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  I have heard there are 2 types of "unders" (implant going under the muscle), PARTIAL unders and
COMPLETE unders. I read with partials 2/3's of the implant is behind the muscle, the lower 1/3 is
not. With complete unders the whole implant is under the muscle. It seems that having the implant
completely under the muscle would make complications such as bottoming out less likely. Do
most surgeons do partial or complete unders?
S.C.


Dear S.C.
  Some plastic surgeons are using complete unders as a marketing tool to differentiate themselves
from other plastic surgeons.They suggest that complete unders are better than partial unders.
Several years ago there were a few articles in the plastic surgery journals suggesting that complete
sub-muscular augmentation was better than the more common partial sub-muscular augmentation.
  The vast majority of plastic surgeons who have experience in both techniques, now believe that
partial submuscular implants look more natural than complete submuscular implants.
The original description of the complete submuscular implant was described using an inframammary
incision. More lately some surgeons have described performing this technique through an axillary
incision. The suggestion that this technique results in less bottoming out is simply not true. Bottoming
out is an unusual complication which occurs with equal frequency no matter where the incision is
placed.
  There are several problems with the total submuscular placement of a breast implant. First of all a
totally submuscular implant tends to look rounder than a partially submuscular implant. The totally
under breast tends to look more symmetrically round...like an upside-down soup bowl with as much
implant above the nipple as below. But this is not how a breast should look. A natural breast should
look slightly fuller below the nipple than above. This gives the breast the natural look of a not too bulgy
top and nice fullness below. WIth a partially under breast implant this occurs because the muscle
covers and flattens the top of the breast implant but leaves the bottom uncovered to give the nice
inferior fullness. With a totally under implant the muscle covering the lower pole of the implant results
in lower pole flattening and superior bulging, which is a very unnatural look.
  The other problem with a totally under breast implant is that this is an "unnatural" dissection of the
breast. The pectoralis major muscle does not naturally totally cover a breast implant. Normally (and
especially with a trans axillary approach) no muscle cutting is required. The implant fits "naturally"
under the elevated muscle. With totally under implants the top of the serratus anterior muscle and
anterior rectus abdominus fascia needs to be cut and elevated. This results in a lot of cutting and a lot
of bleeding and bruising. All of this for a breast which looks like an upside-down soup bowl.
Thats why the vast majority of surgeons now perform subpectoral breast augmentation as a partial
submuscular operation.
Dr. Frank Lista M.D., F.R.C.S.C
www.theplasticsurgeryclinic.com
Click here for Dr. Frank Lista's profile

 
 
 
 
   
 
(Please note: Canadaba.ca does not quarantee an answer and will only post general breast augmentation questions and answers. Please do not email personal information, as only a consultation with a surgeon can properly answer specific questions. The answer is the opinion of the plastic surgeon listed and may not be the opinion of other surgeons as each has their own preference and technique. The answers in this section are for general information purposes only.)
 

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