Breast Implants-Subglandular versus Submuscular

Breast implants can be inserted via several incisions. The four most common incisions are:

- below the breast

- around the areola

- via the armpit crease

- via the belly button

The majority of plastic surgeons prefer to use the crease below the breast to insert the implant. It has the lowest risk of causing damage to the nipple and is the easiest to perform. Further the breast incision does not damage the breast tissues or ducts.

The major disadvantages of the submammary incision are the following:

- mild to moderate pain

- rare cases of bleeding

- more visible incision

- slightly more rippling effect

Some complications of Breast Implants

Symmastia (also known as "bread-loafing") is a noticeable condition in which the cleavage line separating the two breasts becomes less deep and the two breasts are not clearly separated. Both the breast appear to blend into each other without a distinct cleavage line. The breasts appear to meet in the middle. Symmastia occurs when the two breast implants are lined up very close to each other. The skin which normally separates the two breast implants is raised and the cleavage line disappears. When the condition is severe, both the implants appear on either the left or right side. The major problem is poor surgical judgment and the problem is technical.

The condition is difficult to treat and requires repeat surgery. The condition can recur again. Many women end up having permanent removal of the implants. The condition generally occurs slight more frequently when large breast implants are placed above the chest muscles.

Capsular contracture occurs almost twice as often when the breast implant is placed above the chest muscles.

Leak/Deflation: Leak or deflation of a breast implant can occur in either position. Some surgeons believe that implant leaks may be slightly more when placed above the chest muscles

Double bubble sign is more common when the implant is placed in woman with saggy breast. This complication occurs with equal frequency with either location of breast implant insertion.

Hematoma: Collection of blood or fluid (Seromas) occurs equally when the breast implant is located either below or above the chest muscles.

Rippling. There is no doubt that rippling is more common when the breast implant is placed just above the muscles

In general, complications can occur with either technique of breast implantation. Rippling and capsular contraction occur more frequently when the implant is placed above the chest muscles.

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