Mammoplasty round implants under the muscle. Mammoplasty: under the gland or under the muscle? Benefits of placing an implant under the pectoral muscle

Breast augmentation operations are by far the most popular and sought-after surgical interventions in aesthetic surgery. Installing an implant helps to solve many problems: increase the size, tighten the skin, correct the shape and make the woman's breasts much more attractive. Plastic surgeons have to modify thousands of female breasts, but few people know that the doctor prepares for each such operation individually. The choice of implant placement method depends on many factors that must be considered in each individual case. Quite often, surgeons prefer the method of installing an implant under the muscle. What are the features of this breast augmentation technique - read on estet-portla.com.

Features of installing a breast implant under the muscle

Placement of an implant under a muscle is called a submuscular implant placement technique.

It is possible to achieve the maximum aesthetic effect with minimal complications by placing the implant partially under the muscle - by about 2/3.

The complete submuscular placement of the implant results in an unnatural appearance of the breast in its lower part due to the placement of the implant above the lower fold of the gland. In addition, the volume and height of the operated breast are poorly expressed due to the density of the pectoral muscle. Full placement of the implant under the muscle is especially not recommended for women who are actively involved in sports.

Placement of an implant under the muscle:

• the main methods of installing breast implants in mammoplasty;
• advantages of placing a breast implant under the muscle;
• what should be considered by the surgeon when placing the implant under the muscle.

The main methods of installing breast implants in mammoplasty

At the stage of preparation for mammoplasty, the surgeon must determine a large number of factors that decide which option for implant placement is optimal. There are three main methods for placing breast implants:

• subglandular location of the implant: it can be used if the mammary gland is sufficiently dense and pronounced in volume, when it is sufficient to evenly cover the entire implant;
• full muscle coverage of the implant implies the formation of a single coating, which allows not to destroy the pectoralis major muscle and preserves all fascia lines, including the axillary;
• installation of an implant under the muscle and under the gland: also used for those patients in whom the mammary gland is quite well expressed, otherwise the result of the operation threatens to be short-lived.

Benefits of placing a breast implant under the muscle

The main advantages of placing a breast implant under the muscle include:

• natural appearance of the upper chest, due to the fact that the pectoral muscle hides the upper edge of the implant;
• minimal risk of capsular contracture, which spoils the appearance of the operated breast and causes pain in the patient;
• minimal risk of "waves" and "ripples" on the breast skin after implant placement;
• almost complete impossibility to feel the implant after its installation;
• the ability to take clear pictures of the breast during mammography.

What should the surgeon consider when placing an implant under the muscle

There are some important points that a plastic surgeon needs to consider when performing mammoplasty with a breast implant placed under the muscle:

• the technique can be used in cases where the patient has intact pectoralis major muscles;
• the method does not allow to eliminate mastoptosis, and therefore it is recommended to patients only in combination with a breast lift;
• installation of an implant under the muscle implies a longer rehabilitation period than with other methods of mammoplasty;
• the use of anatomical drop-shaped implants for installation under the muscle is not recommended;
• It is strictly forbidden to use polyurethane or acrotextured fixation implants.

Placement of an implant under the muscle is an effective method of breast augmentation and improvement of its shape and appearance.

Careful and strictly individual selection of the mammoplasty technique will achieve the maximum result, which the patient will be satisfied with.

Currently, plastic surgeons use fairly gentle, non-traumatic methods and materials that have a lifetime guarantee. This suggests that the installed breast implants are guaranteed to be safe for the body for a long period of time.

Implants can be placed:

1. Installation of an implant under the gland (subglandular location)

The implant pocket is formed under the mammary gland tissues between the gland itself and the pectoralis major muscle.

This method of placing endoprostheses is technically the simplest. This method is less traumatic, technically simple to perform, and the least painful for the patient. Due to this, the rehabilitation period is not accompanied by significant pain, the primary recovery period takes 10-20 days.

However, the installation of an implant under the mammary gland is often accompanied by contouring of the implant, that is, its visualization (often patients say the breast is like a ball), stretching of the tissues in the future and sagging of the breast under the weight of the implant itself. In addition, the risk of capsular contracture with submammary implant placement is slightly higher.

So, let's summarize the pros and cons of submammary placement of breast implants.

• technical simplicity of the operation
• slight pain in the postoperative period
• relatively fast recovery
• breasts are softer and more mobile
• no restrictions on sports

• the possibility of contouring or visualization of the edges of the implant
• a high probability of overstretching of the breast tissues under the influence of the mass of the implant, which can eventually lead to sagging of the breast
• excessive mobility of the implants, which can lead to the displacement of the implants to the sides in the supine position
• slightly higher chance of capsular contracture

Who is eligible for a breast implant?

Most often, this method of surgery is suitable for nulliparous women with well-defined soft tissues, the thickness of which is at least 1.5 cm. At the same time, the soft tissues of the breast must be elastic, and the gland itself must be at least 50% represented by the actual tissue of the breast.

Who is not suitable for a breast implant?

It is not suitable for patients with thin breast soft tissues, with a large number of stretch marks, sagging skin, as well as for those whose breast thickness is less than 1.5 cm and is mainly represented by adipose tissue.

2. Placement of a breast implant under the muscle (subpectoral location)

The essence of this method of breast augmentation lies in the fact that the implant pocket is formed under the pectoralis major muscle, which lies on the chest wall and is located behind the mammary gland. To do this, the surgeon partially dissects the lower part of the pectoralis major muscle.

This method of installing breast endoprostheses is more complex from a surgical point of view and requires the surgeon to be careful and careful with the soft tissues of the breast.

Since the pectoral muscle contains a large number of nerve endings, the patient experiences significant pain in the postoperative period, which requires adequate anesthesia.

However, despite the disadvantages of the early postoperative period, this method of breast augmentation has a number of significant advantages, which makes it the most popular, and in some cases the only possible way to perform mammoplasty. Consider its pros and cons.

• the ability to install implants even in very thin patients with severely thinned breast soft tissues
• lack of contouring (visualization) of implants, even in women with soft breast tissue deficiency
• better fixation of implants in the implant pocket, less chance of displacement of implants under the influence of gravity
• low probability of sagging of the mammary glands due to the weight of the implants
• no effect of "spreading" or displacement of the implants to the sides in the supine position
• less likely to develop capsular contracture

• a technically more complex operation that requires more attention and accuracy from the surgeon.
• more pronounced pain in the early postoperative period
• longer recovery period

Who is suitable for pectoralis major implants?

Who is not suitable for implant placement under the pectoralis major muscle?

There are no unambiguous contraindications to this method of surgery, but surgeons believe that if the patient's soft tissue characteristics are such that they can securely fix the implants in the desired position, mask its presence well, then you should not disturb the muscle, in this case it is better to install the implants under the iron The pectoralis major muscle will come in handy later, for example, during a second operation in a few years.

To increase the size of the mammary glands, specially selected implants are used, which can be installed in various zones: under the fascia, under the gland itself, in two planes, in the axillary region, and also under the muscle. Each method has its advantages and disadvantages, but the plastic surgeon always selects it, guided by an individual approach.

As you know, natural breasts always have a smooth, gentle slope that descends to the nipple area. The main volume is located in the lower zone of the breast, while the area of ​​localization of the nipple is the most protruding. It is believed that if you install a breast implant under the muscle, the result after the operation will look exactly like this.

Also, experts highlight another important advantage of this method - reducing the risk of complications such as capsular contracture. Installing an implant under the muscle makes it possible to improve the coverage of the upper slope, while the endoprosthesis installed in this way does not interfere with mammography and ultrasound diagnostics.

It should be remembered that the initial state of the mammary gland tissues and size must be taken into account by the surgeon when choosing an implant. It is recommended to install it under the muscle or under the gland only with pronounced glandular tissues. If a girl has a zero breast size, then, most likely, experts will advise her another method.

• If the patient has a desire to create a "Hollywood" breast shape, which is characterized by a pronounced upper pole.
• If the woman's original breast size is greater than zero.
• If the patient has large pectoral muscles that have not been traumatized before.
• If signs of mastoptosis are observed (in this case, the method can be used in combination with a breast lift).
• If the patient plans to install round-shaped implants. Teardrop-shaped endoprostheses are usually not recommended for submuscular placement.

For comparison, it is worth looking at what the breast looks like if an implant was installed under the muscle (photo with examples of different options):

Methods for installing an implant under the pectoral muscle

The plastic surgeon determines how to place the implant under the muscle, what type of endoprosthesis to use and what size to choose. He starts from the preferences of the patient, her wishes for a new breast shape, and also necessarily takes into account all the anatomical features of her body, the proportions of the figure, so that everything looks harmonious and proportionate after the operation.

This is very important for obtaining a natural result of breast augmentation. If implants are placed under the pectoral muscles, the surgeon should understand which method of their placement will be better in a particular individual case.

Submuscular location of the implant

This is a method in which the implant is placed under the pectoralis major muscle. In this case, the lower pole is supported by the fascia of the serratus muscle. Many surgeons call the submuscular location of the implant a way to create a "Hollywood" shape of the mammary glands with the most pronounced and voluminous upper slope. Another distinctive feature of the method is the absence of the need to cut the lower part of the muscle.

Subpectoral (or biplanar) implant placement

The method implies only its partial placement under the muscle. The upper part of the endoprosthesis is located under the muscle, the lower part is above the muscle. This installation of the implant under the pectoral muscle is very popular in the United States. It is believed that the subpectoral method allows you to get a more natural result of breast augmentation without the risk of contouring the implant.

How is the implant placed under the muscle?

The main stages of plastic surgery:

• The use of anesthesia and the opening of surgical access.
• Formation of a pocket under the muscle or partially under the muscle and gland, where the implant will subsequently be located.
• Installation of the implant under the muscle or gland in the formed pocket.
• The imposition of surgical sutures.

What does the breast look like if the implants are placed under the pectoral muscles?

Experts warn that placing an implant under a muscle or under a gland allows you to get a “Hollywood” breast shape, which is characterized by the following external features:

• a pronounced upper slope, due to which it visually seems even more voluminous;
• high position of the chest;
• the mammary glands are visually larger than the chest;
• the possibility of contouring the implant with a submuscular location (it is recommended to place endoprostheses partially under the muscle, then there will be no such effect).

What does the breast look like if the patient had an implant installed under the pectoral muscle (photo with real examples):

Benefits of placing an implant under the muscle

• Improved coverage of the upper slope. It becomes more pronounced and voluminous.
• Almost complete elimination of the risk of developing capsular contracture, postoperative complication, which is possible after the installation of the implant in other ways.
• Natural breast result with the right choice of implants.
• No risk of endoprosthesis sagging, which is sometimes possible with other installation methods.
• Impossibility of palpation of the implant: Its edges are invisible from the inner and upper borders.
• No problems with mammography: Implants do not complicate the diagnosis in this arrangement.

Disadvantages of installing an implant under the muscle

• Sometimes, after placing an implant under the muscle, the lower breast area may look unnatural when the implant is located above the lower fold of the gland.
• The breast will look much larger than the chest if the endoprosthesis is too large. If you have chosen a submuscular implant location, it is recommended to opt for smaller sizes.
• An implant under the muscle should not be installed if a woman is engaged in active sports, since ripples of the endoprosthesis may occur during exercise, which will look unnatural and strange.

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. The 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).

The appearance of the breast depending on the placement of the implant above or below the pectoral muscle

It is obvious that if the patient has sufficient volume of her own breast tissue, which is enough to completely hide the implant and avoid contouring and ripples at the edges, placing the implant under the gland will give the most natural result.
This is understandable, since in this case the implant only adds volume to the gland, which mimics breast enlargement in a natural way, adding volume to it, and not lifting it.

Women with a sufficient or large volume of their own breast tissue, in which the implant is placed under the muscle, often complain that, for example, when playing sports, their breasts in motion after implantation look unnatural - like a two-story tower, the second floor of which is displaced relative to the first.

But women with moderate or small breast volume will definitely benefit from implant placement under the muscle. Placed implants above the muscle (subglandular) in such patients will look frankly artificial and false, as they are close to the surface.

Placement of the implant under the mammary gland, but above the pectoral muscle.
Technically, all implants are placed under the mammary gland, since implants placed under the muscle are also under the mammary gland.

However, "placement of the implant under the gland" refers to the placement of the implant between the mammary gland and the pectoral muscle.

The location of the implant partially under the muscle is very often, apparently for brevity, simply called "under the muscle".
Which is not entirely correct.

With subpectoral placement, the implant is placed under the pectoral (pectoral) muscle only partially due to the characteristics of this pectoral muscle. The lower part of the implant in this approach is not covered by muscle.

And although when the patient says “under the muscle”, most likely she means partial, subpectoral placement, there is also a technique when the implant is really completely under the muscle layer.

This technique implies that the implant will be covered from above by the pectoral muscle, and from below and from the sides by the muscles adjacent to the lower part of the implant.

This is another option, standing in line with the placement of the implant "under the gland", "under the muscle" and "partially under the muscle".
Fascia is a thin layer of tissue that covers the pectoral muscle. The surgeon separates the fascia from the muscle and places an implant under it.

And although the technique was fashionable a few years ago, and many doctors practiced it, time has shown that placing an implant under the fascia does not provide any additional advantages.

Risk of capsular contracture

Many surgeons provide statistical data from clinical studies showing that the risk of capsular contracture is lower when the implant is placed partially or completely under the muscle than when it is placed under the gland.

However, other surgeons cite statistics that indicate quite the opposite.

In fact, there is no single agreed opinion on this matter today.

One option that has been proposed to prevent capsular contracture is a textured implant surface.
Even here, though, there are some debates. For example, some surgeons find that a textured surface makes ripples more visible than a smooth one.

Ripple and implant competition

Patients with a small amount of breast tissue benefit when placing an implant under the muscle.
In this case, this approach reduces contouring and ripples along the edges of the implant, since, in addition to breast tissue, it is also covered by the pectoral muscle.

Mammography

And although technology advances and implant placement under the gland is not such a problem for breast imaging today as it used to be, nevertheless, it is clear that placing the implant under the muscle in no way interferes with the proper image of mammography, in contrast to the option when the implant lies under the mammary gland.

Ptosis (sagging) of the implanted breast

Many surgeons claim that placing an implant under the muscle additionally supports the chest. As a result, in the long term, the risk of breast sagging is less than when placing an implant under the gland.

Unfortunately, mammoplasty does not stop the aging process of the breast in the future.

Whatever method the implant is placed - under the muscle or over the muscle, age-related sagging will not add aesthetics to the shape of the breast. However, as well as for breasts without implants.

Another important issue that is taken into account when choosing one or another implant location is the question of the patient's future pregnancy planning.

And although the implant placement technique today allows you to feed the child in both cases, the risk of damage to the mammary gland during surgery or due to possible complications after is higher when placing the implant under the gland than when placing the implant under the muscle.

Therefore, be sure to discuss this issue with the surgeon, as this may affect the choice of implant placement.