Surgery:

The method of inserting and positioning of a breast implant will depend on your anatomy, your preference and your surgeon's recommendation. There a different methods for placing the implant as shown here, however all methods will result in scars being as inconspicuous as possible. Working through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centred beneath your nipples.

INCISION DECISIONS:

A small (30-50mm, 1 '/2-2 inches) incision needs to be made in order to insert the implant beneath the breast. Surgeons have definite preferences, and some patients may desire a particular incision site, thus, your surgeon must be au fait with all types of surgical approaches.

Inframammary: This is the easiest, least painful, and probably the most common incision used. However, the incision may be visible, especially in small, pert,conical breasts, especially if you wish to go topless, as many in Australia do.

Periareolar: A curved incision is made in the lower half of the areolar, at the junction of the areolar and breast skin, thereby disguising it very well. This gives the surgeon good control over the operation, as well as the patient having a very acceptable scar in a usually concealed area. There are high incidents of post-operative numbness in the nipple, which with time usually recovers.

Auxiliary (armpit incision): This is best in patients who may scar badly, and when saline implants are used. The scar is tucked away in the hollow of the armpit, and is barely seen, but the surgery is technically more difficult, with post-operative pain more likely, and the incidents of imperfect implant placement is higher. Also, any revision surgery, which may be necessary, is difficult to perform through this incision.

Trans umbilical incision: Via an incision in the bellybutton, a tunnel is made under the upper abdominal skin into the breast, and a saline only implant can be inserted via this route, and is not used in this clinic.

IMPLANT PLACEMENT

The decision on whether to place the implant above the muscle partially, or wholly beneath the muscle, is made at the time of consultation between you and your surgeon. The decision depends on how much breast tissue you have, especially in the upper part of the breast, your desired eventual size, the position of your nipple complex on the chest wall, the type of implant that you desire (shaped or tear drop implant), and how physically active you are, especially in the upper body.

Subglandular (above the muscle): This is the most anatomically correct place to put an implant, as the breast is normally above the pectoral muscle. Thus, when ever possible, your surgeon will choose this site for you as it gives a very natural shape, with good cleavage and breast movement, especially when used with a newer cohesive gel silicone implant, which has a very breast like feel. In thinner patients, who do not want the rounded "Pammy" look, A shaped or tear drop implants will give a gradual slope of the breast in the upper part.

Submuscular (under the muscle): If you are slim, and your ribs are visible, then it is most likely that you will require a submuscular placement of the implant, in order to avoid the above look. The implant can be placed wholly, or partially beneath the muscle, but importantly, the flat sheet of pectoralis muscle is gently elevated, and released in part, to create a pocket for the placement of the implants. Again, this is a placement of choice for saline implants.

	Examples of implant placement.
Implant placement is over the muscle		Implant placement is under the muscle