A good breast augmentation result must simulate the appearance of unoperated breasts—and that means no implant rippling, they are soft to the touch, and have a teardrop shape in which most of the volume is in the lower poles.
Contrary to popular belief, natural results are not only achievable through the use of the “right” breast implant size and style. Breast enhancement expert Dr. Tarick Smaili says that surgical techniques, particularly the implant placement, can also play an important role in delivering good cosmetic outcome.
There are two basic ways to position the implants relative to the muscle: unders or sub-pectoral (also called submuscular), and overs or subglandular.
For many patients, Dr. Smaili says that the sub-pectoral breast implant placement in which the prosthesis lies underneath the thick layer of muscle is a more suitable choice than subglandular technique or overs.
In this technique, the upper two-thirds of the implant is covered by pec muscle, thereby preventing or at least minimizing the risk of rippling and palpability. But because the lower third of the prosthesis is only covered by the soft natural tissue, the technique allows the breast to appear teardrop in shape.
While most breast augmentation patients can benefit from the sub-pectoral approach, Dr. Smaili says that it is particularly favorable to thin and small-breasted women who have little “coverage.”
For patients with little natural tissue, rippling and palpability are more likely to occur with the use of subglandular in which the implants lie above the pec muscle. To achieve good results from this surgical technique, one has to have an adequate amount of glandular tissue and fat.
Aside from cosmetic benefits, the sub-pectoral implant placement could also minimize the risk of capsular contracture or tissue hardening, explains the renowned plastic surgeon.
Studies have suggested that capsular contracture is often caused by low-grade infection or contamination of the implant at the time of surgery. But with sub-pectoral, the muscle can serve as a barrier that prevents the prosthesis from making contact with the tissue that is known to harbor bacteria.
In terms of allowing the breast to age “gracefully,” the sub-pectoral implant placement is often considered a better option than subglandular because the muscle also acts as a “sling” that supports the implants. According to Dr. Smaili, the technique specifically reduces the risk of bottoming out in which the prostheses “go down south” due to tissue laxity and gravity.
But one potential issue with sub-pectoral is breast animation, which happens when the implant is slightly pushed by the muscle each time it is being flexed. Nevertheless, this is a tradeoff if one has little tissue and does not want visible rippling, which of course is more problematic.