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November 2006
Medical / Plastic Surgery
By Amy M. Ortega, M.D.
Breast Augmentation Answers: Part 2
Previously addressed in last month’s column, breast augmentation has become one of the most commonly requested procedures in the United States, and one that poses many questions and concerns. Here is a list of some frequently asked questions that your client should get answers for.
Shape
Q: Do implants that are more “anatomic” in shape look more natural than round implants?
A: Whether your surgeon uses smooth, round implants or shaped implants is often based on the surgeon’s experience and preference. Many surgeons achieve excellent results with both types of implants. However, I think that the “anatomic implants” actually do not appear as natural as the round implants, mainly because the anatomic implants have the risk of flipping, which creates a very unnatural breast shape.
Even if the implant does not flip over, the fact that the breast stays a certain shape, even with the patient is lying down versus standing up, does not appear very natural.
A woman’s breast is a mound that is mainly circular in shape when the patient is lying down on her back. When she stands up, the tissue and weight tend to pull to the bottom producing more fullness to the lower portion of the breast.
Smooth, round implants actually behave the same way. When the patient is lying on her back, the implants are more of a round shape and also tend to flatten out somewhat. When the patient is standing up, the implant, because of gravity, will also tend to be fuller at the bottom, much like a natural breast.
With this observation in mind, after a discussion with my patients, they often choose round implants over shaped implants for elective breast augmentation. However, shaped implants or tissue expanders, which essentially are just a type of adjustable implant, can be very useful in reconstructive breast surgery.
Placement
Q: Is it true that it is better to put the implant behind the chest muscle?
A: The logic to placing the implant behind the chest muscle is that is has been thought that this type of placement will prevent a capsular contracture (a hard scar that may develop around the implant). However, research studies are a bit inconclusive on this point.
In my experience, the patient who tends to develop capsular contractures will develop a capsule no matter where the implant is placed, whether above the muscle, called subglandular placement because it is directly behind the breast, or behind the muscle, called submuscular placement.
It is also thought that at times placing the implant behind the pectoralis muscle can “provide extra coverage” for the implant and, therefore, the augmentation would appear more natural. I have not necessarily found this to be true either. Sometimes the pectoralis muscle does not cover the entire implant, and furthermore, the pectoralis muscle in many women is quite thin. If the patient has some natural breast tissue, this will generally provide adequate coverage.
With those considerations, the choice of subglandular versus submuscular placement becomes more of a personal preference. When placing the implant in the subglandular position, the patient avoids the movement of the implant, which can happen in a submuscular position. If the implant is placed subglandularly, the implant will “settle” more and the patient may have less fullness at the upper portion of the breast. Also if the implant is not placed behind the muscle, the patient may find it easier to achieve cleavage when attempting to displace the breasts toward the center of the chest.
When the implant is placed behind the muscle, every time the patient moves her arm, the implant will move. This can be noticeable in some cases and can look unnatural.
Another disadvantage to placing the implant behind the muscle is that it can be more painful and it also weakens pectoralis muscle. This concern, in addition to implant motion on pectoralis movement, may cause many patients who work out frequently or who are active body-builders to choose not to have the implant placed behind the muscle.
Placing the implant behind the muscle does have the advantage of supporting the implant for a longer period of time. This may be helpful especially if the patient is choosing a large implant; therefore, the implant will not settle as much and will not sag as soon. The implant will stay higher longer. The implant will also display more fullness on the top side. Some patients find this attractive and some do not.
There is no right answer to this question. The descriptions of advantages and disadvantages are based more on my personal experienced than from something that can be gained from reading a textbook or research study.
Your plastic surgeon can help you make this decision if you are clear when describing your goals.
Cancer risk and detection
Q: If I have breast implants will I be more likely to get breast cancer?
A: The presence of a breast implant does not increase your risk for cancer.
The presence of a breast implant also has been studied with regard to the detection of cancer. Although one might think that the presence of the implant may make mammography less accurate and, therefore, could delay the detection of cancer, this has been found not to be true in statistical studies.
If you have breast implants, you will have extra views when receiving your mammogram. These will help the mammographer see all of the breast tissue.
Keep in mind that whether there is an implant present or not, a mammogram is not definitive in cancer diagnosis nor does it always encompass all of a patient’s breast tissue.
This three-part series on Breast Augmentation Answers will conclude next month.
Amy M. Ortega, M.D., is a board-certified, double-fellowship trained cosmetic plastic surgeon with special interest in cosmetic surgery of the face, breast and body. Her office is located in Atlanta, GA. To reach her, call (404) 751-2500. For more information ABOUT DR. ORTEGA, visit her website, www.ASAbeautiful.com.
