Where Are the Implants Placed with Respect to the Breast?
Placement of breast implants, either under or over the Pectoralis Major or chest muscle has important consequences.
Subpectoral: "Under the Muscle"
In Subpectoral placement, the breast implant is positioned under the Pectoralis Major muscle and directly over the rib cage. In this circumstance, the lower part of the implant is not covered by any muscle. This is preferred by many surgeons because it creates a more tear drop breast shape. On the other hand, some surgeons prefer submuscular implant placement, where the implant is entirely covered by the chest muscles. Another disadvantage of submuscular placement is that flexing of chest muscles during exercise can contract the implants or push them in and out of place.
Subglandular: "Over the Muscle"
Through this method, the implant is placed above the chest muscle, but below the mammary gland. This is a less complex surgery, with less pain and a somewhat shorter recovery. Some surgeons prefer this method because of its ease and speed of implant placement as well as a shorter period of time that it takes for the implants to settle.
How Does the Surgeon Enter the Breast to Place the Implant?
There are four ways to make the incision into the breast for the placement of the implant.
Your cosmetic surgeon will discuss what kind of incision is best for you, depending on your body type, and concerns about scarring and other risks.
Do Implants Come in Different Shapes?
Yes. There are various shapes to implants – including Round, Teardrop — or "Anatomic" as well as a variety of Implant Profiles.
As a general rule, Round implants are wider, provide greater cleavage, and fill in the upper portion of the breast. However, the Teardrop or "Anatomic" implants might be best for women who are seeking fullness mostly in the lower breast. Although Teardrop, or Anatomical implants, were previously more popular, several studies have demonstrated that when a woman is standing, a Round implant takes on a Teardrop shape. The main disadvantage of Teardrop implants is that they do not emphasize the cleavage; and because they have a long shape, if they rotate and tilt onto their side, they can appear odd, or unattractive.
Recently, several manufacturers have introduced a variety of implant profiles from low to high profile. While round profile implants are usually wider and flatter, high profile implants are narrower and taller, resulting in a more pronounced looking breast.
Do Implants Have Different Surface Consistencies?
Yes. A woman can choose between Textured implants, or Smooth implants. Textured implants have a rougher surface. The textured implant’s primary advantage is that it has a much lower incidence of Capsular Contracture, or hardening of the breast capsule. When implants are placed over the muscle, the incidence of Capsular Contracture with smooth implants is approximately thirty percent compared to seven percent for textured. The incidence of Capsular Contracture becomes the same (seven percent) when either implant is placed under the muscle. Some surgeons feel that textured implants are more palpable and do ripple more, but the differences are not documented in large clinical studies. Considering this information, Smooth Implants are preferable, unless the patient has had Capsular Contracture in the past.
Mentor Corporation offers the same implant replacement policy and 5 years warranty for replacement cost. Mentor does offer an extended ten-year warranty for an additional fee.
Both implant manufacturers have implants from 125cc to 850cc volume. Larger implants are not currently being manufactured by either company. The specific volume or size of the implant does not guarantee a bra size; as final breast size also depends on the original size and shape of the breast.
Although the implants that we have discussed are usually for cosmetic Breast Augmentation, they are also used for breast reconstruction after the post-mastectomy chest wall skin has been stretched out to several sizes larger that the intended breast sizes, with a breast implant tissue expander.