Many different surgical options exist in breast augmentation. To be able to offer you options, a surgeon must be familiar with different approaches and implants and have the experience and skill to apply those options confidently.
No specific set of surgical options is best for every patient. If you are offered only one set of options, that may be the only options a surgeon can offer consult other surgeons. Every patient tends to think that the options she chose are also the best options for someone else. that isn't true because no two women are exactly alike. Your tissues are definitely different! No surgical option is perfect. No surgical option is without trade-offs.
The question is whether you know the relative benefits and trade-offs and pick the options that best maximize the benefits and minimize the trade-offs.
If you and your surgeon don't discuss your tissues and how your tissues influence the best choice of implant for you, you will need to blame something or someone for the consequences.
You will probably blame the implant or the surgeon, when it's really you who's largely responsible.
Your breast implants may be placed either partially under the pectoralis major muscle (submuscular) or on top of the muscle and directly beneath the breasts (subglandular).
Submuscular placement may provide you with youthful-looking breasts for a longer time, may make your recovery longer, may be more painful, and may make it more difficult to have some reoperation procedures, when compared to the subglandular approach. The possible advantages of submuscular placement are that it may result in less palpable implants (less likely to "feel" the implants through the breast), less capsular contracture, and will make it easier to image the breast with mammography.
The most important priority in selecting a pocket for the implant is to assure optimal tissue coverage over your implant for your entire lifetime. Optimal tissue coverage means assuring that all portions and edges of your implant are covered by the most tissue available, given your body characteristics.
If your tissues are thin in the areas that cover your implant (and we will show you how to measure later), you may need to put the implant partially behind muscle, especially in the upper and middle areas of the breast, to assure adequate tissue cover over the implant. If you don't, you run more risks of seeing the edges of your implant and seeing visible traction rippling later, both of which are usually uncorrectable. But there is much more to making the decision.
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