One of the primary decisions in breast augmentation surgery revolves around choosing implant volume and where to place the implant. The implant can be positioned behind the pectoral muscle (submuscular), in front of the pectoral muscle (subfascial), or behind the breast tissue (subglandular). The best placement varies from patient to patient; every plastic surgeon may approach this differently based on their experience. And it goes without saying that each position has its own advantages and disadvantages. Here, we'll delve into these placements, from the deepest option to the most superficial one.
Submuscular Breast Implant Placement
Most surgeons prefer the submuscular placement of silicone implants during breast augmentation. If a patient has insufficient breast tissue to cover the upper part of the implant, this placement becomes particularly beneficial.
In patients with a broad body and muscular structure, who desire a minor change in volume, the breast implant can largely be accommodated under the chest muscle. However, when a more pronounced implant volume is desired or suitable, it's often not possible for the implant to remain entirely under the muscle. Therefore, in most submuscular placements, the muscle covers the middle and upper parts of the implant, leaving the lower part exposed.
The objective here isn't to entirely envelop the implant with muscle but to keep the most noticeable top part under the muscle layer. This creates a smooth transition between the breast tissue and the implant, preventing the implant from becoming unpleasantly noticeable in the future. However, there may still be some visible rippling in patients with thin muscle tissue receiving more voluminous implants.
One of the main benefits of submuscular placement of breast implants is maximizing the protective layer offered by the muscle tissue over the implant. This method also helps the implant to elevate the breast tissue and place the nipples in a higher position.
A frequently asked question during consultations is whether submuscular placement prevents sagging. Since the chest muscle is attached to bones and is largely stable except for arm movements, patients tend to assume that the muscle will "hold" the implant in its place. This assumption, however, is incorrect.
Breast tissue covers a wide area and can separate from the underlying muscle tissue over time due to gravitational effects and loss of tissue and skin elasticity. This is a primary cause of sagging in cases of significant weight fluctuations. Therefore, placing implants behind the pectoral muscle doesn't prevent sagging.
In rare cases, an undesirable appearance can result if the muscle tissue adheres too much to the implant and the breast tissue slides down over time. Although some surgical approaches can minimize this, post-operative healing and tissue displacement can vary greatly among individuals.
In such instances, treatment options might include opening the capsule surrounding the breast implant and pulling down the existing implant or a larger one to increase fullness in the lower part of the breast. Or, if required, a breast lift surgery can be performed.
Subfascial Breast Implant Placement
The fascia—a layer covering all muscles in the body, including the chest muscles—varies in thickness depending on the individual and their muscle structure. Despite being thinner than the muscle, the fascia still acts as a protective barrier for the implant. The level of protection it provides depends on the thickness of the patient's breast tissue, the fascia itself, and the implant volume.
Subfascial placement can help with a less painful recovery period. It can also reduce the risk of implant displacement due to excessive chest muscle activity, an issue that can occur with submuscular placement. This method prevents complications caused by the implant being held too tightly by the muscle, as discussed above. It can also provide an additional layer of protection compared to directly placing the implant behind the breast tissue.
To optimize the benefits of this thin layer, it's critical to separate this tissue very carefully during surgery to preserve its integrity.
Subglandular Breast Implant Placement
The breast is composed of breast tissue, fat tissue, skin tissue, and connective tissue. In patients with ample breast tissue, the implant can be placed directly behind it. The sufficiency of the tissue depends on not just its thickness but also the size of the intended implant. Factors such as skin thickness and breast tissue thickness, as well as potential changes such as weight loss, should also be taken into account when planning the surgery.
Subglandular placement often results in a less painful post-operative period than submuscular and subfascial placement. This approach also offers benefits like direct elevation and projection of the breast tissue.
With subglandular placement, the entire breast is separated from the underlying muscle and fascia. No intervention is done on the breast tissue in this technique.
Breastfeeding After Breast Augmentation Surgery
Prospective breast augmentation patients often voice concerns about breastfeeding post-surgery. It's important to note that irrespective of the implant's placement, the milk ducts remain intact during breast augmentation. Therefore, patients can safely breastfeed after the surgery. However, pregnancy and breastfeeding can alter the size and shape of the breasts. It may be advisable to postpone procedures such as breast augmentation and breast lift until after childbirth to achieve optimal aesthetic results.
Dr. Bora Ok is an expert surgeon with advanced surgical skills. He understands the profound physical and emotional impact that breast surgery can have on patients. If you're in search of a top breast surgeon in Istanbul, Dr. Ok is ready to answer all your inquiries. For information about the cost of breast augmentation in Istanbul, please arrange a consultation with us via Whatsapp at +90 552 822 23 21