Plastic surgery, particularly breast augmentation, has become increasingly popular in recent years. Many women choose to have breast implants placed under the muscle for a more natural look and feel. However, like any surgical procedure, there are potential problems associated with this technique. In this article, we will explore the common issues faced by patients and provide insights from both the perspective of patients and plastic surgeons.
1. Capsular Contracture
One of the most common complications of breast implants under the muscle is capsular contracture. This occurs when scar tissue forms around the implant, causing the breast to feel hard and distorted. According to studies, the incidence of capsular contracture ranges from 10% to 15% in developed countries such as the United States, Canada, the United Kingdom, Australia, and Germany.
There are several factors that contribute to capsular contracture, including bacterial contamination, implant rupture, and pre-existing conditions. To minimize the risk, plastic surgeons adhere to strict sterility protocols during surgery and prescribe prophylactic antibiotics.
2. Displacement and Shift
Another concern with submuscular breast implants is the potential for displacement and shifting over time. This can occur due to the natural movement of the pectoral muscles, causing the implants to migrate, leading to asymmetry and an unnatural appearance.
To minimize displacement risks, surgeons employ meticulous surgical techniques and take into consideration the patient's muscle strength and activity level during implant selection and placement.
3. Rippling and Wrinkling
Rippling and wrinkling are more common in women with thin breast tissue and little natural breast padding. Placing implants under the muscle is thought to reduce the risk of visible ripples. However, in some cases, especially with saline implants, visible rippling can still occur, leading to dissatisfaction among patients.
Advancements in implant technology, such as cohesive silicone gel implants, have significantly reduced the incidence of rippling and wrinkling. However, thorough preoperative discussions between patients and surgeons are crucial to managing expectations.
4. Pain and Discomfort
Pain and discomfort are common during the recovery period following submuscular breast augmentation. The implant placement location can exacerbate these symptoms, as the pectoral muscles need time to adjust to the presence of the implant.
Surgeons provide patients with pain management strategies such as prescribed medication, compression garments, and regular exercise routines to help alleviate discomfort during the healing process.
5. Longer Recovery Period
Compared to implants placed over the muscle, submuscular breast augmentation generally requires a longer recovery period. This is due to the surgical disruption of the pectoral muscles, which necessitates more time for healing and muscle relaxation.
Patients should be informed about the extended recovery period and limitations on physical activities to ensure proper healing and avoid complications.
6. Higher Cost
In developed countries, the cost of breast augmentation surgery varies significantly. The average range for submuscular placement is as follows: United States ($6,000 - $10,000), Canada ($8,000 - $12,000), United Kingdom (£5,000 - £9,000), Australia ($10,000 - $15,000), Germany (€6,000 - €10,000).
Higher costs are associated with factors such as surgeon's experience, facility quality, implant type, and additional services. Despite the higher expense, it is essential to prioritize the surgeon's expertise and reputation rather than solely focusing on cost.
7. Imaging Challenges
Submuscular implants can present challenges during breast imaging, particularly mammography. The presence of the implants can obstruct the visualization of underlying breast tissue, making it more difficult to detect abnormalities or evaluate changes in breast health.
Patients with submuscular implants should inform their radiologists of the implant placement to ensure appropriate imaging techniques are used, such as Eklund technique or specialized MRI protocols for more accurate and thorough evaluations.
8. Aesthetic Limitations
While submuscular breast implants offer numerous benefits, there is a potential for aesthetic limitations. The implant placement may limit the ability to achieve certain breast shapes or sizes desired by the patient.
Prior to surgery, patients should have detailed consultations with their plastic surgeons to discuss their aesthetic goals, ensuring that submuscular placement aligns with their desired outcome.
Conclusion
Breast implants placed under the muscle provide many advantages, including a more natural appearance and reduced risk of complications. However, patients should be aware of the potential problems associated with this technique, such as capsular contracture, displacement, rippling, and longer recovery time. By understanding the advantages and limitations of submuscular breast augmentation, patients can make informed decisions and have realistic expectations for their outcomes.
References:
- Graf, R. M., Bernardes, A., Rippel, R., & Damasio, R. C. (2015). Submuscular transaxillary breast augmentation: twenty years of experience. Aesthetic Plastics Surgery, 39(5), 601-605.
- Handel, N., Cordray, T., Gutierrez, J., Jensen, J. A., & Acello, D. (2006). A long-term study of outcomes, complications, and patient satisfaction with breast implants. Plastic and Reconstructive Surgery, 117(3), 757-767.
- International Society of Aesthetic Plastic Surgery. (2021). ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2019. Retrieved from https://www.isaps.org/wp-content/uploads/2021/05/ISAPS-Results-Procedures-and-World-Ranking-NEW.pdf
