I have written several blogs on this issue, and the topic deserves to be explained even more. While sub-muscular (SM) placement remains popular in the US, South-American and European Plastic surgeons are now rarely using this method. The reason is that there are several problems that SM placement cal lead to. Below are my top five deformities that result from SM placement.
1. Animation deformity:
SM placement results in an unnatural position of the breast mount and with pectoralis muscle contraction, significant deformity results.
This patient has her muscles relaxed on the left and on the right the deformity becomes obvious with pectorals contraction.
SM placement results in the implant progressively being pushed further and further laterally. This is especially noticeable when recumbent (laying on your back). The deformity becomes more and more noticeable as time progresses. An unnatural hollow becomes obvious in the area where the muscle has been detached.
This patient is photographed from above as she is recumbent on the table and the lateral shift becomes quite noticeable.
3. Bottoming out:
This results in the implant progressively sliding down the chest-wall. The nipple rises to an unnatural elevated position and the distance between the nipple and the fold increases. This low riding augmentation eventually results in very high nipples that peek out above the bra line.
4. Waterfall deformity:
This unnatural result from a SM placement shows as a double breast mount with the natural breast tumbling over the implant-mount like a “waterfall. The pectorals muscle attaches to the implant and pulls the new breast-mount up out of position. In the SM method the lower border of the pectorals muscle is detached from the ribs and subsequently pulls up in a much higher position pulling the implant up with it.
5. Double bubble deformity:
The SM placement frequently results in the persistence of the old fold visible above the new fold. This is another example of an below the muscle augmentation.
In conclusion the SM augmentation remains a popular method in the US but it is really not anatomic at all, and leads to problems of its own. Five of the typical deformities are shown above. SM augmentation has very specific indications where it is appropriate but SM is falling out of favor with the most surgeons around the world.
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