Place of placement of breast implants
The breast implant can be lodged directly behind the gland, (retromamary or submammary situation), or behind the pectoral muscle (retromuscular or submuscular situation). There is also the possibility of placing it behind the fascia of the pectoral muscle (subfascial situation).
We will describe the advantages and disadvantages of each situation, according to our experience:
The placement of the prosthesis behind the mammary gland was the one used at the beginning of breast augmentation surgery, it is the oldest technique.
- More simple intervention at the technical level; It can be practiced with local or local anesthesia and sedation.
- Less pain in the post-operative than the submuscular situation.
- Does not interfere with the function of the pectoral muscle.
- Aesthetically the result is inferior to the retromuscular; In thin patients, the edges of the prosthesis can be marked.
- A much higher frequency of encapsulation and when it occurs is much more appreciated, both visually and by touch.
- By increasing the weight of the mammary gland as a whole, it can produce a fall of the entire breast.
- Greater difficulty in studying the breast and risk of injury to the prosthesis if a breast puncture should be performed.
We use it sometime; it would be indicated in the following cases and with certain limitations regarding the measurement of the implants:
- Professional sports patients
- Professional sports patients
Tubular breasts and breasts in which the mammary belly is missing; In this cases we practice a mixed technique, submammary inferior pole and subpectoral superior pole.
- There must be a good subcutaneous tissue coverage; that is, they cannot be very thin.
It is a technique created to improve the problems that occurred with the previous one; We have used it for more than 20 years.
- Most natural appearance; The entire prosthesis is covered by the muscle, so the contours are not usually appreciated.
- Lower incidence of capsular contracture; The prosthesis is placed in a virtual plane of displacement of fascias, so the detachment is less traumatic and less tissue is created around the prosthesis. If it becomes contracted, it is less noticeable, both visually and to the touch.
- The muscle acts as a band around the implant that keeps it in position even if we place important volumes; the prosthesis is not falling by gravity.
- More natural touch
- Being the muscle between the breast and the prosthesis, allows to practice guided punctures without risk of a prosthesis puncture.
- The main drawback is the surgical technique itself, it is more complex than the submammary, and requires general anesthesia or very deep sedation.
- In patients with very strong musculature, an ascent of the prosthesis, caused by the action of pectoral muscle. It is important to control this possibility in the post-operative period and prevent such a rise.
- Post-operative with more pain; Anyway the pain can be treated effectively with analgesics.
This technique has recently appeared; designed to avoid some of the drawbacks of the previous techniques.
It is based on the placement of the prosthesis in a plane located between the fascia (membrane that covers the muscle) and the pectoral muscle.
The approach to this plane can be done from an axillary incision, where the prosthesis is placed on the upper part at the subfascial level and on the lower part at the submammary level. Sometimes the fascia is very thin and tears easily, so on a practical level the result is very similar to the submammary prosthesis.
It can also be accessed from the areolar line or from the submammary groove. In these cases, the subfascial dissection can be completed better and get a reinforcement of the lower pole of the breast.
In our view it is very similar to the submammary path, with all its advantages and disadvantages, except in this reinforcement of the lower pole that may slow the fall of the breast.
We use it on some occasion, but in general it does not improve the results obtained with the retropectoral situation.
We use it in the cases in which we would have previously practiced a simple submammary technique, to reinforce the fixation of the prosthesis and avoid the descent of it.
DUAL OR MIXED SITUATION
The prosthesis is placed on the upper part at the submuscular level and on the lower part at the submammary or subfascial level.
It requires a direct approach, either through an areolar incision, in the breast groove or incisions of a mastopexy.
It is indicated in cases in which you have to create a breast beause of a lack of development of the same, in very high submammary grooves, in cases of patients with very powerful pectoral inserts, but certainly the most appropriate case is the surgery of tubular breasts.
The advantage of this situation is that it allows us to take advantage of a submuscular situation in the upper part and gives us the desired shape in the lower part.