As you might know, breast implants are sometimes placed in front of the pectoral muscle layer in some patients, and behind this muscle layer in others. The decision has much to do with a particular patient's constitution and the desire to keep the final result as natural-looking as possible.
In women with a feminine or fairly curvaceous physique, the implant is often positioned between the mammary gland and the pectoral muscle — just behind the muscle, to be exact. This is where the breast naturally belongs and any potential visibility of the contours of the breast implant is eliminated by the generous natural tissue covering it.
In women who are mostly on the slim side, however, it is now common practice to place the breast implant behind the pectoral muscle, which provides an additional layer of visual smoothing and ensures that the contours of the implant remain invisible, especially in the décolleté area, to both sight and touch.
Other factors are sometimes taken into consideration and the ultimate decision should be taken in consultation with your aesthetic surgeon.
Potential patients often wonder about the different routes used to put the implants in place, and whether scarring is an unavoidable part of the procedure. Although a small scar might remain after the operation, a talented, reputable surgeon is an important part of the equation. Another factor is the access route, with three common ones currently in use. Insertion can be made through:
1. an incision in the natural crease under the breast
2. an incision in the armpit (axillary method)
3. a semi-circular incision at the lower edge of the nipple
The first method is the most frequently used, with the surgeon safely sliding the implant above or below the pectoral muscle through a small opening under the breast. This technique carries the added advantage that all subsequent procedures and changes can also be done through the same nearly invisible scar.
Access through the armpit is considered a particularly elegant method, as it leaves no visible scars in the breast area. It is technically more demanding and requires more experience on the part of the surgeon than the first method, which is why many plastic surgeons prefer not to offer this technique. On the other hand, the absolutely outstanding aesthetic result and the clever concealment of visible scars is highly valued by patients, and the reason why one third of breast augmentation operations at our clinic use this skilful approach. Its only disadvantage is that any subsequent treatments or changes cannot be handled through the same axillary access, but such procedures are necessary only in the rarest of cases anyway.
Access via the nipple (periareolar) involves placing the implant in a prepared pocket through a crescent-shaped incision at the base of the areola. That method has not been used at our clinic for more than ten years — ever since the latest-generation, more reliable, cohesive silicone-gel implants became the top standard in our profession. Previous-generation implant pads were inserted empty inside the breast then filled with saline solution, all through the relatively small areolar incision, but such implants are no longer in use in Switzerland today. Their reliability was not optimal, with leakage and loss of volume reported as fairly common problems.
