Why SubMuscular Breast Implant Placement
"Bottoming Out" Repair
Subglandular placement:
The breast implant is placed beneath the breast tissue and skin, but over the Pectoral musculature.Submuscular Placement:
The breast implant is placed beneath the Pectoralis major muscle as well as breast tissue and skin. This is commonly called "Under The Muscle."A Subglandular Placement Example:
This image shows the result of a mid-sized implant placed in the Subglandular position . The young lady presented to my office one year after her first breast augmentation operation using saline implants (by another surgeon). As she was displeased following the surgery, she went back to the original surgeon four months following the surgery. He responded by making the implants even larger and leaving them "Over The Muscle." The aesthetic problems:
- The implant's margins are very visible here especially toward the cleavage.
- Even though the patient is only one year from surgery, the breast "mound" has already descended objectionably leaving the nipple and areola positioned "too high" on the mound. This is called "Bottoming Out ." and is far more commonly seen with subglandular implants as the Pectoralis major muscle (in the Submuscular case) supports the implants to an extent retarding extreme descent.
- The cleavage is poorly-developed even though the patient is displeased that the implants are too large. Usually larger implants develop the cleavage better.
Here is the same patient ten weeks after her re-operative breast implant surgery. The old implants were removed from the subglandular pockets and replaced with smaller saline implants, which were placed beneath the Pectoralis major muscles. A modified breast lift was performed to reposition the nipple and areola correctly on the new breast mound. The patient's breasts look more natural and the cleavage is better developed. This was a fair bit of work leaving the patient looking almost as nicely as she would have if a Submuscular placement had been performed at the first operation. She required no further breast surgery.
Summation
(1) Bottoming Out Corrected.
(2) Breast Contour Appears More Natural.
In over twenty years of plastic surgery practice, no patient with submuscular implants has requested that her implants be replaced in the subglandular position. There are many patients like the one above who requested the opposite. So Dr D chooses Submuscular Breast Implants nearly all of the time. :)