What is the best location for a breast implant – under the muscle or under the gland/ over the muscle?
Here is a recent question answered by Dr Marucci on the breast.com.au forum:
Hi I’m hoping someone can help me…I’m due to have a BA on the 7/5/13. My surgeon has come highly recommended and I’m comfortable with him. Quite a lot of people I know have had an BA and the majority of them have had the placement of the implant under the muscle. I’m 41, I’m currently a C cup and will be a DD after the BA. I’m 163 cm and 50kg with a petite frame with good and plenty of breast tissue except the upper pole lacks due to having 2 children and age:) My surgeon has recommended placement to done OVER the muscle. I have done so much research and have seen 3 surgeons before choosing the once who is doing the BA. I’m so worried about him doing the placement over the muscle as I have read that doing so has more of a risk for CC, rippling and bottoming out. Also most sites on BA are American sites and almost 100% of BA’s are done under the muscle.
Also, my doctor recommended that I not fly for 3 weeks after surgery as I planned a trip over seas. Does this sound right?? How long will I have to wear the garment put on my breasts after surgery for?
And Dr Marucci’s reply was:
Different surgeons will give you different honest opinions -which can make life confusing I know. In terms of whether to place an implant under or over the muscle: most surgeons will do a skin pinch test on the chest above the nipple to see what the tissue coverage (or camouflage) for the breast implant will be. If less than 2cm of tissue can be pinched up in this location, it means that the shape of the upper part of the implant may be visible under neath the skin, giving you a less than natural result. If more than 2cm of soft tissue can be pinched up, then the implant can safely be placed under the gland with little risk of visibility. Placing the implant under the gland is an easier operation than under the muscle, and the risks of bleeding (haematoma) are less. The implant can also be placed closer to the midline (giving you a more pronounced cleavage) if it is under the gland (the muscle attaches to the side of the sternum, which prevents the implants being placed much closer than this). As you point out, there is a statistical higher risk of capsular contracture with implants under the gland as opposed to under the muscle. The final thing to add is that if you have a small degree of breast sag (or “ptosis”) which your plastic surgeon is trying to correct, then your surgeon will certainly want to put the implant under the gland, as this seems to lift the nipple position more than under the muscle. If in any doubt, please schedule another appointment with your plastic surgeon BEFORE the big day, just so all your questions are answered. I think hanging around town for a few weeks after the surgery is a good idea, in case there are any problems, I ask my patients to wear a sports bra with no underwire day and night for 2 weeks after the surgery (but everyone tells their patient something different, so I”d go with what-ever your PS says!) Good luck with it all!
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Dr Marucci is a Sydney plastic surgeon who performs breast augmentation and breast implant surgery. To arrange an appointment with Dr Marucci, call 9588 6374.
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