Determination of implant placement

Hi
I just wanted to know, when ladies go for consultations with a surgeon what does a surgeon take into consideration when he/she suggests what placement (under, over) he/she feels would look best. Is it weight, whether they have had children, the pinch test etc
Also if quite a young person came for a BA and was boarderline over or under placement and they wanted to have children in the future do you consider this and does it have an affect on what placement you would choose.
Thank you

Good question hunnie, I would be interested in why a surgeon comes to these sorts of decision.

Hi there !
I seem to have missed this excellent question when it was posted.
Its a complex matter usually as to where to place the implant - there are some absolute reasons to put an implant above or below the muscle, but often it is simply what the surgeon prefers. I know some surgeons who never put implants under the muscle, and some who say they always do - I prefer to decide based upon the patient - here are a few reasons why "over" may be indicated;
The patient has a good covering of her own breast tissue and wants a more natural movement.
May be better in a slightly droopy (ptotic) breast where an uplift is not acceptable.
A patient may want a large round full projection "augmented" look.
A patient may not have the pectoral muscle (Polands Syndrome).
The muscle may be very important - performance athlete / Body builder etc.

Under the muscle tends to give the implant an extra layer of protection and smooth out the upper pole a bit more - avoiding what my patients call the "posh spice" look.
In very slim individuals it therefore improves the overall cover for the implants- and may give a more natural shape.
Unders may move with exercise however - this is usually a minor movement and acceptable for the benefit of more cover.
Generally it is accepted that textured silicon gel implants under the muscle encapsulate to a lesser / slower extent.
Unders are a little more painful in the immediate post operative period.
Where implants have encapsulated in the "over" position, many surgeons will put replacements under the muscle to improve the covering over the implant.
If implants are placed under the muscle, and then the breast grows a lot or a pregnancy occurs, then the implant may stay where it is, but the breast droop over the implant - this gives rise to a "double bubble" or "snoopy dog" appearance. - So this may be a consideration too !!

I hope this gives some guidance as to where and why!

Any more specific scenarios - just ask !!

JP

Thank you John this will help a lot of people who are unsure why their surgeon chose one way or the other and is ideal in that we can now refer people to your answer when they ask in a different section of the forum.

Thank you, I'm sure I'll think of more scenarios as I've always got something going around in my head.

If implants are placed under the muscle, and then the breast grows a lot or a pregnancy occurs, then the implant may stay where it is, but the breast droop over the implant - this gives rise to a "double bubble" or "snoopy dog" appearance. - So this may be a consideration too !!

Uh oh i hope this doesnt happen to me when i get pregnant! If this did happen would a uplift be required or just replacement of the implant? And would the implant then go over the muscle? Xxxx

Hi
It is a possibility that this can happen, and then two choices are possible, an uplift over the implants to restore the breast skin tightness - or an exchange of implants to larger, either sub glandular or submuscular to refill the skin - the important thing is to support your breasts well during pregnancy and breast feeding so that things dont stretch too much. Most people get good skin shrinkage as the breast size reduces post pregnancy and do not need further surgery.

Hope that helps :-)

JP