Methods of installing implants. Installing a breast implant under the muscle: what is important for a surgeon to know How to install breast implants

In recent years, the demand for breast augmentation plastic surgery has increased dramatically. Today this direction in aesthetic medicine can be called one of the most popular. Plastic surgeons have many techniques, approaches, and types of implants in their arsenal. If a specialist uses these capabilities correctly, a good result is guaranteed.

Implant location: advantages and disadvantages

The implant can be installed under the mammary gland, subglandularly, it can be installed under the fascia of the pectoralis major muscle, subfascially, or under the pectoralis major muscle, submuscularly. To achieve the most natural result, a breast implant must have adequate coverage of soft breast tissue. If this criterion is not met, the edge of the implant may be visible or even felt.

Disadvantages of installing an implant under the gland: palpation, fibrous capsular contracture, impaired sensitivity of the nipple, waves.

Placing a breast implant under the gland has significant disadvantages, especially when the thickness of the soft tissue of the gland is not sufficient to adequately cover the implant. In addition to visualization and palpation of the implant, when installed under the gland, complications such as fibrous capsular contracture, waves, and impaired sensitivity of the nipple often occur. Placing an implant under the pectoralis major muscle has become popular after it was found that it avoids the disadvantages associated with placing an implant under the gland.

The disadvantages of installing implants under the pectoralis major muscle include that the operation is more traumatic - the postoperative period is more difficult than when installing an implant under the mammary gland, and when the pectoralis major muscle contracts, the breasts can become flattened or even deformed. If surgical techniques on the pectoral muscle are not performed correctly, the implant may move upward or downward and outward.

The correct solution to the problem of obtaining a sufficient amount of soft tissue to cover the implant without deforming the mammary glands during contraction of the pectoralis major muscle in the postoperative period is to install the implant under the fascia of the pectoralis major muscle. The pectoralis major fascia is a well-defined layer that can be used to prevent the edge of the implant from being visible under the skin, without damaging the pectoralis major muscle, it remains intact, and the implant is completely covered by soft tissue. The fascia securely covers the implant. When installing an implant under the fascia in the postoperative period, the breast will not be deformed when the pectoralis major muscle contracts. Complications such as displacement of the implant due to contraction can also be avoided.

Endoscopic breast augmentation through the armpits allows you to avoid scars on the mammary gland.

The purpose of placing an implant under the pectoralis major fascia is to achieve a beautiful, natural-looking breast shape. Fascia is an additional soft tissue layer between the implant and the skin; in addition, it increases the elasticity of the integumentary tissue, thereby reducing the degree of visualization of the implant edge.

Breast augmentation, while installing an implant under the fascia of the pectoralis major muscle, can be done through access in the armpit, transaxillary, in the fold under the breast, submammary, or along the lower edge of the areola, periareolar, which depends on the wishes of the patient, her anthropometric characteristics and the number of pregnancies .

Endoscopic breast augmentation through the axillary approach is ideal for women with small breasts, as well as for women with loose skin, but without ptosis of the mammary glands. The advantage of endoscopic breast augmentation through the axillary approach is that it allows you to avoid scars on the mammary gland.

Access in the crease under the breast allows for the placement of larger implants. During breast augmentation through an axillary approach or through an approach in the crease under the breast, the mammary gland parenchyma is intact. For patients with minimal breast sagging or areola ptosis, the areola approach is suitable.

Postoperative care

After breast augmentation, it is recommended to wear special compression garments for 1 month. If endoscopic breast augmentation was performed through the axillary approach, it is recommended to wear a pressure elastic bandage in the area of ​​the upper slope of the breast for 10-14 days, which will help keep the implant in the correct position. After one month, hand movements are fully permitted.

Possible complications

One of the complications of breast augmentation is implant displacement. Downward displacement of the implant may occur in patients with loose skin. Upward displacement of the implant is typical for endoscopic breast augmentation through the axillary approach. Other complications: capsular contracture, hematoma, decreased sensitivity, asymmetry of the mammary glands, seroma, infectious complications are rare. After conducting research, plastic surgeons came to the conclusion that the fewest complications occur when installing implants under the fascia of the pectoralis major muscle.

conclusions

Installing an implant under the fascia of the pectoralis major muscle during breast augmentation allows you to create a natural breast shape and ensures good tissue coverage of the implant. In addition, the fascia of the pectoralis major muscle eliminates the possibility of damage to the implant when the pectoralis major muscle contracts. The incidence of complications does not exceed that when using other methods of installing implants for breast augmentation. Compared to placing an implant under the pectoralis major muscle, the subfascial technique creates a better breast contour and the result is more natural looking. The incidence of long-term complications, for example, capsular contracture, characteristic of subglandular implant placement, is significantly lower when using this technique.

Mammoplasty in our time has turned from an exotic and risky operation into almost an ordinary cosmetic procedure. Despite this, breast plastic surgery raises no less questions, and perhaps even more, than 10 or 20 years ago: medical technologies are changing rapidly, doctors are offering more and more options for correcting aesthetic defects.

We shared our siblings’ thoughts and doubts with Olga KULIKOVA, a specialist in mammoplasty, plastic surgeon at the Euromed Clinic multidisciplinary medical center, Candidate of Medical Sciences, and asked her to answer the most pressing questions.

Breast anatomy: a small educational program

So, at the base of our chest lies the pectoral muscle. These are two peculiar muscle “fans” running from the sternum to the left and right - to the large tubercles of the humerus. Located above the muscle ( and it is attached to it) mammary gland - this is where the milk that we feed our babies is produced. Its size is approximately the same for most women, and we owe differences in breast size and shape to the fat layer that surrounds the gland.

Not all women are happy with their breasts; To some, she seems too small, “boyish”, and their full-breasted friends eventually begin to suffer from the effects of heartless gravity, uncompromisingly pulling the mammary glands to the ground. So there are probably no women who are not interested in mammoplasty in principle.

Excellent silicone: another little educational program

When the potential owner of luxurious silicone breasts begins to wonder about the prospects for her future happiness, she discovers that “everything is complicated.” Silicone implants can have the anatomical shape of a drop or a perky hemisphere. They differ in filling - they can be “filled” with silicone gel to the eyeballs or only 85%. And also the width and height of the base ( width and projection), as well as height above chest level ( profile). The implant can be installed under your own mammary gland, under the pectoral muscle, under the fascia ( “inside” the pectoral muscle), as well as under part of the muscle. Finally, the surgeon must decide where to make the incision: under the breast (in the inframammary fold), under the armpit, or along the contour of the nipple ( periareolar approach).

There are so many options that your head is spinning - which is better? What will bring you closer to the desired result? What will you (and not the surgeon?) like? Let’s figure it out!

Where to cut and where to put

Siblings' opinion:

A friend had her breasts done through her armpit, she was bent over in pain for a month, she couldn’t do anything, and she was so surprised that I (under the breast access) didn’t have any pain, that’s what different access means.

Olga Vladimirovna, does the access site really play a fundamental role in the pain and duration of the rehabilitation period?

No, that's not true. The main role is played by the location of the implant - under the mammary gland or under the muscle. Installation under the pectoral muscle is always painful, and it does not matter whether we install the implant through the nipple, under the breast or from under the arm. It’s just that the axillary approach is designed specifically to “dive” under the head of the pectoral muscle, so it always causes discomfort.

- So is it worth the pain and putting an implant under the muscle?

Indeed, when an implant is installed under the mammary gland, everything heals quickly, often after a day there is no longer any pain - a very short rehabilitation period. The breasts immediately become soft and look very natural, but... But an implant, especially a large one, has weight. And when installed under the gland, only your own skin will hold it. But no one has canceled the laws of gravity - are these breasts artificial or natural...

” - The larger the implant, the faster it descends. If we install it under the muscle, then it will descend 10 times slower.

Of course, a lot depends on the tone of the muscles: for some they will hold the implant until they are 80 years old, but for others it’s like a rag; there was no point in installing it under the muscle. In such cases, I always warn the woman that she can only go without underwear on major holidays.

Opinion of siblings

An anatomist placed an implant under the gland. Three years later, the breasts are full, but saggy. It was necessary to choose access under the muscle!

A medium profile is normal, a high profile, they say, there is a greater chance that it will sag even with installation under the muscle due to the fact that it protrudes forward strongly, and the part will still sag.

- Is this the only reason for installing an implant under the muscle?

No, not the only one. The implant looks good when it is covered with as much of its own tissue as possible. When a girl comes in who, apart from skin, has nothing to cover it with, then this is an absolute indication for installing an implant under the muscle - then it will not be contoured.

- That is, we put everyone under the muscle?

There is a group of women for whom, on the contrary, it is better to have an implant placed under the mammary gland. This applies primarily to female athletes: body fitness, bodybuilding, powerlifting... in a word, to girls who actively work their pectoral muscles. With heavy physical activity, the muscle can contract and dislodge the implant.

” -On the other hand, in 18 years of practice, I have only seen implant displacement twice - this happens extremely rarely. I even had a patient who was a world bodybuilding champion. We placed the implant under her muscle, because before the competition it “dries out” so much that the muscle is drawn very clearly; the implant would be too noticeable. In preparation for competitions, she works out with heavy weights, but, as she said, “the main thing is to do everything smoothly,” and the implant stays in place!

But even if it shifts, nothing terrible happens. It is promptly put in place, the pocket that has stretched is sutured.

Your breasts are still swelling!

Opinion of siblings

There is no point in putting a high profile under the muscle - it will be flattened by the muscle.

390 will not be enough, I’ll tell you right away. The muscle will be pressed and the chest may not be very lush, and if you really set it, then from 450...

To stand, you need a high or extra-high profile, and that’s the only way. With medium and medium + 450 they will lie.

Olga Vladimirovna, but the muscle contracts, is it possible to get high and voluminous breasts by installing an implant under the muscle?

The muscle actually flattens the implant first, this is normal. After all, in its natural state, the pectoral muscle lies on the ribs, and when we put something under it, it contracts and resists. But over time, the muscle stretches; there is also an expression - “the breasts have swollen.” The muscle will “release” the implant and the breast will take its final shape. But this will have to wait from two months to a year - we make sure to warn all girls about this.

- And installation of an implant under the fascia ( connective tissue membrane that forms a kind of “case” for the muscle) - what are the advantages of this method? Perhaps the “fluffing” process will go faster?

I don’t see any point in separating the fascia and injuring the gland. There was such an experiment, this is a fairly young science - mammoplasty has been practiced only since the fifties of the last century. Today, it seems to me, everyone has already abandoned fascia.

Opinion of siblings

The implant is attached somehow cunningly, I remember in the picture, it’s difficult to describe. In general, the implant can move if it is hidden completely under the muscle from top to bottom, but if it is half attached to the muscle and part of it is under the gland, then everything is ok. The implant grows into the muscle as usual and stays in place without any displacement. In addition, the doctor also attaches it in two places additionally under the muscle there, so that everything grows calmly and takes root as perfectly as possible.

- What about the partial installation under the muscle, which is being talked about a lot now?

The pectoral muscle never completely covers the implant - this is anatomically impossible. But there is a very wide pectoral muscle when most of the implant ends up under it. To make the breast softer and more natural, we partially remove the implant from below above the muscle. There is no need to cut the muscle itself - we simply move the fibers apart, making literally two or three cuts. But, as I mentioned, even if most of the implant is covered by muscle, it will still expand over time.

- Should we expect surprises in a year - maybe the breasts will “swell” in the most unpredictable way?

No, the result is always exactly predictable. I have 4-5 mammoplasties a day, and when a girl comes into the office, I immediately remember patients with a similar anatomy, with the same rib hump, and show her photographs: this was what happened, this happened - what do you like? This is such and such an implant, such and such a size. Sometimes, on the contrary, I ask the patient to bring a photo of the breast that she likes. And, looking at the photo, I can always say: this is an anatomical implant installed under the muscle, high profile. This is a round implant installed under the gland... But I will never be able to do this for you, because you will not have enough skin or gland to cover the implant, it will look like a caricature. Such visualization gives a complete picture of the results of the future operation.

- Could something go wrong, for example, noticeable asymmetry of the nipples?

Asymmetry cannot arise due to the operation - if a symmetrical person comes to us, where does it come from? But if there was asymmetry, then it is emphasized by installing the implant. And this issue must be discussed before the operation! After all, there are women who believe that they have lived with such nipples for many years, and will continue to live, they don’t see anything wrong with it. For others, it is important that the nipples are positioned strictly symmetrically.

Doctor, don't be shy, place the balls!

- Is there a fashion for the shape and size of breasts?

Nowadays they often ask for a natural shape. Those who installed “balls” in the 90s are now going and removing them, even downsizing and tightening them. Now they are asking for the first size! There are very beautiful anatomically shaped implants that are carefully inserted through the areola under the muscle. The seam is then masked with tattooing, and no one will ever guess that there is something “not our own” there. The shape is simply fantastic, it turns out very beautifully!

” - But, of course, there are still girls who say: “Doctor, forget about naturalness, I need balls!” Don’t be shy in terms of volume or size, as much as you like - to the fullest!” Everyone has their own ideas about aesthetics.

- That is, you can “order” any size?

No. There are very precise markings, calculation formulas, and if the surgeon says that more than 400 ( milliliters - they measure the volume of implants) won’t fit, then you shouldn’t beg him, beg him and wait for a miracle to happen. There are weak-willed surgeons... It seems to me that it is especially difficult to refuse male surgeons; beautiful girls come! Some bend, but this is fraught with problems for both the surgeon and the patient. I refuse those who don’t hear me, and then, when someone is “bent in”, they come to me with problems...

Speaking of problems...

Well, while we're on the subject, let's talk about possible complications. Many women would like to reduce the distance between the mammary glands as much as possible for the “seductive cleavage” effect. Is this possible?

Well, nothing is impossible if you have a sharp instrument in your hands, but it is not physiological. The distance between the breasts is due to the fact that the muscle is fixed at the edges of the sternum bone. Sometimes patients are greedy and ask for more implants than the body can accept. And then, instead of a seductive cleavage, this platform rises, the pockets into which the implants are inserted are connected into one. This complication is called synmastia. My patients didn’t have synmastia, but they came from another clinic and asked for correction... I don’t like to correct after other surgeons, and sometimes it’s impossible to correct everything.

- So, no cleavage?

You just need to be patient. At first after surgery, it is impossible to close the breasts even with your hands, but then the muscle relaxes, stretches and “releases” the implant, and the distance between the breasts decreases. In a year you will achieve the desired shape.

- What about the “double bubble” effect, when the implant stands out, as if a woman has double breasts?

It occurs in two cases: the first option is when the implant “slides” below the inframammary fold, and the second option when the surgeon deliberately lowers the inframammary fold. There is a so-called restrictive type of breast structure, when the distance from the nipple to the inframammary fold is small. If you insert an implant, the nipple will be completely under the breast. Then (after discussing all the risks with the patient), a periareolar breast lift is performed, the nipple is raised as high as possible, and the implant is placed as low as possible. There is a danger that the border between the implant and the own gland will stand out as a second inframammary fold, but there is nothing more to be done here.

Opinion of siblings

My gland is slipping off the implant, the border is clearly visible. It had to be placed under the muscle.

- The anatomist suggested a high profile and... how to put it correctly... in general, wide implants, that is, the base, the back part - a diameter of 13 cm, was calculated on me. In order to “flatten” the chest in all directions and remove all the sagging as much as possible, I have some of my own material, the size is not zero.

- What if it’s not the implant that “slips,” but the mammary gland?

And this is the “waterfall effect”. Those who initially have ptosis are at risk ( breast prolapse), for example, after breastfeeding. In this case, the surgeon explains that without a lift ( incision around the areola and vertically down, from the nipple to the inframammary fold) not enough. But... “I’m not like that, I’ll be fine, I don’t need a lift.” The surgeon places the implant under the muscle, hoping that the mammary gland, contrary to the law of gravity, will happily climb onto this muscle. Sometimes, when a large implant is installed, this is possible. But, as a rule, with a pronounced degree of ptosis, we cannot set the volume to 600, but set, for example, an acceptable 300. They stretch the muscle, and the mammary gland sadly hangs down from it. Don't be afraid of a lift!

Opinion of siblings

You cannot insert a small implant under the breast, for example 300, especially if the breast is not damaged by feeding several children. The breast will not cover the mammary fold and the seam will be clearly visible.

It is best to insert through the armpit, where the skin is different, the seam heals most easily and becomes invisible.

- Can stretch marks appear on the breasts during mammoplasty?

Never! Stretch marks are always caused by hormonal levels. They appear during puberty, not only in girls, but also in boys, and not only on the chest, but also on the stomach, on the thighs, under the arms... And the second period is pregnancy. And not because the breasts are growing, but because the body is undergoing hormonal changes!

” - There are women who have more elastic fibers than collagen, and they will inevitably develop stretch marks, no matter what creams they use and no matter what cosmetic procedures they resort to. Alas, an entire industry is working to deceive them!

But nature never takes away without giving something in return. Such a patient always develops very invisible sutures: you can cut her either lengthwise or crosswise, and after a year you will no longer find any traces of the suture.

- And what is pain and swelling during the rehabilitation period - what is the norm, and what is already a complication?

Swelling is a normal post-traumatic reaction. What is pain syndrome? The swollen tissues compress the nerve endings, so this is also normal and physiological. Not only the chest swells: due to gravity, the edema descends through the cellular space down to the front wall of the abdomen - this is also normal. It lasts for at least 10 days, but usually up to two months. Some people have pastiness ( slight swelling) lasts for a year!

” - Moreover, patients after surgery are prone to swelling at the site of surgery. That is, if you drank alcohol the day before, the first thing that will swell in your morning is your breasts if you had breast surgery, your eyelids if you had eyelid surgery, and your stomach if you had an abdominoplasty.

And so on for a year, until blood circulation is restored! You need to be careful - less salty, spicy and alcohol at this time.

Another complication that is often mentioned is contracture, the formation of a layer of dense connective tissue around the implant, which causes the breast to become rock-hard...

I haven't encountered this for a very long time! Contractures often occurred in the past when implants had a smooth surface. Since we started working with textured implants ( "velvet") surface, this problem simply disappeared - fibroblast cells “cling” to such a surface, and the body does not perceive the implant as a foreign body and does not try to isolate it with a dense capsule of connective tissue ( and it can be as hard as cartilage, you can’t even cut it with scissors). It happens that patients come in who had an implant placed somewhere at the dawn of the era of mammoplasty, 20 years ago, but in this case nothing terrible happens. We remove the implant, remove the contracture, install a new implant, but of a larger size, since the contracture “eats” part of its own tissues.

And another “horror story” is the rupture of the implant, when the silicone “scatters” throughout the body. Is it true that this happens with implants that are not completely filled - folds can form on their surface that are easily “worn”? Maybe a filled implant is better?

We mainly use implants filled to 85%. They are softer and look more natural. But it happens that a girl has so little covering tissue that even installation under the muscle does not save the situation. In this case, minor folds on the implant can contour and become noticeable even through the skin. In this case, it is better to opt for a fully filled implant.

” - As for implant rupture, this is a very rare complication that I see once or twice a year. And the reason for it is not folds, but the bending of the implant, when a too small pocket was formed under it, in which it could not straighten out completely. It is this bent edge that can cause a rupture.

But even in this case, nothing terrible happens, since modern implants do not spread: the molecules are stitched together with chemical bonds, and the filler resembles jelly. We simply take out the old implant and insert a new one. By the way, this is free for the patient, because each implant has a lifetime guarantee!

Interviewed by Irina Ilyina

This is already beyond good and evil. A provincial woman, who herself has not undergone breast enlargement surgery, sells cheap silicone sisto to suckers in the hope that two farrier surgeons will supply her with the same thing, but at a discount.

Disregarding all standards of decency, this scum with stupid aplomb declares something that makes even the cynical me’s hair stand on end.

For example, that all physical restrictions are removed one and a half to two months after the operation. After this time, you can do chest presses, push-ups, and otherwise load the pectoral muscles. As a killer, he gives an argument: if this were not so, not a single fitness professional would do breasts.

Fitnessists indeed often resort to breast augmentation surgery, but, as a rule, they place implants under the mammary gland, and not deeper - under the muscle. Implants installed under the muscle “wear” more reliably, with them the breasts look beautiful and natural and are pleasant to the touch. Implants installed under the mammary gland:

a) very noticeable visually,

b) palpable,

c) “walk” under the skin when you move.

But in a push-up coat and a sports bra they look more or less tolerable.

These photographs clearly show what breasts with implants installed under the glands look like:

Pay attention to how the implant installed under the gland “walks” on the lady in the red bra.

On the other hand, this method of installing implants actually completely removes restrictions on physical activity. Since the pectoral muscles do not put pressure on the implants, they can be pumped. If the implant is under the muscle, and you pump it, the muscle begins to compress the implant. Breasts harden. There may even be a rupture.

I repeat again: when I asked my surgeon whether I could put pressure on my breasts, he replied: “Well... My wife doesn’t touch my breasts.” His wife is all about fitness no less than me. Initially, the doctor, knowing my workload, suggested installing an implant under the gland, but honestly warned: it would be ugly. I chose beauty, sacrificing physical fitness.

Finally, understand: this will not happen without sacrifices. Don't be fooled by the cynics.

My victims:

1) You can’t train your chest. At all. Never.

2) After the operation, my face aged by 5 years, or even 10. This is not a trip to a beauty salon, this is an operation under anesthesia, which ages, and whatnot. I had to restore my face, but fortunately I have every opportunity to do so. Do you have them? If you have saved up a ton for surgery, keep in mind that you will need at least a third of this amount to restore your face.

Here is a very honest photo illustrating how my face wrinkled and sagged after the operation:

And here's what it looked like a few days before the operation:

Now here it is:

I had to invest heavily to solve the problem. And these were not masks at home and massages from a cosmetologist “in the area.” This is actually a third of the cost of the operation. And this is in America.

3) Sensitivity seems to be restored, but not what it was before. Maybe it will come back completely, maybe not. Don't forget: they cut you to the quick there. No one knows what remains there and what will happen.

Well, I won’t even talk about the fact that sleeping on your side is uncomfortable, and on your stomach is impossible: compared to what I experienced, these are trifles. I will say one thing: when you lie on your stomach, you can really feel the implants. This is a very unusual and uncomfortable sensation.

And most importantly: if you are an ugly person with short legs, a terrible fuck or a fat ass, no silicone tits - don’t let “made in the USA” decorate you. And “made in Russia” will also cripple you.

Well, one last thing! Turn on your brains for at least half a minute, damn it, and think: if you have a foreign body in your chest, does it affect breastfeeding? If the incision goes through the nipple, does this affect breastfeeding? Yes, it does. How does it influence? Bad influence. Ovulyashki, do not believe those who say otherwise. I am an ideological childfree, a terrible egocentric, and I don’t want to waste my precious life serving another creature. If I left myself even the slightest chance of childbearing, I would not get implants.

Questions?

UPD. I take away an important question from the comments: “And if the pectoral muscles weaken, will the boobs sag?” I give the answer: “They will weaken in any case, and correction will be required. Implants are not installed once and for life. Do not believe those who say otherwise.” /lj-cut>

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.

One of the main factors determining the quality and durability of the result of the most popular plastic surgery today (breast augmentation) is correct choice of anatomical layer for the silicone implant being installed.

Of course, a large number of factors are first determined to decide which of the four options is optimal.

What indicators does this choice primarily depend on:

1. position of the mammary glands on the chest wall. It can be congenitally high, medium and low;
2. the presence or absence of acquired mastoptosis (prolapse of the mammary glands), its degree;
3. characteristics of the skin and subcutaneous tissue: thickness, elasticity, presence or absence of stretch marks;
4. severity (thickness, area, elasticity, anatomical features) of the pectoralis major muscles;
5. presence of deformation of the sternum and ribs.

Under the gland

Under the fascia

In 2 planes

Under the muscle

So, what are the main points that the surgeon and the patient should take into account when they decide to install an implant under the muscle during breast augmentation:

1. This method can be used in all cases where the patient has intact pectoralis major muscles;
2. This method cannot be used in the presence of ptosis (drooping) of the breast, unless this problem is solved surgically (endolifting or breast lift);
3. Both the surgeon and the patient should know from the outset that a good long-term result is always achievable, but the rehabilitation period in some cases can be extended, sometimes twice as long. That is, if after other options the desired result comes in 1 month, then here in 2. And for this you will need to do a special exercise 8 minutes a day;
4. When choosing implants, there is no point in using anatomical teardrop-shaped implants (except in special cases). Otherwise, the very shape of the implants will hinder rapid rehabilitation;
5. It is absolutely NOT possible to use fixed implants (macro-textured or polyurethane). This may cause some problems.

Over 20 years of installing an implant under the muscle in more than 1000 patients, in all cases a good long-lasting result was obtained. All patients who had previously had experience wearing implants under the gland or in two planes noted that after surgery using a full myofascial pocket they began to feel more protected. Most patients no longer feel the implants as something separate, constantly reminding them of themselves. Look