The most common cosmetic surgical procedure in America is breast augmentation. It is simply an enlargement of the breast using an implant. The implant can be filled with saline, which is water that is used in IV fluids, or silicone gel.
Breast tissues are naturally located above the muscle. Implants can be placed in one of two locations: above the pectoralis major muscle or below the pectoralis major muscle. You may have heard of this referred to as “above the muscle” or “below the muscle.”
If you are considering a breast augmentation procedure, there are two main considerations:
1. Choice of saline or gel implant:
Gel was the traditionally desired choice for breast implants due to its natural-feeling consistency. Over the years there have been studies on the potential increased risk of complications when using gel implants. Overall research has concluded that there is no evidence to suggest that gel implants increase the risk of connective tissue diseases, breast cancer, or reproductive problems.
Saline breast implants are filled with a saltwater-based solution that offers the same volume and projection benefits found in gel implants, but with a different feel. Saline breast implants themselves are less expensive than their gel counterparts. Some surgeons may also charge extra for the surgical procedure when using gel implants, though there is no real difference in the application process. Reynolds Plastic Surgery does not add an additional fee for gel implant surgery above the increased cost of the implants themselves.
During your consultation, Dr. Reynolds can discuss in depth the research and what you can expect from choosing either type of implant.
2. Choice of above or below the muscle insertion:
The natural position of the breast is above the muscle, so the choice of the position of the implant is important. “Above the muscle” placement refers to positioning the gel or saline implant above the pectoral muscle, but below natural breast tissue. “Below the muscle” placement refers to creating a pocket under the muscle to place the implant.
Above the muscle placement is generally a less complicated procedure than below the muscle placement. Some surgeons may charge less for above the muscle procedure as opposed to below the muscle procedure. Above the muscle breast implant placement generally produces a more noticeable cleavage and “projected” appearance. Here are other advantages of above muscle breast implant placement:
Pros of above-the-muscle placement for breast implants:
- Reduced recovery time and pain compared to below the muscle placement
- Above the muscle is the natural position of the breast, so this placement may offer a more natural appearance
Cons of above-the-muscle placement for breast implants:
- Appearance of the actual implant may be more noticeable because the implant is sitting on top of the muscle (especially if the patient is thin)
- More interference with Mammogram procedures
- Increased chance of implant “bottoming out”
Pros of below-the-muscle placement for breast implants
- Less sagging over time
- More support over time
- Lowered risk of bottoming-out
- Less likelihood of feeling the implant
Cons of below-the-muscle placement for breast implants
- More risk of discomfort during the recovery time after the procedure
- Longer recovery time overall
- More difficult procedure overall
You and Dr. Reynolds will be able to have an in-depth discussion to determine which placement of the implant is best for you, and which will help you determine the appearance you are after.
The single most important decision for the patient is to select a plastic surgeon whom you feel comfortable with. Regardless of which plastic surgeon you choose, be sure you have had all of your concerns addressed and that your doctor has given you ample time during consultation.