Want bigger boobs? Thinking about breast augmentation? What do you need to know to make an informed decision and get the result you want to see? There are 5 important surgical decisions you will need to make with your surgeon. The five basic surgical decisions in breast augmentation are:
- The implant size & projection
- The look you want – natural or fake
- The implant type – shape, shell and filler
- The pocket location – over vs under vs Dual Plane
- The incision location
Understanding these options before going in for your consult will help you and your surgeon discuss and decide what is best for you. This blog is going address number 4 – The pocket location – over vs under the muscle. It’s not the sexiest decision in breast augmentation but it is super important, here’s why.
If you don’t put a breast implant under adequate soft tissue coverage, you will see and feel the implant. It is that simple. So choosing the proper pocket location is very important.
Understanding Anatomy
First, let’s look at where the breast implant is actually going live on your chest wall. A pocket must be made so that the implant can be placed centered behind the nipple areolar complex. The question is, where should that pocket be? Most women who want a breast implant are thin in the upper chest area. If you were to try to measure pinch thickness of tissue in the upper breast near the sternum, most would measure less than 2 cm in thickness. If you are super thin in this area and the implant is just put under thin skin and very little breast tissue, chances are you will feel and see the implant. That means seeing edges and rippling all the time. Putting an implant under just breast tissue or “submammary” in thin patients can yield a very unnatural looking and feeling breast.
But if you put it “under” muscle, what muscle are we talking about? The muscle in question is the pectoralis muscle. It runs across your chest wall like a Miss America sash. So if the entire implant sat under “muscle” the placement would be much more like shoulder pad than a breast. So if there is less than 2 cm of pinch thickness in the upper breast, and more soft tissue coverage is needed, how does that work with the pectoralis muscle? A key word is missing from this over vs under debate and that is the work partial. Generally speaking, when an implant is placed “under” muscle it is placed partially behind the pectoralis muscle or partially subpectoral.
Breast implants can certainly be placed completely submuscular, which involves using pectoralis and serratus, but that extreme measure is more commonly used in breast reconstruction following mastectomy when there is very little soft tissue to work with.
Under
Submuscular augmentation is most commonly used. Because there is more tissue covering the implant, there is less palpability and visibility of the implant and a more natural upper pole slope. In thin women, placing the implant under the muscle gives a more natural appearance by hiding the edges of the implant especially in the inner and outer parts of the breast. One of the major benefits of submuscular augmentation is that there is a 50% lower incidence of capsular contracture (scar tissue formation around the implant) using this approach. When breast implants placed are placed partially under the pectoralis muscle, mammograms are easier to perform and read.
Submuscular augmentation is slightly more painful and requires time for the implant to assume its final position. In the first several days after surgery, the muscle will be tight over the implant which pushes the implant upwards (riding high). Over time the muscle will stretch and relax so that the implant will lower itself into a more natural position.
Is there a better option?
Dr. Mark Deuber, Dallas plastic surgeon, uses a third and better option to develop the pocket location for his patients desiring breast augmentation. A Dual Plane pocket is the literally the BEST of both worlds. It is partially subglandular and partially submuscular. This approach is beneficial in cases with looser skin and a more droopy or ptotic appearance. The dual plane allows more perfect centering of the implant directly under the breast to prevent the implant from sitting too high in relation to the breast (double bubble). Dual plane breast augmentation allows for submuscular placement of the implant and creates release of the breast tissue above the muscle to allow the breast to position itself more directly over the implant and avoid a double bubble appearance.
This technique is useful in cases of breast ptosis or pseudoptosis where the breast is somewhat droopy or ptotic such as occurs after childbirth and breast feeding. Breast implants that are placed in a Dual Plane pocket provide an easier approach for mammograms and self breast exams. Creating a Dual Plane pocket allows Dr. Deuber to truly customize the location of the implant for each individual patient.
24-Hour Recovery Breast Augmentation
By using the best of both of the worlds in soft tissue coverage in breast augmentation, Dr. Deuber creates the most natural result with the least risk of complications. Placing the breast implant in a Dual Plane pocket allows Dr. Deuber to maximize soft tissue coverage while minimizing muscle distortion over the implant and his breast augmentations, breast lifts with implants and breast implant revision patients still enjoy a 24 hour recovery. Twenty-four-hour recovery breast augmentation is Dr. Deuber’s specialty. Patients experience a little tightness after surgery but go home with no bras, bandages, drains, bruising or pain meds. They are up and active and resuming normal activity the day of surgery. 24 hour recovery breast surgery patients can shower the day of surgery, drive the day after surgery and can resume cardio vascular activity in 2 weeks following the procedure.
To learn more about which pocket location is best for you, please call Dr. Mark Deuber at 214-220-2712 and make an appointment. During your consultation, detailed measurements and soft tissue assessment will tell you and Dr. Deuber which breast implant pocket location is best for you.