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

In recent years, the demand for breast augmentation plastic surgery has skyrocketed. Today, this direction in aesthetic medicine can be called one of the most popular. In the arsenal of plastic surgeons there are many techniques, accesses, types of implants. With proper use by a specialist of these opportunities, a good result is guaranteed.

Implant location: advantages and disadvantages

The implant can be placed under the mammary gland, subglandularly, can be placed 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 the soft tissues of the mammary glands. 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.

Placement of a breast implant under the gland has significant disadvantages, especially when the thickness of the soft tissues of the gland is not enough to adequately cover the implant. In addition to visualization and palpation of the implant during installation under the gland, complications such as fibrous capsular contracture, waves, and impaired nipple sensitivity often occur. Pectoralis major implant placement became popular after it was found to avoid the disadvantages associated with a pectoralis implant.

The disadvantages of installing implants under the pectoralis major muscle include the greater trauma of the operation - the postoperative period is more difficult than when installing an implant under the mammary gland, with contraction of the pectoralis major muscle, the chest can flatten or even deform. If surgical techniques on the pectoral muscle are not performed correctly, the implant may move up or down 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 place the implant under the fascia of the pectoralis major muscle. The fascia of the pectoralis major muscle is a well-defined layer, it can be used to prevent visualization of the edge of the implant under the skin, while the pectoralis major muscle is not damaged, it remains intact, and the implant is completely covered by soft tissues. The fascia securely covers the implant. When installing an implant under the fascia in the postoperative period, the breast will not deform when the pectoralis major muscle contracts. Complications in the form of displacement of the implant under the action of contraction can also be avoided.

Endoscopic breast augmentation through the armpits allows you to do without scars on the mammary gland.

The purpose of placing an implant under the fascia of the pectoralis major muscle is to obtain 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 tissues, thereby reducing the degree of visualization of the implant edge.

It is possible to perform breast augmentation, while installing an implant under the fascia of the pectoralis major muscle, through the access in the armpit, transaxillary, in the crease under the breast, submammary, or along the lower edge of the areola, periareolar, which depends on the wishes of the patient, her anthropometric features 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 prolapse of the mammary glands. The advantage of endoscopic breast augmentation through the axillary approach is that it avoids scarring of the mammary gland.

Underbust crease access allows larger implants to be placed. When breast augmentation is performed through the axillary approach or through the inframammary fold approach, the breast parenchyma is intact. For patients with minimal breast prolapse or areola prolapse, an areola approach is appropriate.

Postoperative care

After breast augmentation, it is recommended to wear special compression underwear for 1 month. If endoscopic breast augmentation has been performed through the axillary approach, it is recommended to wear a pressure elastic bandage in the region of the upper slope of the breast for 10-14 days, which will allow the implant to be held in the correct position. After one month, hand movements are allowed in full.

Possible Complications

One of the complications of breast augmentation is implant displacement. Downward displacement of the implant may occur in patients with loose skin. An 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 the research, plastic surgeons came to the conclusion that the least number of complications occurs when implants are placed under the fascia of the pectoralis major muscle.

conclusions

Placement of the implant under the fascia of the pectoralis major muscle during breast augmentation allows you to create a natural shape of the breast and provides good coverage of the implant tissues. In addition, the fascia of the pectoralis major muscle eliminates the possibility of damage to the implant during contraction of the pectoralis major muscle. The incidence of complications does not exceed that when using other methods of implant placement for breast augmentation. Compared to the placement of an implant under the pectoralis major muscle, the subfascial technique allows you to create a better contour of the breast, and the result looks more natural. The incidence of long-term complications, for example, capsular contracture, characteristic of subglandular implant placement, is much lower when using this technique.

Mammoplasty in our time from an exotic and risky operation has turned 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 offer more and more options for correcting aesthetic defects.

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

Anatomy of the chest: a small educational program

So, at the base of our chest lies the pectoral muscle. These are two peculiar muscle "fans" going from the sternum to the left and right - to the large tubercles of the humerus. Above the muscle is located ( and attached to it) mammary gland - it is there that milk is produced, which we feed babies. Its size is approximately the same in most women, and we owe the differences in the size and shape of the breast to the fatty layer that surrounds the gland.

Not all women are happy with their breasts; some she seems too small, "boyish", and their full-breasted girlfriends 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.

Fine silicone: another little educational program

When a potential owner of a luxurious silicone breast becomes interested in the prospects for her future happiness, she discovers that "everything is complicated." Silicone implants can have an anatomical shape of a drop or a perky hemisphere. They differ in filling - they can be “stuffed” with silicone gel to the eyeballs or only 85%. And also the width and height of the base ( width and projection), as well as the height above the level of the chest ( profile). An 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 submammary fold), under the armpit, or along the contour of the nipple ( periareolar access).

There are so many options that my head is spinning - which is better? What will bring you closer to the desired result? What will you (and not the surgeon?) like?

Where to cut and where to put

Symbum's opinion:

A friend made breasts through the armpit, bent over from pain for a month, could not do anything and was so surprised that I (access under the breast) didn’t hurt anything, that’s what different access means.

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

No, it's not. The main role is played by the place of implant installation - under the mammary gland or under the muscle. Placement under the pectoral muscle is always painful, and it does not matter whether we place the implant through the nipple, under the breast or under the arm. Just axillary access is designed specifically to "dive" under the head of the pectoral muscle, so it always causes discomfort.

- So is it worth it to suffer and put an implant under the muscle?

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

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

Of course, a lot also depends on the tone of the muscles: for some, they will keep the implant until the age of 80, and for some, like a rag, there was no point in installing it under the muscle. In such cases, I always warn a woman that you can only go without underwear on major holidays.

Opinion sibmam

She put an implant-anatomist under the gland. Three years later, the chest is full, but sagged. It was necessary to choose access under the muscle!

The average profile is normal, high, they say, it is more likely that there will be sagging even with the installation under the muscle due to the fact that it bulges forward strongly, and the part will still hang.

- 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 by the maximum amount of its own tissues. When a girl arrives, who, in fact, has nothing to cover it with, in fact, 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 who, on the contrary, are better off installing an implant under the mammary gland. This applies primarily to athletes: body fitness, bodybuilding, powerlifting ... in a word, to girls who actively work with pectoral muscles. With heavy physical exertion, the muscle can contract and displace the implant.

” -On the other hand, in 18 years of practice, I have seen implant displacement only twice - this happens extremely rarely. I even had a patient - a world champion in bodybuilding. We put the implant under her muscle, because before the competition she “dries” so much that the muscle is drawn very clearly, the implant would be too noticeable. In preparation for the competition, she works 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 terribly happens. It is quickly put in place, the pocket, which has stretched, is sutured.

Your chest is still fluffy!

Opinion sibmam

It makes no sense to put a high profile under the muscle - it will flatten the muscle.

390 will not be enough, I say right away. The muscle will press and the chest is not very lush, it can turn out, and if you really put it, then from 450 ...

To stand, you need a high or extra high profile, and that's the only way. With the average and average + 450 will lie.

Olga Vladimirovna, but the muscle is compressed, is it possible to get a high and lush chest when installing an implant under the muscle?

The muscle really flattens the implant first, this is normal. Indeed, 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 such an expression - "the chest has fluffed up." The muscle, as it were, “releases” the implant and the breast takes its final shape. But this is to wait from two months to a year - we will definitely warn all the girls about this.

- And the installation of the implant under the fascia ( connective tissue membrane, forming a kind of "case" for the muscle) - what are the advantages of this method? Perhaps the process of "fluffing" will go faster?

I see no reason to separate the fascia and injure the gland. There was such an experiment, because this is a rather 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 sibmam

The implant is attached somehow cunningly, I remember in the picture, it is difficult to describe. In general, the implant can move if it is completely hidden from top to bottom under the muscle, and if it is half attached to the muscle and the part is under the gland, then everything is ok. The implant adheres to the muscle as usual and holds without any displacement. In addition, the doctor also attaches it in two places additionally under the muscle there, so that everything will surely grow quietly and take root as ideally as possible.

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

The pectoral muscle never completely closes the implant - this is anatomically impossible. But there is a very wide pectoral muscle, when most of the implant is under it. To make the breast softer and more natural, we partially remove the implant from below above the muscle. At the same time, the muscle itself does not need to be cut - we simply push the fibers apart, making literally two or three cuts. But, as I mentioned, even if most of the implant is covered by muscle, over time it still straightens out.

- Is it necessary to wait for surprises in a year - maybe the chest will “fluff up” in the most unpredictable way?

No, the result is always exactly predictable. I have 4-5 mammoplasties a day, and when a girl enters the office, I immediately remember patients with a similar anatomy, with the same costal hump, and show her photos: it was, it became - 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 placed under the gland... But I will never be able to do this to 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 a future operation.

- Or maybe something goes wrong, for example, there will be a noticeable asymmetry of the nipples?

Because of the operation, asymmetry cannot arise - if a symmetrical person has come to us, where does it come from? But if there was asymmetry, then the installation of the implant emphasizes it. And this question 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 do not see anything wrong with this. And for others, it is important that the nipples are strictly symmetrical.

Doctor, put the balls in, don't be shy!

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

Now more often they ask for a natural form. Those who put “balls” in the 90s are now going and removing them, even doing a size reduction and tightening. Now they ask 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 a tattoo, and no one will ever guess that there is something “not their own”. The shape is just fantastic, well, it turns out very beautifully!

” - But, of course, there are still girls who say: “Doctor, forget about naturalness, I need balls! Do not be shy either in volumes or in sizes, as much as you like - in full! Everyone has their own idea of ​​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) does not fit, then you should not beg him, beg and wait for a miracle to happen. There are surgeons who are weak-willed... It seems to me that it is difficult to refuse male surgeons especially, beautiful girls come! Some bend, but this is fraught with problems for both the surgeon and the patient. I refuse those who do not hear me, and then, when someone is “bent”, they come to me with problems ...

Speaking of problems...

Well, since we are talking about this, let's talk about the possible complications. Many women would like to reduce the distance between the mammary glands as much as possible for the effect of a “seductive cleavage”. Is it possible?

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

- That is, no hollow?

You just need to be patient. The first time after the operation, it is impossible even to bring the breasts together with your hands, but then the muscle relaxes, stretches and “releases” the implant, the distance between the breasts is reduced. In a year you will reach the desired forms.

- And what about the “double-bubble” effect, when the implant stands out, as if a woman has a doubling of her breasts?

It occurs in two cases: the first option - the implant "slips" below the submammary fold, and the second option, when the surgeon deliberately underestimates the submammary fold. There is a so-called restrictive type of structure of the mammary gland, when the distance from the nipple to the submammary fold is small. If you insert the implant, then the nipple will be completely under the breast. Then (having discussed all the risks with the patient), a periareolar breast lift is performed, the nipple is raised as high as possible, 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 submammary fold, but there is nothing more to be done here.

Opinion sibmam

My gland is slipping from the implant, the border is clearly visible. It was necessary to put under the muscle.

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

- And if it is not the implant that “slips”, but the mammary gland?

And this is the “waterfall effect”. At risk are those who initially have ptosis ( prolapse of the mammary gland), such as after breastfeeding. In this case, the surgeon explains that without a facelift ( an incision around the areola and vertically down, from the nipple to the submammary fold) not enough. But ... "I'm not like that, I'll be fine, I don't need a lift." The surgeon puts 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 placed, 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 braces!

Opinion sibmam

You can not insert a small implant under the breast, for example 300, especially if the breast is not spoiled by feeding several children. The chest will not close 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 the easiest and becomes invisible.

- Can stretch marks appear on the breast during mammoplasty?

Never! Stretch marks are always hormonal. They arise in the pubertal period, not only in girls, but also in boys, and not only on the chest, but also on the stomach, on the hips, under the arms ... And the second period is pregnancy. And not because the breasts are growing, but because the hormonal changes in the body are taking place!

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

But nature never takes without giving something in return. In such a patient, very inconspicuous sutures are always formed: it can be cut even along, even across, after a year you will no longer find any traces of the seam.

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

Edema is a normal post-traumatic reaction. What is pain syndrome? Swollen tissues tighten 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 at least 10 days, but usually up to two months. Some have pastosity ( slight swelling) is stored for a year!

” - Moreover, patients after the operation are prone to swelling at the site of the operation. That is, if you drank alcohol the day before, the first thing that will swell in you in the morning is your chest, if you have operated on the chest, eyelids, if you have operated on the eyelids, and the stomach, if you have had abdominoplasty.

And so for a year, while 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, due to which the breast becomes hard as a stone ...

Haven't come across this in a very long time! Contractures often happened earlier when the implants had a smooth surface. Since we started working with implants with textured ( "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, 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 who put the implant 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, put a new implant, but of a larger size, since the contracture "eats" part of its own tissues.

And one more “horror story” is the rupture of the implant, when the silicone “scatters” throughout the body. Is it true that this happens with incompletely filled implants - wrinkles can form on their surface, which are easily “wiped”? Maybe a better filled implant?

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

” - As for the rupture of the implant, this is a very rare complication that I see once or twice a year. And the reason for it is not the folds, but the bending of the implant, when too small a pocket was formed under it, in which it could not completely unfold. 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 cross-linked by chemical bonds, and the filler resembles jelly. We just take out the old implant and insert the new one. By the way, for the patient it is free, because the guarantee for each implant is a lifetime!

Interviewed by Irina Ilyina

This is beyond good and evil. A provincial butterfly-horse, who herself has not undergone a breast augmentation operation, sells cheap silicone sislo to suckers in the hope that two horse-dressing surgeons will supply her with the same one, but at a discount.

Disregarding all the norms of decency, this scum with stupid aplomb declares things that make 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 press from the chest, and do push-ups, and in every possible way load the pectoral muscles. As a killer, he cites an argument: if this were not so, not a single fitness woman would make breasts.

Fitness women really often resort to breast augmentation surgery, but, as a rule, implants are placed under the mammary gland, and not deeper - under the muscle. Implants placed under the muscle “wear” more reliably, with them the breast looks beautiful and natural, and is pleasant to the touch. Implants placed under the mammary gland:

a) very noticeable visually,

b) palpable

c) "walk" under the skin when you move.

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

These photos clearly show what the breast looks like with implants installed under the glands:

Pay attention to how the implant installed under the gland in a lady in a red bra "walks".

On the other hand, this method of installing implants really 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. The chest hardens. There may even be a break.

I repeat once again: when I asked my surgeon if I could load breasts, he replied: “Well ... My wife does not touch her breasts.” His wife is all about fitness no less than me. Initially, the doctor, knowing my load, suggested installing an implant under the gland, but honestly warned: it would be ugly. I chose beauty by sacrificing physio.

Understand you finally: without victims will not do. Don't be fooled by cynics.

My victims:

1) You can not train chest. At all. Never.

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

Here is a very honest photo for you, illustrating how my muzzle wrinkled and sagged after the operation:

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

Now - here:

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

3) Sensitivity, it seems, is being restored, but not what it was before. It may come back completely, or it may not. Do not forget: they cut them "on the living". What is left there and what will be - no one knows.

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

And most importantly: if you are an ugly woman with short legs, a terrible fuck or a fat ass, no silicone boobs - let "made in the USA" not adorn you. And "made in Russia" - they will also cripple.

Well, and the last! 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 over the nipple, does it affect breastfeeding? Yes, it does. How else does it affect. Bad influence. Ovulyashki, do not believe those who say otherwise. I am an ideological childfree, a terrible egocentric and do not want to waste my precious life on the service of another being. If I left myself even the slightest chance of childbearing, I would not put implants.

Questions?

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

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 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 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.

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

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

On what factors does this choice primarily depend?

1. position of the mammary glands on the chest wall. It can be innately high, medium and low;
2. the presence or absence of acquired mastoptosis (omission 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. the presence of deformity 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 (omission) of the breast, if this problem is not solved surgically (endolift or breast lift);
3. Both the surgeon and the patient must 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. That is, if after other options the desired result comes after 1 month, then here after 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 anatomic teardrop implants (except in special cases). Otherwise, the very shape of the implants will impede rapid rehabilitation;
5. It is categorically NOT possible to use fixed implants (macrotextured or polyurethane). This may cause some problems.

Over 20 years of placing an implant under the muscle in more than 1000 patients, in all cases a good long-term result has been obtained. All patients who previously had experience of wearing implants under the gland or in two planes noted that after surgery using a full myofascial pocket, they began to feel more secure. Most of the patients generally ceased to feel the implants as something separate, constantly reminding of themselves. See