Ask a Surgeon - Breast Augmentation - What are the advantages/disadvantages of where a breast implant is placed (ie:...

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What are the advantages/disadvantages of where a breast implant is placed (ie: behind...

Q:

What are the advantages/disadvantages of where a breast implant is placed (ie: behind or in front of the muscle wall)? I am looking to preserve as much muscular function as possible. As well, I am aiming for the most natural shape possible. If I can, how do I look for a surgeon that will give me the stylistic results I desire?

A:

In my opinion, it is highly desirable in most patients to place the saline implant behind the muscle as it looks and feels more natural and has less chance of becoming hard (developing a contracture) over time. This technique also preserves the pectoralis muscle. Seek out a board-certified plastic surgeon, preferably one who is a member of the American Society for Aesthetic Plastic Surgery. You can expect to receive complete information about the procedure, postoperative care and potential risks. According to the ASAPS Bylaws, all ASAPS members must perform this type of surgery only in an accredited outpatient facility, so you have reassurance about the quality of care you will receive. Confirm that your surgeon has privileges to perform your breast augmentation in a hospital setting, as well. Ask to see patient photographs and results, but remember that every patient is different.

Rod J. Rohrich, M.D., FACS - View Other Answers by this Doctor

Dallas, TX

Practice Website

A:

I regularly perform breast augmentation surgery for patients who participate in body building, fitness and figure competitions. While many are initially concerned about sub-pectoral placement and the potential for distortion of the appearance of augmented breasts when the pec major contracts, I am absolutely confident that the aesthetic outcome for these patients will be far superior with implants placed under the muscle.

A pre-pectoral implant in a slender patient, especially one with well-developed muscles, looks just as you imagine it would: like a foreign object, not like a natural-appearing breast. The muscle does not have to contract for a pre-pectoral implant to look unnatural in this group of patients - it looks unnatural every minute of the day.

Achieving the ideal aesthetic position for a sub-pectoral implant requires release of part of the inferior origin of the muscle from the chest wall. I perform the minimal release of the origin of the pec major that is required to get the implant in an ideal position vertically, but also weaken the origin in the area where muscle contraction tends to displace an implant. As a result the vast majority of patients have little to no distortion of their breast appearance when the pec major muscles are tensed. Patients also do not experience any loss of function, strength or range of motion from release of this very limited part of the pec major origin. Many patients have indicated that their natural (but augmented) breast appearance has provided a significant advantage for them in competitions.