Breast Augmentation (cont.)
Incisions - Pocket Location - Silicone vs. Saline - Implants and Mammography - Implant Massage Exercises
Pocket Location
There are 2 alternatives for the location of the implant pocket, subglandular (on top of the muscle) and subpectoral (under the pectoralis major muscle). An implant in the subglandular position has the potential for more visible rippling as well as distortion of the natural slope of the breast. Our preference is to place implants in the subpectoral position, where the pressure of the muscle helps to smooth out the implant and minimize rippling. The muscle also drapes over the superior portion of the implant, creating a natural slope in profile. Patients who have previously had implants placed in the subglandular position can have them replaced in the subpectoral position if they are dissatisfied with the visibility of the implants.
| Before |
After |
 |
 |
 |
 |
Age: 44 yo
Procedures: Bilateral capsulectomy; implant exchange from subglandular to subpectoral position
Incision: Inframammary
Implants: Silicone, moderate profile
- Left: 350 cc
-
Right: 350 cc
Time after surgery: 3 months |
Top of page
Silicone vs. Saline
In November 2006, the FDA approved silicone implants for breast augmentation in patients over 22 years old. Prior to that, silicone implants were only available to patients getting breast reconstruction, participating in clinical trials, or in other special circumstances. The decision whether to use silicone or saline is a personal one, though there may be situations where one may be a better choice than the other. Typically, if a patient has a small amount of breast tissue, silicone implants will feel more natural and have less visible rippling. If there is already a moderate amount of breast tissue present, then the breasts can be enhanced with either silicone or saline implants. Additional information regarding silicone implants will be provided at the time of consultation.
| Before |
After |
 |
 |
 |
 |
Age: 50 yo
Incision: Inframammary
Implants: Saline, moderate profile
- Left: 275 cc
-
Right: 275 cc
Time after surgery: 3 months |
Top of page
Implants not only come in a variety of sizes, but also different shapes (anatomic vs. round), profiles (moderate vs. moderate plus vs. high), and surfaces (smooth vs. textured). Anatomic implants are shaped like breasts with less volume in the upper half and more in the lower half. They are textured to prevent them from rotating, as this may cause distortion of the breasts, and are only available in saline at this time. Our preference is smooth round implants, as they will slope when the patient is standing and round out when lying down like natural breasts. They also come in different profiles, allowing us to individualize breast augmentation for each patient.
| Before |
After |
 |
 |
 |
 |
Age: 28 yo
Incision: Periareolar
Implants: Saline, moderate profile
- Left: 375 cc
-
Right: 365 cc
Time after surgery: 12 months |
Top of page
Implants and Mammography
When an implant is placed in either a subglandular or subpectoral position, it compresses the breast tissue, making it appear denser on a mammogram. In the subglandular position, the breast tissue wraps around the implant, making it more difficult to assess the peripheral tissue. In the subpectoral position, there is a distinct layer of muscle separating the breast tissue from the implant. Ecklund views are included in breast augmentation patients. These views involve pushing the implant out of the way to better visualize the glandular breast tissue.
| Before |
After |
 |
 |
 |
 |
Age: 44 yo
Incision: Inframammary
Implants: Saline, moderate profile
- Left: 325 cc
-
Right: 400 cc
Time after surgery: 6 weeks |
Top of page |
