Cosmetic Surgery and Beauty Magazine #68

feature
Implant texture
The surface of breast implants can either be smooth or
textured. Smooth-shelled implants are acclaimed for their
natural movement and feel, they are relatively easy to
insert during surgery and have a thinner shell than textured
implants. There is a downside to smooth implants, however:
they have a greater chance of capsular contracture
(hardening of the breast), which is a common reason for
revision surgery.
In comparison, textured implants – usually coated
with polyurethane foam – exhibit greater adherence to
surrounding tissue, meaning there is less friction between
the implant and breast pocket. This reduces the change
of capsular contracture and helps protect against implant
movement following surgery.
Implant placement
Breast implants can be placed either above or below the
pectoral muscle and, in some cases, a dual plane approach
means the implant is partially placed in both fi elds.
Subglandular placement is when the implant is positioned
above the pectoral muscle, beneath the glandular breast
tissue. This implant positioning is best suited to patients
who have adequate existing breast tissue, as this tissue
will cover the implant’s edges after insertion. Subglandular
implant placement often causes a pronounced ‘roundness’
to the breasts, and the implant moves relatively naturally in
this position following surgery.
In patients with less soft tissue in the breast area,
implants placed underneath the pectoral muscle –
called submuscular implant positioning – are often less
conspicuous. This placement helps camoufl age the implant
edges and can create a more natural-looking contour at the
top of the breasts.
In dual plane placement, the implant is placed partially
beneath the pectoral muscle in the upper pole, while the
lower half of the implant falls in the subglandular plane.
This placement will camoufl age upper implant edges
and provide full projection in the lower pole, suited to
women with a high degree of sag or an accentuated
breast fold. It will reduce the defi ned ‘roundness’ usually
associated with subglandular implants and will offer a
natural breast contour.
The incision site
The incision site will determine the visibility of scars and is
generally decided based upon the personal preferences of
the patient and surgeon. There are surgical advantages and
drawbacks for each site.
The inframammary incision is the most common incision
site for breast implant placement and it is made in the
inframammary fold, or the crease under the breast.
The periareolar incision is made on the border of the
areolar – the area of darker skin surrounding the nipple.
A transaxillary incision is made in the armpit fold, and
a channel is created to deliver the implant to the breast
pocket. And, fi nally the transumbilical incision, which is not
so commonly used, is made on the rim of the navel and an
endoscope is used to tunnel to the breast.
Breast lifting
Mastopexy – commonly known as a breast lift – can
help restore height, volume and shape to the breast.
Breast implants may also be used in conjunction with this
procedure to achieve the desired result.
During breast lift surgery, excess skin is removed to lift and
reshape the breast, creating a more youthful contour. The
appropriate technique and incision pattern is determined
according to the size, shape and degree of sagging of the
breast, as well as the position and size of the nipple. The
nipple is lifted and reshaped to appear smaller, rounder
and more in proportion with the new breast. The skin that
surrounds the areola is brought together to contour and
reshape the breast.
Breast reduction
Breast reduction (or reduction mammoplasty) is a surgical
procedure to remove excess breast and fatty tissue from the
breast. It seeks to relieve symptoms caused by very large
breasts, including back and neck pain, breast tenderness,
shoulder grooving (from bra straps), intertrigo (rash
between folds of skin) and overall discomfort participating
in everyday activities.
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