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Placement of Breast Implants the Beverly Hills Style
By Stuart A. Linder, M.D. | August 8, 2008
Today’s blog has to do with the placement of breast implants, whether saline or silicone. In general, breast implants should usually be placed subpectoral (behind the muscle) whenever possible because:
- it reduces encapsulation and scar tissue
- reduces visibility and palpability of the bag
- it just looks more natural in appearance
There are cases of placing an implant above the muscle. Sometimes if a patient has very thick tissue and has an endomorphic or a barrel chest (this can be seen in a lot of Eskimo or Latin American patients with very thick chest walls), they may do better with the breast implants above the muscle so that the fullness of the bag can be more appreciated and it won’t be as flat or blunted.
However, with the majority of our patients, we like to go subpectoral (behind the muscle).
Subpectoral Placement of Breast Implants
Now what does subpectoral really mean? Patients ask me every single day, “How much of the breast implant is covered by muscle?” Specifically, we use the dual plane technique, meaning that anywhere between one-half and three-quarters of the implant from the middle of the chest towards lateral is covered by the muscle. The lateral third of the bag is usually only covered by breast tissue. So the dual plane technique or submuscular really means about three-quarters of the bag at most is covered by the pectoralis major muscle.
There really is no such thing as total muscle coverage unless the serratus anterior muscle on the side of the chest is pulled up laterally. This really is not performed in elective cosmetic breast augmentation surgery. The serratus muscle should be spared for women who require breast reconstruction for cancer reconstructive surgical purposes.
Therefore, when a patient says, “How much of the breast implant is really being covered by muscle,” in the dual plane technique at most two-thirds or three-quarters is the correct answer.
The most natural looking breast in the world has implants placed in the dual plane with some muscle coverage. This reduces the fullness in the upper pole and allows for a more natural shape. This is especially important in patients who are found in the Entertainment Industry, including Playboy, Penthouse, Hustler and all the other magazines where women make a living off the appearance of their breasts.
The round ball look really isn’t in at this time in 2008 and thankfully, I don’t get too many requests for the round ball stage look with implants above the muscle.
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