Breast augmentation 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 placed under the breast 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 reduces the recovery period, as the muscles are not injured.

However, this method has its drawbacks:
– the implant is easily determined by touch;
- it is difficult to achieve a clear image with mammography;
- the breast after the operation does not look quite natural;
- high risk of fibrous capsular contracture - the formation of dense fibrous tissue around the implant.

Breast Implant

The implant is partially located under the pectoral muscle - approximately 2/3. Part of the implant is closed 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 pictures during mammography. Minimal risk of capsular contracture.

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

Breast Implant Revision: Problem Solving

Revision of implants solves the problems that have arisen after breast augmentation surgery. It corrects the size, location, surface or asymmetry.

It is believed that breast augmentation is an easy procedure to perform, but it is not. The right technique and attention to detail is the key to a good result. But often this is neglected, which leads to complications. As in 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
- don't like the feeling in the chest;
- the chest looks unnatural.

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

Related publications:

Submuscular location of the implant (partially under…
Subglandular location of the implant (in front of…
Breast enlargement changes before, during and after…

The breast does not change its 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 attempts and efforts, its shape still changes, even if the gland is small. There is no escape from this for every woman. Therefore, it is necessary to make a decision about breast plastic surgery (mammoplasty). It should be noted that among the patients of aesthetic surgeons who decide to resort to mammoplasty, there are many young girls who want to increase the volume and shape of their breasts. At the same time, the surgeon should strive to ensure that it looks as natural as possible, both to the touch and in appearance. Experts, after conducting a series of studies, found that most often mammoplasty is preferred by women aged from eighteen to thirty-thirty-five years.

Having come for a consultation with a surgeon, you need to find out in detail about the procedure for mammoplasty. He, in turn, will take into account all the wishes of the patient, which will allow them to choose the method of surgical access, the type and shape of the implant together. Without fail, all patients before mammoplasty must be photographed.

Most often, augmentation mammoplasty is performed using periareolar access (the incision is made along the areola), submammary (under the mammary gland) and axillary (less commonly 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 in the future to resort to lactation without any problems. In the latter, axillary access is more often used to place a 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 passing along the border of the nipple, where the light and pigmented skin is located, remains invisible (the wound is not sutured, but glued with special glue). An implant can be placed under the muscle when enough tissue is seen.

The advantages of this method of placing an implant in 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 detectable as the muscle covers the implant.

The disadvantages of this method include:

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

It also happens that during this mammoplasty, the prosthesis can 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 carry out such a mammoplasty, so the submammary method is used.

Mammoplasty under the gland

Submammary access in mammoplasty allows more precise and symmetrical formation of the pocket for the implant and makes it possible to better stop bleeding. In this case, the pocket will be formed in the interfascial space, which is limited by the own fascia of the mammary gland and the leaf of 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. Muscles when performing such access during mammoplasty are not damaged. 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 setting the 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;
if ptosis (breast prolapse) 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 in the future;
an increased risk of capsular contracture;
breasts after such mammoplasty will look unnatural.

Mammoplasty under the muscle

There is also a two-plane arrangement of the implant during augmentation mammoplasty. So, the lower part of the prosthesis will be located under the tissue of the gland, and the upper part under the muscle. The positive aspects of this method are good because the chest looks quite natural.

The disadvantages of this method are:

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

A rare method of placing an implant is to insert it under the fascia of the pectoralis major muscle, but in principle, this method practically does not differ from the location under the gland and only some surgeons use it.

The choice of implants for mammoplasty

When performing augmentation mammoplasty, the choice of implants is very important. Indeed, depending on what type of prosthesis will be - anatomical or spherical, its location may also depend. Spherical high-profile implants are used for those women who have a pronounced prolapse of the breast. With mammoplasty in this situation, the prosthesis is placed under the pectoralis major muscle. When the prosthesis is located under the large 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 eventually create a more real breast and is usually installed submammary (under the gland).

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

We welcome readers on our website who are interested in mammoplasty, the advantages of prosthesis implantation under different structures in the breast area (muscle, gland, fascia), and implants that are preferable to use for such operations. Today we will talk about what is mammoplasty under the arm, the advantages and disadvantages of the procedure.

The opinions of plastic surgeons regarding the preferred method of installation are ambiguous:

some of them consider it the best option to install them under the muscle, when the tissues cover almost the entire prosthesis, with the exception of its lower edge;
other surgeons prefer a mixed method of implantation of the prosthesis: partly under the muscle, partly under the gland;
still others consider the submammary (subglandular) location of the endoinsert to be the optimum.

But under the fascia, implants are extremely rare. And few surgeons choose this method of arthroplasty.

Which method to use, whether it is better to place the implant under the muscle, combined or under the gland, will depend on a whole range of factors.

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

The choice of implantation method and prosthesis placement 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;
the amount of tissue (muscle, glandular, fat);
the distance between the submammary fold and the nipple.

There are two theoretical possibilities to install a submammary prosthesis:

dissecting BGM (pectoralis major muscle);
and without cutting it.

With a small breast, it is almost impossible to do without dissection. BGM is attached in the region of the ribs a little higher than the subglandular fold passes. This means that if a rather large implant is placed in the pocket of a naturally small breast without cutting the muscle, then under muscle effort it will eventually move up, and the nipple will “look” down. Agree - it's not very pretty.

Therefore, more often surgeons resort to dissection of the BGM. This is especially necessary for hypomastia. In this case, they have to:

dissect BGM, which lengthens the rehabilitation period;
increase the distance between the nipple and the submammary fold, which, according to natural data, is very small.

The latter is achieved by forming a new inframammary fold. Lower than it was provided by nature. This avoids the "jumping of the prosthesis" and lowering the nipple down. 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 "bare" more, and patients or their partners under the subcutaneous fat will be able to feel the prosthesis. The smaller the prosthesis, the more it is covered with muscles, and the more natural the breast will be on palpation.

Yet even small, this method is carried out. And the results, at least visually, are very good. Judging by the pictures before and after the procedure. Although it is not worth believing 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 with average volumes of their own bust. It is used when glandular tissue has involuted due to postpartum or age-related atrophy.

Submuscular mammaplasty: advantages and disadvantages

The main advantages of such placement of the endoprosthesis are:

good filling of the upper part of the chest, its beautiful natural shape;
dense "fixation" of the implant by the muscle, which minimizes the risk of its displacement, ripples, the 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;
endo-inserts do not overlap the mammary gland and allow it to be clearly visualized during examination.

The disadvantages include:

insufficient filling of the lower part of the chest;
weak expressiveness of the height of the bust due to the density of muscle tissue;
inability to correct drooping breasts, required to be combined (with a lift);
longer recovery period;
it is highly undesirable to install;
it is not recommended to implant under the muscle acrotextured prostheses and polyurethane variant of endoinserts.

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

Recovery period after implantation of the prosthesis under the muscle

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

During the normal course of the operation, you may need bed rest only on the first day, and then you will go home to recover. Although the "savings mode" in the first month will need to be observed. It makes no sense to paint the recovery period by day. But we will highlight the main stages:

early postoperative period (until the patient leaves anesthesia);
the period of removal of sutures (this process normally takes place on 5 less than 7 days);
after 20-25 days you will say goodbye to edema;
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 lead a normal life, all discomfort will leave you and you will begin to forget that your chest has additional foreign inserts;
after 365 days, a full recovery will come, and it will be possible to think about procreation, if this topic is relevant for you, the sea breeze and the full-bodied sports rhythm of life.

Under muscle or gland? This question arises in every patient, 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 an implant is placed under a gland, it is placed in the space between the gland and the pectoralis major muscle.

In this case, the implant is closed only by the skin, subcutaneous tissue and gland tissue. The muscle in this case is not touched. The implant is placed under the gland, and only the gland tissue and subcutaneous fat cover it from above.

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

What are the cons? For thin patients, this method is unacceptable, the thickness of the soft tissues is very small and in some places the implant can be palpated. If the patient is ready for such a risk, then an implant can be placed under the gland, if not ready, then another method should be used.

Placement of an implant under the muscle

When the implant is placed under the pectoralis major muscle. In this case, things look a little different. In Fig.2. the implant closes the pectoralis major muscle, on top of the iron. 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 a substantial coverage that minimizes the risk of contouring from above and below. The likelihood of implant contouring is reduced to a minimum.

What are the disadvantages of this method? It's quite painful. Placement of the implant under the muscle causes it to stretch, and this, in turn, causes severe pain. Here you can not do without painkillers.

Let's ask the question: if you put 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 the submammary placement of the implant and those who are suitable for placement strictly under the pectoral muscle.

If the patient is thin, there are not so many soft tissues, so if an implant is placed under the gland, there is a high probability that in six months or a year the implant may begin to contour in the upper part and on the side, that is, its edge will simply be noticeable.

If the patient has a sufficiently large mammary gland, a dense physique with good tissue elasticity, but at the same time there is ptosis (omission) 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 tissues will not allow the implant to be contoured.

When choosing a method for installing an implant, it must be remembered that the idea of \u200b\u200bwhat a beautiful breast is for all people is different.

Breast augmentation standards in the world

For example, in Brazil, in the USA, implants are preferred to be installed under the mammary gland, Americans and Latin Americans love a fairly pronounced breast, voluminous, with an upper pole, and they often say that they do not put implants less than 500, but only more.

Breast augmentation in Russia

In Russia, Eastern Europe, patients are asked to make the volume reasonable, so that it looks natural enough, the size of the breast should fit the figure. And in this case, installation under the gland will not work, it will be necessary to put it under the muscle so that the implant is not visualized, the breast is as natural as possible.

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

How is breast augmentation surgery performed?

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

But if the muscle fibers are carefully stratified 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 was carried out correctly.

What are the options for placing implants?

Many have heard that there is a method implant placement 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, so a pocket is formed 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. Therefore, the method of creating an implantation pocket in two planes is called.

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

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

conclusions

Now you know the main ways to install breast implants, each of which has its 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 all the pros and cons, tell the surgeon about your wishes and, based on this, make a decision.

The decision about the need for mammoplasty in 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 breast. But the outlines of the future breast depend not only on the type of implant, but also on the method of its installation.

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

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

Implant placement methods

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

Let's analyze the features of each location of the implants.

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 can be seen 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 besides the disadvantages, this method also has advantages.

Advantages:

The pectoralis major muscle is not affected, as a result of which the recovery period is reduced, which passes with minor pain sensations or with their complete absence. Edema is also minimal, the mammary glands take their final shape in a short time;
Under physical load, the implant installed in this way is not deformed or displaced;
The subglandular way makes the breast fuller.

Flaws:

Possible capsular contracture;
With thin breast skin, a small amount of adipose tissue and a lack of mammary glands, implants can be seen and felt;
Irregularities in the form of ripples and waves may appear on the skin around the implant;
Due to the lack of muscle support, large implants can stretch the skin and make the breasts sag;
The risk of infection and disappearance of sensitivity is higher;
The appearance of stretch marks on the chest;
Difficulty in blood supply;
Perhaps the appearance of breast asymmetry.

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

Plastic surgeons do not often choose the over-muscle method, but it may be ideal for women who have enough breast volume to cover implants, have ptosis but do not want to undergo a facelift, have scarring or dystrophy of the pectoral muscle, have strong muscles due to 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 the OPREH.

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

Installation method under the pectoralis major muscle

With a submuscular arrangement of implants, they are completely covered with muscles. This method at one time became an alternative to the subglandular. However, this method also has a sufficient number of significant drawbacks: increased trauma, a difficult recovery period, with a load on the pectoral muscle, the chest can be distorted and deformed. If the implants are incorrectly placed under the pectoral muscle, they can subsequently shift.

Advantages:

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

Flaws:

Not the most natural result;
The density of the muscles covering the implants does not allow to achieve the desired size and height of the breast;
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

The method of installing the implant under the fascia of the pectoral muscle is considered by surgeons to be the most optimal

Imperfections in the installation of implants by the above methods led to the emergence of an optimal method. Complete coverage of the implant without the risk of deforming the mammary glands has become possible with the 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 firmly holds the endoprosthesis.

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

The subfascial method is used for breast augmentation with various accesses:

Axillary;
Subglandular;
Periareolar.

It is this method that most specialists use with augmentation mammoplasty.

Advantages:

The most natural look, the transition of the breast is smooth and smooth;
Reduces the risk of developing capsular contracture;
The fascia supports the implants and prevents them from sagging;
There is almost no risk of deformation of the implants during physical exertion.

Flaws:

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