- Submuscular Breast Implant Placement and Dual Plane Techniques
- Dual Plane Breast Augmentation
- Inframammary-Periareolar-Transazillary Approaches
SUBMUSCULAR BREAST IMPLANT PLACEMENT AND DUAL PLANE TECHNIQUES
Breast augmentation is the surgical placement of a saline or silicone implant under the skin, breast tissue and muscle of the chest. Dr. Neil J. Zemmel believes placement of the implant beneath the pectoralis major muscle is critical for obtaining an excellent result. There are two reasons for this. First, placing the implant under the muscle provides an additional tissue layer over the implant thereby limiting visibility of the implant. This thicker tissue “pad” hides the implant and gives a more normal contoured look and a gentle slope at the upper pole of the breast. The risk of traction rippling is lowered. Dr. Zemmel’s goal is to give you the most natural look possible.
The second reason for submuscular placement is that it reduces the risk of capsular contracture. Both saline and silicone implants when placed beneath the muscle have a much lower rate of capsular contracture. Furthermore, submuscular placement of implants has the lowest risk of interfering with mammography.
DUAL PLANE BREAST AUGMENTATION
The dual plane breast augmentation approach is a combination approach, which utilizes the best features of both submuscular and subglandular (on top of the muscle) positioning. The common name for the surgical procedure is dual plane breast augmentation and it has become the state of the art method of breast enhancement today. Dual plane breast implants offer a well-balanced mixture of natural look and feel, support and fullness, with the added benefit of very limited additional surgery. Dr. Zemmel offers this technique to all qualified candidates for breast augmentation.
Positioning of Dual Plane Breast Implants
Dual plane breast implants are surgically placed underneath the pectoralis major muscle of the upper chest and breast tissue of the lower chest. The muscle covers the upper one third to one half of the breast implant, leaving the bottom of the breast implant free to descend into a subglandular breast pocket. The implant lies both under the muscle and under the breast tissue, creating a 2 plane (dual plane) approach. Dr. Zemmel prefers this approach to maximize the natural look and feel of the implant.
The Look of Dual Plane Breast Implants
The look of dual plane augmentation is very natural and proportional. The upper pole of the breast implant is well camouflaged by multiple layers of skin, subcutaneous tissue, breast tissue, and muscle. The muscle helps to hold the upper pole of the implant against the chest wall, creating a natural sloping contour without an obvious surgical appearance. This approach minimizes the rounded upper pole look that can give many subglandular breast implants a “coconut shell” look. Dr. Zemmel wishes to always avoid this look. The lower half of the implant moves into the subglandular space creating a realistic bottom contour which features the natural roundness and movement of an natural breast, with the added benefit of additional fullness.
Dual Plane Breast Implants Texture
The type of breast implant material will influence the overall feel of the breasts. In general, Dr. Zemmel believes that silicone breast implants feel somewhat more natural than saline. Cohesive silicone gel mimics natural breast tissue viscosity more than saline solution. The texture of submuscular implants is slightly firmer at the upper pole of the breast and softer and more pliable at the bottom of the breast. This is similar to a natural breast and the added coverage of the pectoral muscle helps to mask the upper rim of the breast implant shell. Post-operatively, many women describe this approach as an even compromise between firm and soft, natural and enhanced.
Dual Plane Breast Augmentation Recommendation
During your consultation, Dr. Zemmel will perform a full history and physical. Dr. Zemmel will measure many dimensions of your breast and evaluate the quality and thickness of your breast tissue, chest muscle, and skin. You will also try on several different shapes and size of implants and together you will choose the best breast implant for your goals.
INFRAMAMMARY-PERIAREOLAR-TRANSAXILLARY APPROACHES
Dr. Zemmel usually accomplishes sub-muscular placement or dual plane breast augmentation via a periareolar, inframammary, or trans-axillary (arm-pit) approach. While all three approaches can provide excellent enlargement of the breast with enhancement in contour, each technique has its unique benefits.
The inframammary technique places the incision in the fold beneath the breast where the breast meets the chest wall. This was the first technique used to place breast implants, and it is the oldest and most traditional technique. A 2.5 cm ( one inch) incision is used for saline implants and 4 cm incision is used for silicone. The approach provides good access for the placement of the implant in the submuscular pocket, and it allows easy access to the pectoralis muscle for release. This approach also has an extremely low complication rate. The scars for this approach typically heal very well and at 6 to 12 months after surgery becomes a fine line well hidden in the breast fold from the frontal view. The scars are usually hidden with a normal bikini, but in very small bikini tops or topless they maybe visible.
The periareolar technique uses a small 2-4 cm incision located around the bottom of the areola (the dark skin around the nipple). The incision is hidden at the juncture between the areolar and chest wall skin. Dr. Zemmel believes that this approach also allows better shaping of the breast pocket. The dual plane approach can easily be performed through this approach. The scars from this incision heal very well and this is Dr. Zemmel’s preferred approach. The final scar using a periareolar approach typically heals extremely well and often is barely visible 6 to 12 months after surgery.
The trans-axillary approach uses a small 2-3 cm incision located in the deep fold of the armpit. The most important benefit of this technique is that the breast is left without any incisions. The armpit scar however may be visible when in a tank top or in a bikini as the arms are raised and sometimes maybe thick due to the constant motion of the arm. Research has shown a significantly higher complication rate with this procedure including implant malposition. Furthermore the dual plane technique cannot be performed using the approach. Silicone implant also may not be placed through this approach. Dr. Zemmel will consider performing this technique if requested by a patient.