I’ve been practicing breast surgery for over 15 years at the Saint Louis Hospital, and privately in two clinics.
The breast from an embryological point of view, is an appendage of the skin and consists of skin, glandular tissue and fat distribution that varies according to age.
In a young woman before her first pregnancy, the breast is firm with a greater proportion of glandular tissue than fat tissue.
The shape of the breast is aesthetically ideal if the skin is firm and elastic.
The implant is simply placed on the pectoral major muscle, so the breast remains supple without distortion and is naturally in its place.
The contraction of the pectoral muscle is caused by arm gestures of daily life.
When an implant is placed behind the muscle, we too often see an unattractive double break in the crease of the lower breast that corresponds to the lower edge of the pectoral muscle that has been released.
During muscle contraction, the prosthesis is moved, causing a deformation of the inner part creating an unattractive slight depression (see photo).
To avoid this anomaly, which is often visible and worsens over time, I prefer to put breast implants in front of the muscle if the local anatomical conditions will allow.
This placement maintains the natural appearance of the breast and allows the implant to be ideally positioned in the crease. The postoperative course in this case is significantly less painful.
Double outline under the breast, resting
Unattractive double crease under the breast, exaggerated in the active position with a migration of the implant upwards and outwards.
The texturisation of implants, reduces the risk of retraction and prevents early mobilization of the prosthesis from its position.
Round implants present several advantages, they can be fully filled and look natural.
I mainly use round implants with a broad-based moderate projection for obtaining no visibility of the prosthesis on the upper breast.
The round implant in the upright position naturally becomes anatomical since the distribution of smooth silicone gel goes to the lower part of the implant. Silicone moves naturally into the prosthesis with the rest of the breast.
I do not exclude recommending anatomical implants for specific cases.
Anatomical textured breast implants
Round textured breast implants
Moreover, if a implant rotates round its axis a few degrees, the breast is not distorted which is unfortunately not the case with an anatomical implant.
This situation which is totally unforeseeable through time, can be difficult to correct and may in some cases require reoperation to reposition the implant with a recurrence risk of more frequent bad position.
My experience in breast reconstruction has allowed me to better arrange information in my breast surgery, to better visualize the complex anatomy of the pectoral muscle and its relationship with the mammary gland.
In breast reconstruction after cancer, the complete lack of mammary gland requires a position of the implant behind the muscle with an anatomical shape to recreate the missing breast, often with a prosthesis with a broad base and a strong projection. In this case a very cohesive silicone retains the prosthesis and has a definite shape and is less mobile.
The anatomical implants that I use in breast enlargement for aesthetic purposes are reserved for women with cup A or below, and for mammary agenesis.