New York Breast Augmentation

Serving Manhattan And Surrounding Areas Of New York City

Breast Implant Placement

Breast Augmentation Before & After Gallery

Breast augmentation is achieved by placing the implant either above or under the pectoral muscle. Your final outcome, as well as your breast shape, is determined by the method chosen by you and Dr. Bellin, New York City Plastic Surgeon.

A breast implant can be simply placed behind the breast – but still on top of the muscle (sub-mammary) or it can be inserted behind the pectoralis major muscle (sub-pectoral placement).

Approximately 60% of the plastic surgeons in the US prefer to place the implant above the muscle, while about 40% prefer behind the muscle. I am in the majority, placing most of my breast implants directly behind the breast and above the pectoral muscle, unless there are extenuating circumstances. The following are reasons why I prefer placing the breast implant on top of the muscle, rather than behind it:

1) Appearance: My patients are looking for the most natural appearance. Done correctly, a breast implant appears perfectly natural when it is placed over the muscle, much like it is found in nature. Behind the muscle, the appearance often gives too much upper pole fullness. This not only looks less natural, but it may also cause the nipples to look like they are pointing down. This is also more likely to appear when the incision is made under the arm.

2) Local anesthesia available: Having breast implant surgery over the muscle may allow the surgery to be done with intravenous sedation and local anesthesia. This is usually safer and more cost-effective, but general anesthesia is an available option as well. In cases were the placement of the implant is behind the muscle, it always requires general anesthesia, or a series of nerve blocks.

3) Preserve the pectoralis major muscle: In sub-pectoral procedures, the surgeon must cut the inner attachment of the muscle to provide enough space for the breast implant. This increases the potential of bleeding after the surgery, but it also can significantly weaken the main chest muscle. In some cases, the implant may need to be removed and placed on top of the muscle, because they look so abnormal. The pectoral muscle can be destroyed from the pressure of the implant beneath it, or because the muscle is not attached at both ends and cannot contract or be exercised. Thus, the muscle atrophies.

4) Less painful: Breast implants placed above the muscle typically cause less post-operative pain to the patient and don’t usually require strong narcotics. Pain medication is typically used for only the first two days. Patients can usually go back to work in about two or three days. Because of the surgery to the muscles and surrounding tissue, under the muscle placement is much more painful and usually requires strong narcotics for a week and often two. It also requires you to usually be away from work for a week, or more.

If you are considering breast augmentation, schedule a consultation with New York City Plastic Surgeon, Dr. Howard Bellin, at CosMedica today to discuss all of your surgical options before making any decisions.

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