The technique breast implants under the muscle, or more commonly referred to as submuscular implant placement, positions the device under the chest muscles to achieve these goals:
- Additional soft tissue coverage
- More natural contour / more teardrop shape
In patients with small breasts or low body fat percentage (e.g., female athletes and body builders), the risk of visible scalloping especially around the implant’s edges is higher than women with ample amount of soft tissue coverage. The same is also true for individuals who have had mastectomy or breast cancer surgery.
The most effective way to eliminate or at least minimize the risk of scalloping in thin and small-breasted women is to use the submuscular technique. In addition, this implant placement has been known to reduce palpability and firmer feel due to the additional soft tissue coverage.
For patients with very little coverage, breast implants over the muscle, or subglandular technique, can lead to less than optimal results. Some even have described their breasts to feel and look like a stiff water balloon; this problem is further aggravated by the use of large saline implants.
Saline implants are filled with sterile salt water, so most doctors prefer to position them underneath the muscle, particularly if there is little soft tissue coverage. Silicone implants, meanwhile, contain a more cohesive filler material that almost feels like the glandular tissue and fat.
Proponents of the submuscular technique suggest that it promotes better shape—i.e., the upper cleavage appears relatively concave while the bottom half looks rounder. While anatomical or teardrop implants may also simulate this look, they pose a risk of flipping over and causing deformity.
Round implants, which in essence are shaped like a flattened sphere, do not pose the same risk as the anatomical implants. And once inside the breast pocket, the gravitational effects turn their innate shape into something that resembles a teardrop, thus obviating the need for a “real” teardrop implant.
But with the introduction of form-stable, highly cohesive silicone implants (gummy bear implants or fifth generation silicone implants), the “teardrops” are making a comeback, according to Los Angeles plastic surgery analysts.
To recap everything, the submuscular placement favors women with little tissue, especially if they are using saline implants. However, the technique remains a viable option for patients with ample coverage and prefer silicone implants.
The subglandular technique, meanwhile, is [almost] only used in patients with sufficient breast tissue who are using silicone breast implants.
Breast implants are often used in cosmetic breast augmentation in which the goal is not just to increase the “cup size” but also to reshape it in a way that it looks natural and proportionate. Some women also ask for these prostheses to achieve more fullness in their upper cleavage, which sometimes deflate after pregnancy or weight loss.
One of the most common concerns of women considering getting their breasts augmented is the unnatural feel and look.
Contrary to popular belief, breast implants are hard to detect by touch especially if the patient has a good amount of coverage to begin with, i.e., breast tissue and fat, as suggested by renowned Beverly Hills plastic surgeon Dr. Tarick Smaili.
In case that you have some deficiency in breast tissue, Dr. Smaili recommends silicone breast implants to compensate for the lack of coverage. These prostheses are prefilled by their manufacturers with a highly cohesive medical-grade silicone gel that “behaves” and feels like natural tissue.
Saline implants, meanwhile, are positioned inside the “pocket” empty before they are inflated by plastic surgeons with a predetermined amount of saline, or sterile salt water solution. For thin and small-breasted women, Dr. Smaili says they could lead to a more globular look and more palpability as well.
Aside from using silicone implants to make the breasts feel natural, the renowned Beverly Hills plastic surgeon also positions the devices underneath the thick layer of muscle—a technique called submuscular—to further prevent them from being detectable by touch.
The opposite of submuscular, called subglandular, may result in more palpability especially in athletic and naturally thin women, he warns. In this technique, the implants are settled above the muscle, with only the breast tissue, fat, and skin enveloping them.
Another way to make your postop breasts feel natural, Dr. Smaili recommends choosing a small to moderate augmentation so your underlying anatomies will not be stretched beyond their innate limits.
With overlarge implants, or a size that overwhelms the amount of soft tissue, Dr. Smaili warns that palpability is a huge concern, in addition to higher risk of visible rippling, implant displacement (e.g., bottoming out and lateral malposition), and results that look fake overall.
Despite the use of conservative-sized silicone implants positioned underneath the muscle, Dr. Smaili says that some patients remain susceptible to more palpability and visible rippling due to their anatomies or previous surgeries (e.g., mastectomy), making the use of soft tissue thickener such as fat graft and acellular dermal matrix ideal or even necessary.
As long as the breast implants match the patient’s underlying anatomy, especially in terms of preoperative breast tissue, they can provide results that remarkably look and feel natural.
Aside from anatomy, other variables that dictate the ideal breast implant size and style include lifestyle (i.e., level of physical activities), patients’ cosmetic goals, and even her profession. The idea is to strike the perfect balance between meeting their expectations and respecting their body’s anatomical limits.
Active women—i.e., fitness buffs, running enthusiasts, and professional athletes—can safely have breast implants and enjoy good aesthetic results, although their lifestyle should be treated as one of the main variables that should dictate the ideal or realistic implant size.
In general, implants on the smaller side are the best choice of physically active women who want to continue their lifestyle. The idea is to choose a postop breast size that will not impede with their arm movement, posture, core balance, and arguably the most important, their level of comfort.
Instead of bra cup, plastic surgeons use cubic centimeter or cc to describe the measurement of implants in the most accurate manner. For a woman of average height and weight, a 200 cc implant size can approximately increase her bust to 1 cup.
In general, a 1 to 2 cup increase favors physically active women because it has no or very little impact on their comfort and balance. For such reason, implants that are not larger than 400 cc are believed to be ideal for them and for the vast majority of patients whose goal is to achieve results that look natural.
And because the natural look is the current plastic surgery trend, surveys have suggested that most breast augmentation patients choose implants between the sizes of 300 cc and 450 cc.
While physically active women have different body frames, most of them have a low body fat percentage that predisposes them to higher risk of rippling and implants being more palpable. To counteract these effects, the use of silicone implants is highly ideal because these are filled with a highly cohesive gel that almost feels like the soft tissue.
Saline breast implants, meanwhile, may not provide them with the same natural results because these have the tendency to appear too rounded especially in the upper breast pole for small-breasted and thin women. Some patients have also complained about their water balloon-like and sloshing effect, especially if they come in larger volumes.
The vast majority of breast augmentation patients choose silicone implants because they are filled with a silicone gel that replicates the consistency of natural soft tissue. Nevertheless, saline implants remain a good choice for some women with the “right” anatomy and realistic cosmetic goals.
But some plastic surgeons dislike saline implants, which are filled with salt water solution once inside the breast pocket.
While the choice between silicone and saline breast implants is a personal decision of patients, surgeons in general do not recommend the latter for women whose pre-existing bust size is too small, which could predispose them to higher risk of implant rippling, palpability, and unnatural contour.
Saline implants tend to look and feel less natural compared with silicone implants because of the way salt water solution “behaves” and how it lacks cohesiveness. This is particularly true if they are used in women with very little tissue and/or they are too large relative to the patients’ underlying anatomy.
Breasts augmented with saline implants also look rounder and feel firmer than those enlarged with silicone implants. For many patients and doctors, this is already a deal breaker.
However, Beverly Hills plastic surgeon Dr. Tarick Smaili warns that it would be imprudent to automatically label silicone implants as superior over saline implants (or vice versa) since the ideal choice depends on the patient’s goals and underlying anatomies.
For women whose preoperative breast tissue is relatively abundant, a small to moderate size saline implants can provide natural results almost similar to the silicone implants’ outcome, explains Dr. Smaili.
Dr. Smaili says the popularity of silicone implants primarily stem from the fact that many breast augmentation patients have little tissue to begin with, which could make saline implants a “less than ideal” choice if their main goal is to simulate the natural feel and look of youthful, unoperated breasts.
Nevertheless, the leading Beverly Hills plastic surgeon says the choice between saline and silicone implants is ultimately in the hands of patients, adding that they should stay away from doctors who ask very little input from them.
Aside from the type of implant, other factors also affect the final outcome of breast augmentation. For instance, the submuscular or under-the-muscle implant placement is known to result in a more teardrop shape, while the subglandular or over-the-muscle technique leads to a more rounded appearance.
The underlying anatomy such as the amount of preoperative breast tissue and chest measurement can also affect the final result.
Since the introduction of Keller Funnel in 2009, the device has received nothing but praises from breast augmentation surgeons because it can significantly reduce the risk of breast implant contamination, which leads to other benefits.
The Keller Funnel resembles an icing bag whose internal surface has an oily coating that paves way for a quick and efficient implantation, explains one of the leading breast augmentation surgeons Dr. Tarick Smaili. Right after opening the silicone implant from its sterile package, it is poured inside the device which is then squeezed a couple of times to propel the implant into the pocket.
These are the top five reasons why Keller Funnel breast augmentation is good for you:
- It prevents the implants from touching the skin.
The cone-shaped device allows the transfer of breast implant into the pocket without allowing it to touch the skin around the incision site, which is known to harbor bacteria that could lead to shell contamination and infection.
The narrower end of the cone is positioned about 1 cm into the center of the breast pocket before it is squeezed several times to propel the implant into its proper place.
According to studies, compared to finger-push implantation the use of Keller Funnel can reduce the risk of bacterial contamination by up to 200 percent.
- The technique lowers the revision rate.
With no implant contamination or “deep” infection, the risk of capsular contracture or tissue hardening can be minimized as well. The theory is that a low-grade infection triggers the body to “over-react” and produce a copious amount of collagen around the implant, eventually leading to visible deformity and pain.
- Shorter incision is possible.
The main appeal of saline implants, which are filled with sterile salt water once inside the pocket, is the use of smaller incisions, about 1.4 inches or sometimes even shorter. Nevertheless, their results are not as natural as the silicone implants, which are always prefilled by their manufacturers.
With finger-push method silicone implants require an incision usually longer than 2 inches, but with Keller Funnel device they can be introduced into the pocket through the same opening as required by saline implants, leading to a shorter and less conspicuous scar.
- It can significantly reduce the amount of force.
Excessive force applied to any portion of the implant could affect its long-term stability (i.e., more prone to rupture), which is often unavoidable with the use of finger-push method.
But with Keller Funnel, the force is efficiently redistributed around the implant shell at the time of insertion. As a result, the stability of the prosthesis is relatively unaffected after surgery.
- This breast augmentation technique can reduce tissue trauma.
The insertion of silicone implant with Keller Funnel on average only takes 10 seconds, which reduces surgical trauma and at the same time shortens the surgery by 10 to 20 minutes, as suggested by several studies.