The simplified and primary principle of breast augmentation is to surgically create a cavity within the breast into which an implant is subsequently inserted. However, there are several ways exactly where the breast implant can be placed:
- Between mammary gland and pectoral muscle (also called suglandular)
- Partially behind the large pectoralis muscle (subpectoral)
- Completely behind several breast muscles (submuscular)
Subglandular: uncomplicated variant under the mammary gland
For women who have enough autologous tissue, uncomplicated, subglandular placement (below the mammary gland) may be the right choice. The advantage is a fairly fast operation and, above all, healing phase with usually little pain and above all a very natural appearance of the breast form. In slender patients with a small skin-soft-tissue coat of the breast and implants with saline solution, this localization is rather not recommended, since a pleat of the implant, the so-called rippling, may later form visible dents on the breast. Also Bottoming-out, a sinking of the implant, in which the nipple visually "moves up" a bit in relation, occurs occasionally in this method.
Submuscular: Inner bra prevents the implants from slipping off
More often, the placement behind the pectoral muscle is chosen nowadays. In the case of completely submuscular breast augmentation, the surgeon uses several muscle flaps to form a bag in which the silicone prosthesis is subsequently placed. Mostly it is then sewn around the implant, resulting in a particularly non-slip and stable breast shape. This surgical method is therefore sometimes called "technique with inner bra". One of the advantages is that the optimal coverage of the implants hardly leads to edge visibility or rippling. Capsule fibrosis are also less common than in the subglandular method.
Submuscular: Natural optics sometimes in danger
The disadvantage is that the process is more complex and also in the healing process lengthy, possibly also more painful. In muscle tension, the breast can get an unnatural shape, which is why this implant placement is inappropriate for muscular athletes. Generally, you can only use small implants with this technique, which is why it is not used in women who want a particularly lush bust size. The rare, but for this type of breast augmentation specific optical late effects include the double fold formation in the lower chest and the so-called Snoopy-dog deformity. In the latter, the lower part of the chest does not fall naturally in a gentle arc, but stands - like the snout of the well-known cartoon dog Snoopy - relatively pointed forward.
Subpectoral - the best of both worlds?
In subpectoral implant placement, the large pectoral muscle (pectoralis major muscle, hence the name) is placed over most of the silicone prostheses. The lower third remains free and is - as with the subglandular method - covered only by mammary and adipose tissue. This type of surgery is also called dual-level technique or dual-plane. It basically combines the two methods mentioned above and gives the surgeon the greatest possible flexibility to place the breast implants on the one hand as safely as possible, but on the other hand to give the breast form a largely natural and customized appearance. The advantages and disadvantages of the subpectoral method can also be found at the interface between the two options described above.
Which technique is the right one
Which technique is right for you depends greatly on your individual breast and body shape. A good plastic surgeon will give you comprehensive advice and, of course, your wishes and ideas. Almost every doctor has his "favorite methods" of which he is particularly convinced and in which he has a lot of practice. This narrows down the free decision-making process, but through the experience and skill of the surgeon it can also lead to particularly aesthetic and uncomplicated surgical results.
Author: Dr. med. Monika Steiner