• Breast Augmentation

    • Anna Lee’s Information Center for Beautiful Breasts
    • Breast Augmentation
title Decide location to insert implants
Name optima date 2011-11-03



Implants come to located under or on the muscle of breast (Pectoralis Major muscle), in Asia, which breast tissue is relatively poor, it is safe to locate under the muscle and the method to reduce side effects.

On the muscle and under the muscle, between two locations, what are the differences and how can decide? The choice depends on thickness of your breast tissue which can cover implants.

1. Which muscle? Where is it?

Let’s examine anatomical structure. The picture is cross section of side of upper body. Let’s examine each layer of tissue from skin to cover breast. The under of skin is fat layer (it is different per patient). Skin and fat make skin layer of breast. Skin layer covers breast tissue which is the next layer, and big muscle of breast under the breast tissue is located on the ribs. It is possible to insert implants between breast tissue and breast muscle (retromammary), or under the breast tissue and breast muscle (Partial retroperctoral). To understand the word “partial”, let’s examine the front picture of anatomical picture.





胸肌位在胸部上侧的一半或者3分之一左右的胸部组织下,假体置入在肌肉前,假体下方会被组织覆盖,但上方只能被皮肤和脂肪覆盖。假体若置入在胸肌下,假体的上方会被胸肌覆盖,假体的下方只能被(特别是下方外侧部分)胸部组织覆盖。

所以“部分”这个词是假体上方的一部分在肌肉下,下方胸部没有完全被肌肉覆盖的意思。

胸肌下侧位是前锯肌(serratus muscle),为了完全覆盖假体可以动用此肌肉,可这个方法是难度较高的再手术时使用的方法。假体若完全被肌肉所覆盖(total submuscular), 胸部下侧形状不理想,结果也很难预测。假体受前锯肌(serratus muscle)压迫有可能会上移。






Breast muscle is located under breast tissue about one-third or half of upper part of breast. When implants are inserted in front of muscle, the bottom part of implants is covered by breast tissue, but the upper part would be covered by only skin and fat. When implants are located under the big muscle of breast, the upper part of implants is covered by breast tissue and the bottom part of implants (especially external part of the bottom) is covered by breast tissue only.

Therefore, the word "partial" means that some of upper part of implants is under the muscle, and it is not covered by muscle to the bottom of breast completely.

Currently, this method is most widely used.

On the contrary, as for the method to use scarcely now, there is complete submuscular method.

The side under the breast muscle is serratus muscle. To cover implants completely, it is possible to lift this muscle, but this method is used for the case of difficult reconstructive surgery not the breast augmentation surgery. When implants are covered by muscle completely (total submuscular), the shape of bottom part of breast is not good to see, and the results is scarcely hard to predict. The bottom of breast would be more flat and it would not stretch any more though time passed. In case that the pressure of serratus muscle would be added to implants, then implants could be moved to the upper part.

Currently, this method is hardly used.

2. Location of implants, how is it decided based on what?

The method to decide location of implants

according to thickness of breast tissue

 




  1. Very thin patients (in case that the thickness of breast tissue is less than 2cm)



It should be inserted to cover implants sufficiently.

If not, it would be increased that risk that the boundary of implants is seen and risk that it would be appeared in the long term.

 




  1. Patients with enough tissue (in case that thickness of breast tissue is more than 2cm)



After comparing each strength and weakness, and you decide according to one’s own preference or recommendation of doctor.

 

To decide to insert implants on the muscle or under the muscle, it would be considered as follows:

1) Thickness of layer of fat and skin on your breast tissue

If you are thin and wish the upper part of implants are not to be seen, then insert it under the breast.

2) Evaluate strengths and weaknesses which are occurring according to that the location of implants is on or under the muscle.

Anything is not perfect. You should accept the price for your choice.

Which degree is thin? It is difficult question to answer. Which degree patients are thin, is it accept that boundary of implants are to be seen seriously?

It is a more difficult question. The answer for this should follow objective measurement rather than subjective opinion of patients or doctor. As for the method to know that soft tissue to cover implants are enough to decide whether to insert implants on the muscle or under the muscle for thin tissue, there is simple pinch test. Patient can do it by herself with calipers; it divides by pinching breast tissue and then pulling to under and outside part.

By pinching skin on the breast tissue and subcutaneous fat only, it is done by measuring its thickness with calipers. If the thickness is over 2cm, then the tissue is sufficient to insert implants on the muscle, and there is very low risk that boundary of implants is to be seen. On the contrary, it is thinner than 2cm, and then implants should be inserted under the muscle partially.