Thursday, July 17, 2008
- Erik Nuveen
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.
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. Only when we are correcting severe conditions of abnormal breast form do we recommend this location for implant placement.
Perhaps the most ideal placement is what I call a "muscle sandwich" or partial muscle coverage. This is when there is muscle above the implant and a majority of muscle below the implant. This technique provide the coverage of the implant, reduced capsular contraction rates over the longterm as compared to above the muscle, reduced pain and recovery time over totally below the muscle. This technique was innovated by Dr. Nuveen over the last 5 years and has proven to be one of the many reasons for over 99% patient satisfaction and the very high referral rate of friends to our office for their care.
The final issue is silicone or saline. The FDA has strict criteria as to who meets these requirements and we will be happy to provide you with that information. 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.