Introduction One of the great debates in the field of plastic surgery focused on the spot whether breast implants above or below the pectoralis major. This author's strong feeling, that in most cases, the implant should be placed in subglandular Positions, which is more than muscle.
Breast, subglandular. Cup large cup B.
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Breast, subglandular. Cup large cup B.
History
Breast Procedure was first taken in the early 1900s. Places subglandular placement ever. All of ivory and ebony paraffin was implanted, Of course, reject. In the 1950s, Ivalon sponges were used. Although they were biologically fibrous tissue grew into them, making them extremely difficult. Breast began in earnest in the mid-1960s, when silicone implants were introduced. Again, the place was always subglandular. A major problem
breast implants has been consistently hard. Implants do not become a difficult problem is that the human body recognizes that the implant is a foreign object. Because the body can not reject the implant (silicone not charged binding sites), for the body's defense mechanism is to I am from the membrane wall composed of myofibrils and collagen. This is commonly referred to as the capsule. If the capsule contracts around the implant, the result is similar to squeezing a balloon partially filled with water, it feels hard. It is to be known as the fibrous capsule contracture. Why capsule contracts in some patients remains a mystery. Even more mysterious is the fact that often occurs only in one breast and not others.
silicone implants early support he had from Dacron, which took hold at the implant site. What was not realized by a few years was that That caused a severe reaction to Dacron tissue as capsular contracture in the extreme. In the late 1960s, the idea of \u200b\u200ban implant under the muscle was introduced. This place was popularized in the mid-1970 because of the belief that breast felt softer with subpectoral implantation. Unfortunately, the characteristics of hardness is difficult to estimate. Although Baker classification system is widely accepted including the objective, where firmness of the breasts may be remains subjective, and there is a problem finding the procedure, minimizes Which ten problem.
problem
subpectoral argument (the muscle) placement is as follows:
Muscle covers the implant capsule contracture That So (breast, which feels hard) is less common.
For the same reason, rippling (wrinkling), the implant is less clear.
Mammography is more accurate.
women in very small breasts, outline the implant is less visible.
operation takes less time.
subglandular argument (in the tissue of the breast) placement is as follows:
Breast is obviously in the muscles, so there should be an implant.
subglandular For this reason, most of it looks more natural. Because the muscle covers
only one third of one half does not, when the implant is placed below the implant, Minimum Benefits Introduction There are no implant. (This does not apply not infrequently exercised true submuscular implants, that uses the serratus anterior muscle for coverage.)
Since most implants are not covered by the muscle is the introduction below, the introduction of Minimum Benefits There are no implants. Only a slight reduction in the incidence of capsule contracture, and there is a rippling of the implant.
Subpectoral placement requires cutting the insertion of muscles. For this reason, and / or pressure of the underlying implant, the pectoralis muscle becomes very atrophic and virtually is not destroyed. Claiming that the implant "enter" in a more natural positions in a few weeks after the surgery is false. Actually atrophying muscle (death), which results in reduction of the initial fullness of the Upper Pole.
If any degree of prolapse is present, extracts the breast implant subglandular much better. Properly executed
mammogram shows 95% of breast tissue. Magnetic resonance imaging, but you can imagine 100% of the breast and, possibly, be a standard criterion for cancer detection. Reduced risk of bleeding
Involved is surgery.
much less postoperative pain occurs.1
procedure can be performed in the intravenous sedation anesthesia and local communities that are safer alternatives for the general (full) anesthesia. However
about 50-60% of plastic surgeons perform submuscular implantation. The author of about 2% of implants under the muscle, usually only on the patient's job.
Breast, subglandular. This patient had a previous muscle for implants. Same implants placed in front of the muscle.
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Breast, subglandular. This patient had a previous muscle for implants. Same implants placed in front of the muscle.
Micromastia frequency is a common occurrence.
Presentation
Determine the patient's motivation and expectations. Watch out for the patient, who wants to please her partner's surgery. Try to respond to the expectations of the patient on the effects of which can be achieved. When a patient asks for a chest so big, That the author asks himself whether he wants to look natural. The answer is almost always positive. In such a situation, the author states that will make the breast as large as possible and yet they natural.
On physical examination, paying attention is important asymmetry because patients can not be aware of the problem, it can only be noted that after the surgery and blame the doctor. Differences of up to chest and breast size and shape are common.
This stretch marks and to evaluate their depth. Also observe any thinning of the breast tissue, because these problems cause a higher degree of rippling (wrinkling) of the implants.
Note the degree of ptosis and advice about the patient, how much will remain after surgery. With the exception of extreme situations the author does not wish to carry out the lift, as most patients are satisfied with the extensions and whatever Provides lift and do not want ADDITIONAL scars. Failing that, breast lift is often insufficient. Of course, to locate any discharge or breast masses. During the physical examination, discuss the patient's desires and the size of the implant. Indications
Micromastia (ie, small breasts) is obviously due to patients seeking procedures for extensions. But, surprisingly, what may seem like a big bust for the surgeon may seem quite small, patient to request extensions.
patient from time to time due to Operation CONCLUSIONS asymmetry.
Many of the cases subglandular lift drooping breast implants without the need for additional visible scars.
Relevant Anatomy
Women Breast covers the anterior chest wall with about Zebra second superiorly fourth to fifth or ribs inferiorly. Its upper half overlies a pectoralis major, serratus anterior one of its lower parts, some of the axillary fascia side.
Breasts in fact is the body skin. Closely related to the skin for the suspension tendon (Co ligament). Therefore, it is, that is evolutionarily from the ectoderm in the anterolateral wall of the body and the proliferation of epithelial cells from the glands of this site creates. For this reason, the opening of the natural plane between muscle and it is easy to breast implants can be placed in this place.
breast blood supply from branches of the axillary artery, the intercostal arteries and the arteries inside the breast. Few, if all vessels penetrate into the prostate gland from the primary.
Its nerve supply comes from the anterior and lateral cutaneous branch of fourth, fifth and sixth thoracic nerves. One of the major side branches of the skin can often be seen, preserved during Operation magnification. Contraindications
One of the absolute contraindications to breast enlargements subglandular is irradiated. Because of the blood SUPPLY interference caused by radiation, subpectoral placement is much safer.
Another reason to consider placing an implant in the muscle is very thin breast tissue, may occur after pregnancy.
Some surgeons also believe that subpectoral implantation should be used Small breasts in a very patient, although the author believes, is that to be necessary only in a few patients.
Because a small amount of breast can be obscured at mammography, a patient with breast cancer probably should be strong under the extended Become a muscle, as well as patients undergoing postmastectomy breast reconstruction after the opposite is also magnified.
Involuntarily That a lot of silicone gel implants, the author, in patients with a history of autoimmune diseases is recommended to saline implants.
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