Anyone considering surgery should approach the decision with a healthy amount of respect and caution especially when the surgery is elective (or planned) and is non essential surgery (as aesthetic or cosmetic surgery generally is). All surgical procedures have limitations in terms achievable outcome and it is important that your expectations match what is possible through surgery. The choice to go ahead with surgery is always (or should always be) taken after due consideration of the risk benefit balance for the procedure. Although the majority of patients do not experience problems it is important that you fully understand all the potential risks and complications of breast augmentaion surgery. It is important that you take the time to read over them again prior to your next consultation.
We discussed the different types of implant pocket placement – namely sub glandular (where the implant is placed directly beneath the breast tissue) or submuscular/partial submuscular (dual plane) where the implant is placed fully or partially beneath the muscle. The advantage of an implant being placed in part or fully under the muscle is that the leading edge of the implant is camouflaged leading to a more natural appearance to the upper pole of the breast. The potential problems with placing the implant under the pectoralis muscle are implant animation (this where the implant and breast move upwards with contraction of the pectoralis muscle) and lateralization of the implant with repeated heavy upper body exercise (activating the pectoralis major) such as weight lifting or an occupation that involves heavy manual work such as landscape gardening. If the implant is placed in the sub glandular position then there is a greater propensity to have a visible arc on the upper pole of the breast where the implant begins leading to a more un-natural or ‘augmented’ appearance. Additionally sub glandular placement is associated with higher rates of visible implant rippling (especially in the lower pole of the breast), increased rates of implant descent (where the implant position slips below the level of the inframammary fold – breast crease) and increased rates of capsular contracture. Although all of the above problems tend to occur in the implant settings mentioned they can occur with either implant position.
