The pectoralis major muscle has a very broad origin, from the clavicle, sternum, and upper seven costal cartilages and ribs; it sweeps to the arm with a narrowing muscle bulk, converging on the tendon which inserts into the humerus.
In the sub-pectoral (also called retro pectoral) breast implant, the prosthesis is inserted and fixed deep to the pectoralis major muscle, but the position of the breast in front of this muscle does not completely overlap it. Hence when the implant is aligned with the breast, as it must be, it is only about half to two thirds covered by pectoralis major.
This choice of implant position is likely to be selected for the woman with rather slight breasts, who is not used to breast movement and does not expect it.
Some surgeons will modify this with submuscular implantation, covering the lower “exposed” portion of the prosthesis with the serratus anterior muscle which has laterally directed slips arising from the approximate midpoint of the upper eight ribs; coverage may also be supplemented with the deep fascia from the rectus abdominis muscle.
These following photographs depict a small framed 23 year old woman who wanted to have a larger and fuller bust. She underwent breast augmentation with 280 cc smooth, round saline implants.
The implants were placed beneath her pectoralis muscles through incisions in the axilla.The trans-axillary incision is a good option for a woman who wants no incisions on the breasts. The incision is usually placed in an existing fold in the axilla, minimizing its perceptibility after surgery.
The post-operative photographs depict her at approximately 6 months after surgery.
This 30 year old woman underwent breast augmentation using 180 cc silicone filled breast implants placed partially beneath the pectoralis muscle through an incision along the lower fold of the breast that measured 3 centimeters in length.
Implants can also be inserted through an incision on the edge of the areola, which is the dark colored skin surrounding the nipple. However, when an individual has very small areolas, such as this patient has, this is not possible.
On the other hand, if the areolas are too large or irregularly shaped, they can be resized and reshaped at the same time as a breast augmentation and/or a breast lift is performed. This will, however, result in a scar around the periphery of the new areola. Often, these scars can heal quite well and are less objectionable in their appearance than overly large or irreguarly shaped areolas.
This case depicts a 40 year old woman who wished to have a larger and fuller bust.She underwent placement of 350 cc smooth, round saline implants. The implants were placed partiallly beneath her pectoralis muscles through an incision in the lower fold of the breast.
The post-operative photographs depict her at 3 months after surgery. The inframmamary fold incision is a particularly good option for women who have a well-developed breast fold before surgery. Because of this individual's anatomy, the incisions will be difficult to see at any angle.
The following photographs depict an 18 year old woman who wished to have a larger and fuller bust. She underwent breast augmentation with smooth, round 330 cc saline implants.The implants were placed beneath her pectoralis muscles using incisions placed within the areolas.
The post-operative photographs depict her at approximately 6 months after her surgery. Peri-areolar incisions can heal nearly imperceptibly. They are hidden in virtually all fashions and swimwear. Dr. Belsley can place either saline or silicone implants through this type of incision.
This case depicts a 37 year old woman who had borne one child and had noted that her breasts had begun to sag and develop a deflated appearance.
She underwent a vertical or "lollipop" incision breast lift along with placement of 300 cc smooth, round saline implants beneath the pectoralis muscles. Her post-operative photographs depict her appearance approximately one year after surgery.
This case study also demonstrates how the nipple and areolar positions located too low and too close to the midline in this case, can be improved as part of the procedure.
This case depicts a 29 year old woman who wished to have a larger and fuller bust. She underwent breast augmentation with smooth, round 350 cc saline implants.The implants were placed beneath her pectoralis muscles through an incision in the lower fold of the breast.
The post-operative photographs depict her at approximately 3 months after surgery. The infra mammary incision is a good option for women whose areolas are too small to undergo breast augmentation. Other options for such an individual include placing an incision in the axilla.
This 32 year old woman underwent breast augmentation using saline filled breast inflated to a volume of 195 cc’s and placed partially beneath the pectoralis muscle.
The individual has a mild pectus excavatum, a condition in which a person's breastbone is sunken into the chest. She also has a tendency to stand in a slightly kyphotic position, which means that her upper back is rounded and her head is relatively forward.
Obtaining a natural looking result in a patient who has pectus excavatum and postural abnormalities, as this individual has, can be challenging but is certainly possible.
In the case, the implants were inserted through a 3 cm incision at the lower border of the areola, which is the darker skin surrounding the nipple. These incisions typically heal quite well and can be difficult to see.
This case depicts a 30 year old woman who had undergone breast augmentation with 300 cc smooth, round saline implants placed above the pectoralis muscles via a periareolar incision by another surgeon approximately one year prior to her consultation with Dr. Belsley.
Her Grade IV capsular contracture was revised by exchanging her implants and placing the new 330 cc smooth, round saline implants below the pectoralis muscle and performing a vertical or "lollipop" incision breast lift. The post-operative photographs depict her appearance just under one year after her corrective surgery.
This case depicts a 24 year old woman with a tuberous breast deformity who underwent breast augmentation with 330 cc smooth, round, saline implants placed beneath the pectoralis muscles via a periareolar approach.
Her areolas were reduced simultaneously, necessitating an incision completely around the perimeter of the areola.The post-operative photographs depict her appearance at two weeks after surgery.
I apply the same criteria to patients who have had their surgery elsewhere as I do to my own patients. I am typically reluctant to re-operate on a breast augmentation patient for minor issues, because each time one undergoes revision, many of the risks of surgery tend to be multiplied. This is why I spend a great deal of time discussing size preferences and the likely outcome of surgery with my patients pre-operatively. It is said frequently that the most common reason for re-operation of the breasts in women who have had breast augmentation surgery is that they wish to “go bigger.” Ultimately, I feel that this is a poor reason to undergo repeated surgical procedures that can only result in more scar tissue, which is unpredictable, and thinning of the native tissues, which are necessary to cover the implant and provide a natural looking result. I encourage patients to think carefully about the risks of revision in cases where there is not a major problem.More >>
When it comes to deciding what approximate breast size you wish to achieve, the best advice I can give you is that you should be guided by your physical frame. Indeed, you may in fact be limited by it. In my practice, I select implants based upon your chest measurements, the quality of your breast skin and the size of your breasts prior to surgery.
I perform breast augmentation through a peri-areolar or inframammary approach and I place that vast majority of implants at least partially beneath the pectoralis muscle. My patients are welcome to select either saline or silicone filled breast implants. Silicone filled implants can in some cases achieve a more natural feel and may be a particularly attractive option for women with less breast tissue prior to surgery.More >>