A new look at breast implant placement

San Diego — While the great majority of breast augmentation surgeries are performed placing the breast implant under the pectoralis muscle, surgeons are now exploring possible advantages of placing the implants under the superficial fascia of the muscle. They say the results are better than expected.

Outdated perceptions Traditionally, subpectoral placement has been favored because there was less of a rippling effect, doctors saw less scar tissue formation with the use of the old silicone implants and patients could more easily undergo a mammography.

Speaking at the American Academy of Cosmetic Surgery (AACS), cosmetic surgeon Patrick McMenamin, M.D., Sacramento, Calif., says these perceptions may be outdated, and subfascial placement offer various patient advantages.

Dr. McMenamin responded to each of the statements in support of subpectoral implants:

"There is less scar tissue with any implant used today than in the past — even with silicone — probably because of an increased density of the current silicone and the shell," Dr. McMenamin explains. "There is the same amount of scarring with saline implants whether they are placed above or below the muscle. The individual's scar pattern is a bigger determinant of scar tissue formation."

Dr. McMenamin says women with implants actually have a lower incidence of breast cancer than women without implants because they typically have less breast tissue.

"With saline implants, there will be rippling. It is really a matter of degree, and the patient must decide if they will tolerate this," Dr. McMenamin adds.

Rippling can occur as a result of either subfascial or subpectoral placement. It is a matter of degree, patient perception and a reflection of individual tissue properties and implant size, according to Dr. McMenamin.
He says if the importance of those three factors are negated, then surgeons have to look at both methods of placing implants and look at what other advantages and disadvantages exist.

Implant assessment Dr. McMenamin divided the assessment of the implants into four categories: appearance, movement, settling and rippling.

"When some women who have subpectoral implants flex their pectoralis muscles, the implants move up and out toward the armpit and they can actually get a visible and unattractive crease in the top of the pectoral muscle. I have not seen that with subfascial placement. Under the fascia, it doesn't ride as high, the recovery process is easier and the healing, more predictable."