Pantao Health

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:

1. 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.
2. 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.
3. 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.
4. 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.

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Breast lift is the more common term known for the surgical procedure known as mastopexy. Mastopexy literally refers to any kind of breast surgery. Most people, however, refer to mastopexy as a breast lift. This is because other surgical procedures involving breasts have their own names (i.e. breast augmentation, breast enlargement, breast reduction)

Five of the most common reasons women elect mastopexy procedures are:

• To reshape the areola. A woman may feel that her areolas are too large for her breasts. She may feel that they are not similar looking enough.

• To move the areola. In this case, a woman may think her areolas are pointing too low. Alternatively, they may not point in the same “headlight” direction.

• To change the shape of breasts. Many reasons may make a woman want to change the overall shape of her breasts. Her breasts may have developed abnormally congenitally. They could be misshapen through an accident or necessary surgery. The breasts could also be noticeably different sizes.

• To change the size of the breasts during breast augmentation. This process is done in conjunction with breast implants.

• To raise sagging breasts. Aging, weight gain, pregnancy, and breast feeding have the same impact on the once perky breasts of youth. Over time, most women’s breasts tend to sag and become more pendulant. A woman may want her breasts reshaped so that they do not have as saggy an appearance.

Generally, during a mastopexy skin around the breasts will be cut out. This process sculpts the breast shape. Mastopexy can greatly improve the shapes of the breasts. Early surgeries would leave small vertical scars coming down from the areola. The visibility of these scars differed individually. This type of surgery is called the anchor-shaped mastopexy because of the resulting scar.

Plastic surgeons have made progress with reducing the amount of scarring noticeable from mastopexies. Unless a lot of skin must be removed, an alternative mastopexy procedure is available. This is called the concentric or doughnut mastopexy. This procedure only leaves a thin scar around the areolas. For this type of mastopexy, sometimes only local anaesthesia is used as opposed to general anaesthesia.

Women have been able to convince their insurance company that a breast reduction is medically necessary. Back pain is a main reason used. Ulcerations of skin folds under the breasts are also used as medically necessary. This is the only way insurance companies will sign off for surgery coverage. Unfortunately, the same has not been the case for mastopexy. For most cases, women have not had much luck convincing insurance companies that this procedure is medically necessary. Exceptions occur sometimes when breasts are reshaped as a result of cancer surgery.

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