Breast implants may be placed above or below the pectoralis major muscle, which is the primary muscle of the anterior chest wall.
Implant placement is an important consideration in implant-based breast reconstruction. The primary muscle in the breast region is the chest wall muscle known as the pectoralis major. Breast implant placement is determined in relationship to the pectoralis muscle.
When an implant is placed above the pectoralis muscle, it is closer to the surface of the skin than the chest wall is. This positioning is known as prepectoral placement.
On the other hand, when an implant is placed below the pectoralis muscle, the muscle is cut and elevated to accommodate the implant.. The implant sits behind the muscle in a position known as retropectoral placement.
Implants placed above the muscle have a faster recovery time, since the chest wall muscle remains intact. Implants in this position are more prone to visible rippling, which are wavy lines underneath the skin. However, grafting procedures using fat or collagen sheets are often used to provide appropriate coverage and reduce the potential for rippling.
In the past, retropectoral implants were the most common option for implant placement. In this position, the implant has more tissue coverage, which reduces visible rippling. It may also provide protection to the implant if the overlying skin is very thin. However, the pressure of the muscle over the implant causes many women to experience tightness and pain, especially with larger implants. Also, visible distortion of the implants (known as animation deformity) is almost always evident when the chest muscle is contracted.
Revision breast reconstruction can be performed to move breast implants from below the muscle to above the muscle positioning if there is enough thickness to the overlying breast skin. In many cases, this can reduce pain and discomfort, as well as eliminate the animation deformity caused by the muscle.
Since the pectoralis (chest wall) muscle is cut when the implant is placed below the muscle, it requires a longer recovery time than with an above the muscle placement.
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