can distort the implant).

Valery Yakimets comments:

Leading plastic surgeon, candidate of medical sciences, doctor of the highest category, full member of OPREH.

There is no perfect way to enlarge breasts. Each installation method has its own advantages and disadvantages. For example, when implants are placed under a muscle, the shape of the breast may be slightly distorted when it is tense. If installed under the gland during physical activity, the shape will be more natural. But implants put pressure on the mammary glands from the inside, they become thinner and atrophy, and the implants can become deformed. If breast augmentation under the gland is performed on a female athlete, then the implant will most likely be visible.

Method of installation under the pectoralis major muscle

When the implants are placed submuscularly, they are completely covered by muscles. This method at one time became an alternative to the subglandular one. However, this method also has a sufficient number of significant disadvantages: increased trauma, difficult recovery period, and when the pectoral muscle is loaded, the chest can become distorted and deformed. If implants are placed incorrectly under the pectoral muscle, they may subsequently become dislodged.

Advantages:

The implant is completely covered with muscle (this is suitable for women with breast deficiency);
The implant subsequently remains completely invisible and imperceptible;
Minimal risk of capsular contracture.

Flaws:

Not the most natural result;
The density of the muscles covering the implants prevents the desired size and height of the breast from being achieved;
Deformation and (or) displacement of implants during contraction of the pectoral muscle.

Plastic surgeons do not often use this installation method in their practice.

Method of installation under the fascia of the pectoralis major muscle

Surgeons consider the method of installing an implant under the fascia of the pectoral muscle to be the most optimal

The imperfections of installing implants using the above methods have led to the emergence of an optimal method. Complete implant coverage without the risk of deforming the mammary glands has become a possible subfascial method. Fascia is a well-defined layer, a soft layer between the implant and the skin, under which the edges of the implants will not be visible and the pectoralis major muscle will not be injured. The fascia holds the endoprosthesis tightly.

By placing the implant along the fascia, the breast will not be distorted during contractions of the pectoral muscle. Implant displacement is also virtually eliminated. When installing implants using the subfacial method, the result is natural and harmonious. The fascia helps to increase the elasticity of the overlying tissue and reduces the visibility of the edges of the implants.

The subfascial method is used for breast augmentation using various approaches:

Axillary;
Subglandular;
Periareolar.

This is the method that most specialists use for augmentation mammoplasty.

Advantages:

Maximum natural look, breast transition is smooth and smooth;
The risk of developing capsular contracture is reduced;
Fascia supports the implants and prevents them from sagging;
During physical activity there is almost no risk of implant deformation.

Flaws:

Postoperative pain;
Long recovery period;
Displacement of the implant over time (with loose breast skin).