Breast augmentation using breast implants is probably the most common cosmetic surgical procedure to date. The procedure began in the 1960s and has evolved into a much more sophisticated and safer operation than ever.
I personally prefer exclusively silicone implants. I find that allergen naturalle implants give us the best results. When this operation was first implemented implants were placed over the pectoralis chest muscle. Logically this is the place for the implant since we are augmenting the breast tissue and not the muscle. However through the years one of the issues that came up was wrinkling of the implant over time as the breast tissue thinned with age.
Also during a period of implant controversy the effectiveness of mammograms was questioned when the patient had implants over the muscle. The fear was that some if not microscopic breast tissue could be under the implant and therefore evade mammography detection. Also it was believed that the incidence of hardening or capsular contracture was decreased if the implant was placed under the muscle.
Therefore, decrease wrinkling, better mammography detection, and decreased capsular contracture
were several of the reasons why the trend had moved toward sub muscular placement. Today however
after realizing that some muscular placement has several less than optimal conditions we are moving back toward over the muscle in certain circumstances.
Also the wrinkling is addressed at least by Allegan with implants of varying viscosity. The higher the viscosity or thickness of the gel then less likely will there be over wrinkling of the implant detectable through visible or palpable means. The answer is sometimes it’s better under the muscle and sometimes better over the muscle. The placement of the implant must be discussed very thoroughly between the doctor his staff and the patient before finally deciding. It’s not always easy. The goal is the best outcome for the patient. For example in a primary breast augmentation with very little breast tissue sub muscular is probably the best. But we know that some muscular doesn’t achieve the best results right away because it takes time for the sub muscular implant to settle. Therefore we achieve a faster aesthetic result over the muscle.
However if a patient has pseudo-ptosis or has had long-standing implants the excess skin may not be filled with the implant under the muscle. Therefore in those cases over the muscle with highest viscosity implants may be the best way to go. There’s also consideration for breast lift. In summary each patient is individualized and and I discuss this very thoroughly during the consultation in order to achieve the best decision for that particular patient.