Following the recent scare involving the PIP breast implants, an increasing number of breast enlargement patients are demanding more information from their surgeons before going under the knife. Apart from questions involving the implants themselves and their safety, of crucial importance is also whereabouts within the breasts the implants will be situated. This is a complex issue depending upon many factors and one that confuses a large number of patients.
Dr Allen Rezai, a leading Consultant Plastic and Reconstructive Surgeon of Harley Street, London, and specialist breast surgeon, explains the various implant placement options, clarifying both the advantages and disadvantages of each method, which often relate to a person’s body type and lifestyle.
Dr Rezai explains that “today there are essentially four locations within the breast where implants can be located, each with its advantages and disadvantages. These are regularly referred to as sub-muscular, sub-glandular, dual plane and sub-fascia placement. The choice of which location to use is a function of the patient’s anatomy, their lifestyle, and both patient and surgeon preference.
“In sub-muscular placement the implant is placed below both the pectoral muscle and the overlying breast tissue. This involves separating the pectoralis major and pectoralis minor muscle from the chest wall and inserting the implant in between the two. This location is more appropriate when the patient has a smaller amount of breast tissue since there is less risk of the implants being seen, providing a more natural slope, with the implants being less palpable. This location also has the advantage of offering less obstruction during mammography. Furthermore, if a woman later undergoes a change in weight, perhaps due to pregnancy, the muscle supports the implant and so the breasts and implants are less prone to sagging.”
As to the disadvantages of this location: “sub-muscular placement can be less advisable for women of an athletic build, since their pectoral muscles can be somewhat overdeveloped, and the implant will distort when making certain types of movement, such as during swimming or getting out of a pool. It also requires a slightly longer recovery time than needed for other implant locations,” says Dr Rezai.
Concerning the sub-glandular placement option, Dr Rezai explains that “in sub-glandular placement the implant is placed over the pectoral muscle and under the breast tissue. If the patient has sufficient breast tissue to cover the implant then this type of placement is easily achievable with less pain than in sub-muscular placement and requires a much shorter healing and recovery time. It is also helpful for patients with mildly sagging breasts who do not wish or need to undergo a simultaneous uplift procedure. Furthermore it imparts a more natural feeling to the implant when the chest muscles are used, since there is no distortion.
“Since placement sub-glandularly positions the implant closer to the breast surface,” continues Dr Rezai, “it is not recommended for patients with lesser amounts of breast tissue, since there is a greater risk of the implants being noticeable, including the highlighting of any rippling should it occur.”
Dual plane breast implant placement is sometimes also referred to as sub-pectoral breast augmentation and is a method employing the advantages of both sub-muscular and sub-glandular positioning. According to Dr Rezai, “In dual plane placement the implants are situated partially underneath the pectoralis major muscle in the upper chest, being located simultaneously both under and over the muscle. The surgery is somewhat more complex than that required for other types of placement, however dual plane implants offer a very realistic look and feel together with excellent muscular support and fullness. The feel of dual plane implants tends to be firm at the top of the breast and softer and more pliable at the bottom, very much like that of natural breasts, and the coverage of the pectoral muscle helps to conceal any signs of the implant shell.”
In the case of the more recent technique employing sub-fascia implant positioning, Dr Rezai explains that “this approach combines several benefits of both sub-muscular and sub-glandular placement, which are the two most frequently employed locations. Sub-fascia placement works well in the case of small, thin women who have little tissue to cover the implants, with the fascia layer helping to smooth and contour the implant shell, blending it into the wall of the chest.
“There are several benefits to employing a sub-fascia implant location which offer an advantage over the sub-muscular and sub-glandular approaches, in addition to the fact that it makes mammogram screening less difficult. These include a less frequent incidence of capsular contracture than with sub-glandular placement, no implant distortion when using the pectoralis muscles, and a higher degree of support for the implant. The duration of the surgery is also shorter.
“The potential downsides of sub-fascia placement relate to the fascia layer being somewhat thin, with the resulting possibility of it tearing and the implant position thus becoming sub-glandular. And also, whilst the fascia does provide support for the implant, it is insufficiently thick to provide any additional padding above the implant,” explains Dr Rezai.
Implant size, shape of breast and amount of breast tissue present determine the type of implant placement suitable for the patient. All placements should produce a natural look and feel if chosen according to patient’s suitability.
For more information concerning breast augmentation surgery, breast implants and the options available, and also other types of plastic and aesthetic surgery performed by Dr Rezai, referral can be made to his website at https://allenrezaimd.co.uk
He can also be contacted directly through his London clinic as follows: 40 Harley Street, London, United Kingdom, W1G 9PP
