I’m going to add some quotes here from a BAAPs registered surgeon James McDiarmid, who answered questions for us here hun in regard to whether overs or under were the best placement for women as I fear some may take that page seriously and each woman really should have her placement tailored to suit her own body type, no one placement is right for every woman.
These responses are quoted from James’s ‘ask a surgeon’ section here:
Definitely overs if you have enough tissue to cover the implant naturally.
Unders are great in some patients but not great in others,
Good luck,
JM
I try to go in front of the muscle as much as possible as this produces a
far more natural breast in terms of movement and wobbliness.
Behind
is an option when patients really are lacking soft tissue cover but I
have to say I think the dual plane pocket is over-used. Evidence for
this is the high number of patients who send me their pictures from this
forum with a similar story. The problem I see very often is caused by a
round high profile implant stuck up way too high behind the pectoral
muscle creating a double-bubble appearance. Often looking at the preop
photos it is hard to imagine why the surgeon did not choose the simpler
option of staying in front of the muscle.
And when asked how are unders and overs determined this was his very detailed response:
The usual answer is that it all boils down to thickness of soft tissue
coverage (determined by skin pinch) and to a large extent it does,
however there are several other factors which figure in the decision.
This
conventional wisdom is largely based prior to the advent of form stable
(less ripply) implants and holds very true in extremely thin ladies.
After 20 years of medical
practice and 10 years NHS consultant and private practice the basis
upon which I take the decision to encourage patients to have either
unders (usually partial unders/dual plane) versus overs has evolved
quite far.
I do not think that there is a correct plane for every patient indeed certain patients would have a good static (i:e photographic) result with a round or teardrop shaped implant either in front or behind the muscle.
What I would definitely say to you
though is that the enhanced mobility of a subglandular (over) implant
means a more natural dynamic result. The implant will move with the
breast gland as it is filling the natural plane that the glandular
tissue normally occupies.
So an ‘over’ implant will hang, wobble, feel and age more like a normal breast than an ‘under’.
The
enhanced tissue adherence seen with ‘unders’ means that in addition to
being prone to move with pec major contraction the implants will tend to
be rather fixed to the chest wall and not flop to the side when the
patient lies down in bed or on a sun-lounger. This is both an advantage
and disadvantage as unders will be more gravitationally stable through
this enhanced tissue fixity. It can also make them more prone to
development of double-bubble as the breast ages and droops and the
implant stays up high.
In a nutshell – for the most natural
result go for overs if you can. Unders are great in certain patients but
not necessary unless you are super skinny.
x
