Breast Implant Placement and Techniques
While many women consider only the end result, breast implants or “boob jobs” can be inserted using several techniques. These techniques differ in the amount of recovery time needed and in the quality of the end result. Hence, depending on the body characteristics and the wishes of the patient, a surgeon might give preference to a particular technique. In breast augmentation surgery, technique refers to (a) the location of the breast implant with respect to the pectoralis muscle (chest muscle) and (b) the location of the incision.
Breast Implant Placement
The implant can either be placed above or below the pectoralis muscle.
With subpectoral implants (i.e. when placed under the muscle), there is a lower risk of capsular contracture and there is less interference with mammography. Such implants give a better cosmtic result in women with small breasts and worse results in athletic women. Procedures involving subpectoral implants have a longer recovery period, more pain and swelling. General anesthesia is needed.
With subglandular implants (i.e. placed above the muscle but below the breast tissue), there is a greater risk of capsular contracture and greater interference with mammograms. It does not look so good in women with small breasts but looks better in athletic women. It has a shorter recovery period, less swelling and pain. Local anesthesia is sufficient for such procedures.
Location of Incisions
Breast implants can be placed through four main incision techniques:
- Inframammary technique—is by far the most common technique. The implant is inserted in the fold where the breast meets the chest wall. Scars are thus hidden by the crease that the breast does with the chest wall. Milk production capability is preserved as glandular tissue and nerves are not touched. However, there may still be a reduction in milk production if the implant is placed above the pectoral muscle as it can then exert pressure on the ducts and glands.
- Transaxillary technique—the incision is made near the armpit in order to avoid any visible scars. Such implants are usually placed below the muscle. Impact on milk production is minimal as glands and nerves are not touched. The disadvantage here is that there is poor visibility for the surgeon who sometimes have to use an endoscope for the procedure.
- Transumbilical technique—the incision is made at the navel and the implant is inserted there. It is then manoevered into place in the breast. No incisions are made in and around the breast tissue although breast tissue may be damaged when the implant is placed. A camera scope is usually used. Here also, there is minimal impairment of milk production. However, this technique is more difficult and takes longer to complete owing to the difficulty to place the implants accurately.
- Periareolar technique—incision is made around the areola. The advantage is that scars will be effectively hidden by the nipple. However, in this position, the implant causes a lot of damage to glands and ducts, impairing milk production significantly. Moreover there is increased risk of loss of nipple sensation.
