Oklahoma Breast Augmentation Surgeon

 
This question can only be answered after a physical examination. There are advantages and disadvantages to either technique. There is no difference in the speed of the surgery and there is no significant difference in the techniques used to place the implant in either plane. The fee is the same for each.

The under the muscle placement clearly provides the most implant coverage. The muscle covers over 60-85% of the implant and provides another barrier of coverage to the noticability of the implant to others. In thin chested patients, this is a significant advantage and should be considered heavily. The trade off is the  a slight increase in discomfort  for slightly longer than above the muscle. In over 4,500 implants placed, we have not found a slight reduction in capsular contraction by placing the implant below the muscle. Radiologically, it can be suggested that mammography is more precise in detection of abnormalities with the implant placed below the muscle. Patients with family histories of breast cancer may consider this as an indication for under the muscle placement. About 95% of our implants are currently placed under the muscle. The muscle can and often does cause the implant to distort with flexing of the muscle. This is normal and will not cause problems in the future or worsen over time.

Above the Muscle

Above the muscle placement provides a quicker recovery with less pain. It provides less coverage of the implant and a significantly increased risk of breast capsular contraction or breast firmness over the longterm. The implant is more easily felt. Over time, the breast most commonly develops a scooped out upper portion or a ski slope patients do not appreciate. For these reasons, very rarely do we ever place implants completely above the muscle today, but there are rare exceptions.  Only when we are correcting severe conditions of abnormal breast form do we recommend this location for implant placement and consider acceptance of these well known risks as a consequence.

Under the Muscle

Perhaps the most ideal placement is under the muscle coverage. The surgeon dives down to the muscle, lifts it up, creates a pocket for the implant behind the muslce and then places the implant in this location. This technique provides imporoved coverage of the implant versus above the muscle which results in less complaints of the feel of the implant below the skin. There is a proven reduction in the rates of capsular contraction, or formation of excessive scar tissue around the implant over time. This results in a softer breast and less reoperations to reduce firmness over time. In addition, every woman is at risk for breast cancer and the placement of the implant below the muscle more definitively seperates the implant from the gland above the muscle, makine diagnosis of the lumps or bumps more easy. There is a slightly higher discomfort in performing surgery this way, but the longterm results are better!

The final issue is silicone or saline. The FDA has guiding criteria for who receives silicone gel implants and we will be happy to provide you with that information. The website www.fda.gov also has an extensive review, albeit dated, on implant complications also. The silicone gel implants are more expensive, the surgery fee is the same and takes no longer to perform and has no different risks or problems from other types of surgery. The silicone gel implants go in full, so they do require a slightly longer incision than the saline implants do. This heals well no matter what. We will discuss these options with you on consultation and whether you meet the criteria for silicone gel as it currently stands.

Sincerely,

Erik J. Nuveen, MD, DMD