Sub-Pectoral Implant

Revisional breast surgery implies a repeat operation

The surgical use of the word “revision” implies more than repeat; it means going back to the site of a previous operation and performing another one, similar perhaps but not necessarily the same. The reasons are multiple – there may have been an anticipated or unanticipated complication, the patient may not be satisfied with a cosmetic result although there is no other issue, the procedure may need to be repeated because the implant has become worn or damaged (not only breasts, applies to pacemakers and eye lens implants).

In terms of revision of breast surgery, the patient may be dissatisfied with a poor result, or perfectly satisfied but now wants the breasts made larger or smaller; something may have happened to the prosthesis and it needs to be replaced; the prosthesis may not have changed but the patient wants a different type (switch from saline to gel); there may have been post-augmentation changes due to pregnancy, weight gain or loss, or advancing age.

Cosmetic breast augmentation is different from reconstruction

This procedure is distinct from “reconstruction” after an injury or removal of a breast. It is usually performed when the patient is dissatisfied with the size of her breasts, she may have been teased at school, or suffered negative comments from male companions, or may think she would “present” better in the job market if she had a better figure. As in all forms of aesthetic surgery, the surgeon must be aware of the patient’s expectations and psyche.

The pectoralis major muscle has a very broad origin, from the clavicle, sternum, and upper seven costal cartilages and ribs; it sweeps to the arm with a narrowing muscle bulk, converging on the tendon which inserts into the humerus.

In the sub-pectoral (also called retro pectoral) breast implant, the prosthesis is inserted and fixed deep to the pectoralis major muscle, but the position of the breast in front of this muscle does not completely overlap it. Hence when the implant is aligned with the breast, as it must be, it is only about half to two thirds covered by pectoralis major.

This choice of implant position is likely to be selected for the woman with rather slight breasts, who is not used to breast movement and does not expect it.

Some surgeons will modify this with submuscular implantation, covering the lower “exposed” portion of the prosthesis with the serratus anterior muscle which has laterally directed slips arising from the approximate midpoint of the upper eight ribs; coverage may also be supplemented with the deep fascia from the rectus abdominis muscle.

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Sub-Pectoral Implant

Breast augmentation with trans-axillary sub-pectoral 280 cc saline implants

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