Breast Implants are one of the most common plactic surgery procedures performed today.
It involves the surgical insertion of a silicone or saline filled implant into the breast area, either over the muscle (but under the mammory glands- known as sub-glandular or ‘overs’) or under the muscle (known as sub-muscular or ‘unders’).
Sub glandular
Implant is between the breast tissue and the pec muscle wall
Pros:
- Simplest Procedure for Surgeons
- Less recovery time, with less post op pain/ discomfort. Only skin and fat are cut.
- Can help to fix minor sag (ptosis) however it is not a long term fix, as they will often need a lift in the future, especially when larger implants are used.
- This placement allows for larger implants to be placed in the first operation compared to under the muscle.
- Cleavage is more easily created with this placement, especially in naturally wide set breasts
- For weightlifters and body builders they do not ‘distort’ when the pec muscle is flexed
Cons:
- Ripples are more common in women with very little breast tissue and the edge of the implant may be visible. This is more common with textured implants.
- It is more difficult for a clear image to be taken when having a mammogram.
- There is the highest rates of Capsular Contracture.
- ‘Bottoming Out’ is more likely to occur with over than complete sub-muscular implants. This is where the implant appears to drop below the correct position.
Subpectoral/ Submuscular
The implant is placed under both the mammary glands and the pectoral muscle.
It should be clarified with your doctor whether a complete submucular or partial sub-muscular placement will be performed.
Even the FULL sub-muscular leaves around 1/3 of the implant uncovered (depending on the size of the implant).
Pros:
- Implants are covered by a the layer of faschia and muscle, which makes the implant less visible from around the edges.
- Lowest risk of rippling
- Lowest risk of capsular contracture
- Lowest risk of bottoming out
- The Fascia helps to support the implant somewhat, providing added support rather than just the skin supporting the bottom
Cons:
- More discomfort/ pain during recovery
- Breasts may sit higher on the patient for a short time post surgery.
- In patients with minor sag that do not want a breast lift may find that the implant sits higher than the under hanging skin. This is less likely with a larger implant that fills out the skin but may still occur depending on the extent of the droop. This is known sometimes as ‘double bubble’
- Muscles can look distorted when flexing and weight lifting. Many body builders opt for ‘overs’ for this reason.
Breast Implant Types
Saline and Silicone breast implants are both available in Australia, although silicone tend to be used more commonly. There are advantages to both.
Silicone is found in many different surgical procedures such as in artificial joints, facial implants and various other surgical procedures. They come pre-filled which means that a larger incision is needed for inserting them compared to saline. This limits the size that can be placed in certain incision sites (eg. The transax (arm pit incision) can not fit larger implants through. However saline implants are inserted unfilled and can therefore have a smaller scar and be filled to a greater volume.
Silicone breast implants tend to feel more natural and are less likely to ripple. They can also come in anatomical shape, whereas saline do not.
Saline breast implants generally deflate quickly (over the space of a few days) if they rupture and the body absorbs and disposes of the saline...
Breast Implants also come in Textured and Smooth shells
Textured breast implants are designed to reduce the chances of capsular contracture. There are mixed opinions amongst surgeons about whether there is any actual benefit of these textured shells. Studies in regards to this seem to be inconclusive.
Textured implants also come in anatomical shapes. This prevents the rotation and movement of these shaped implants (round implants can move and rotate but atomically shapes need to retain their orientation in the breast pocket).
Textured implants have a thicker shell and tend to feel firmer than the smooth implants
Smooth Implants have a thinner shell than textured implants but a longer life span and are less likely to leak and ripple than textured shells.
Profiles
Implants come in several different profiles. These allow for varying desired profiles and for a variety of body shapes.
High Profile
This shape has the smallest diamater or base compared to the projection (if viewed from the side of a patient this is the amount the breast ‘projects’ outwards). On a narrow chested patient this can allow for a larger volume implant to be used.
These also come in Ultra High Profile, with the highest projection/ lowest width ratio.
Moderate Profile
These have a wider base dimeter and a moderate projection or ‘height’. These give a wider look and tend to achieve more ‘cleavage’ compared to a similar volume in High Profile (HP).
These also come in Moderate + profile. These are in between high and moderate profile in dimensions.
Low Profile
Although not commonly used these allow for maximum width with the lowest projection.
Smooth Round Low Profile
Anatomical Shape
This is designed to be a ‘natural’ breast shape, with more volume in the bottom part of the implant and a gently sloping upper fullness (upper pole). These were originally designed for breast reconstruction patients but have become available for women who prefer this shape.
There are mixed opinions on whether they do achieve a more natural result. Some argue that when a woman stands upright the round implant falls naturally into the bottom part of the breast pocket creating the same look as the anatomical implant but when the woman lies down, the round implant lies more naturally, but the anatomical implant retains the same shape of an upright woman- making it less natural looking.
These impants are only available in textured shells to prevent the rotating of the shape and distortion occurring.
Incisions
Four main types of incisions are used during breast augmentation:
- Inframammary Incision (crease or fold incision)
- Periareolar Incision (nipple incision)
- Transaxillary Incision (transax or armpit incision)
- TUBA Incision (belly button, navel, or transumbilical incision)
It is important to remember that your surgeon will discuss the best placement for you, and that it is important to chose an incision that he is well experienced in. The skill of the surgeon in achieving a good result for you is more important than the placement of the scar in the end.