This position is frequently recommended for women who already have a fair amount of breast tissue. They may also have a mild degree of breast droopiness (ptosis). A moderate amount of breast tissue will help conceal an implant placed in a sub-mammary pocket. In addition, a mild amount of breast droopiness can be corrected.
Sub-mammary pocket placement is also recommended for women with unusually shaped breasts, as the implants will help to change the shape of the breast better than implants placed in a sub-pectoral pocket.
Finally, professional, competitive body builders and fitness models are usually better off with implants placed above the chest muscle as well.
Dual plane pocket implant placement
Dual plane is a term coined by a Texan plastic surgeon back in the late 90s and is defined as placement of the implant behind the pectoralis major muscle and partially behind the breast tissue overlying the muscle, so it sits on two levels inside the chest. This is why it’s called “dual plane”. The top 2/3 of the breast implant is placed below the pectoral muscle. The muscle provides more coverage so that the implant is less visible and less palpable, lowering the chance of rippling and a visible upper border (the breasts won’t look like they’re bolted on as much). It gives the breast that nice natural slope. The bottom 1/3 of the implant is placed under the breast itself in the sub-glandular position. This allows the breast tissue to drape around the implant, contouring itself to the roundness and thereby adopting a pleasing fullness that better emulates a natural breast shape.
Alteration of some of the pectoralis major muscle is also performed to achieve optimal improvement of the breast as well as allowing for a subtle lift for patients with minor drooping (ptosis). Dual plane was designed so that the benefits of both subglandular and submuscular placement could be obtained for the patient.
This type of implant placement can be performed with any incision (infra-mammary, trans-axillary, or peri-areolar) and has been found to provide more benefits for patients in the study, Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types.
There are several varieties of dual plane augmentations that subtly differ one from the next (there are types 1-3). You will receive the most suitable one depending on your goals and the expertise of your surgeon. However, for certain patients, such as those with sagging breasts, sub-mammary placement may be preferred.
Advantages of dual plane placement include a lower risk of capsular contracture (a condition that is characterized by an undesirable hardening of the breasts), and making mammograms easier to read (which can be beneficial for a woman with a family history of breast cancer).
There is a third type of placement: complete sub-pectoral or sub-muscular placement. This involves the implant placed entirely under the chest muscle. Because of its related disadvantages, our surgeons perform complete submuscular coverage only for breast reconstruction purposes.
Following your surgery
The healing time following surgery varies according to each patient. The following represents a general idea of what to expect after your surgery. Individual patients may experience variations from this course. The team at Edelstein Cosmetic will help you through your recovery and will be there for you at all times.
The first few hours after surgery
When you awake from your surgery you will be in the recovery room, where you’ll remain for a few hours under the watchful eye of your dedicated team of nurses and doctors. You will have a bra on, and possibly a tensor band wrapped around the upper portion of your breasts. If you are not staying overnight (as is the case for most patients), you will be able to go home when you have fully recovered from the sedation. You will be given a prescription for pain medication and antibiotics. It is extremely important you take the antibiotics to prevent infection during your breast surgery recovery time.
first 24 hours
A few patients react negatively to the anesthetic after surgery. You may feel nauseous and vomit. This usually lasts less than 24 hours and should be treated with lots of fluids, Gravol and rest.
Although it is best to sleep on your side or back initially, sleeping on your front should not cause injury or rupture to the implant.
Immediately following surgery, you’ll find that your newly enhanced breasts appear very full and swollen, especially in the upper portion above the nipples. Your skin will most likely look very tight, and your nipples may point slightly downward as well. The shape and overall appearance of your breasts appear will probably appear unnatural. This is because when breast implants are first put into your body, they typically sit higher up in the chest as it’s the path of least resistance–your body requires some time to adjust to their presence, regardless of whether they’re sub-mammary or sub-muscular. (They will become more natural in appearance over time, usually by about three to four months after surgery.)
The second day
You’ll be able to take showers from the second day after your surgery. When taking a shower, remove the bra (and tensor bandage, if necessary). Take off the gauze and Vaseline mesh that is taped over your incision. The small white tapes (steri-strips) that are under the gauze directly over your incision should be left on.
Wet and soap yourself everywhere, including the tapes and your incisions. Use mild soap such as Dove, Ivory, or Zest. Pat yourself dry using a towel (do not rub) and put your bra and tensor back on. You don’t need to cover the small white tapes over your incision. This daily routine will help keep the incisions clean, and will promote wound healing.
It is VERY uncommon, but a soft drain may be placed under your breast that will be removed within a day or two. This helps to minimize the risk of blood collecting around the implant in patients who appear to bleed a lot during the surgery. However, this is unusual, even when the incision is placed in the armpit (trans-axillary).
The first three days
For the first three days you should try to restrict your arm movements. Move your arms slowly and avoid sudden jerky movements of the chest and breast area to prevent complications from occurring.
We encourage you not to spend all your time in bed during your recovery. This will minimize the risk of deep clots in your leg veins.
After three days
You will be able to resume relatively normal non-strenuous activities, however avoid lifting.
The third to fifth day
Maximum swelling occurs at this time.
After five days to a week
You may be able to go back to desk work, although this can vary from person to person.
You may need to wait a little longer if your work is physically challenging.
Although implants can rupture in extreme circumstances (e.g. high speed car accident), normal physical activities and contact will not significantly increase the risk of rupture and should be enjoyed within reason.
A week to 10 days
If you are advised to do massage, it would be a week to 10 days after your surgery. This is because your body is still recovering from the trauma of surgery. It is still “raw” inside, and massaging your breasts too early may cause bleeding, increasing the risk of capsular contracture. It also hurts! When textured implants are used, it is also important that the texturing on the implant integrates, or attaches to, your own tissues. Massage will interfere with this and could lead to fluid collections called seromas, or rotation of a tear-drop (anatomic) implant.
If you are instructed to do massage exercises, it is important to remember that a slow steady stretch is more effective than a quick jerky movement. Don’t worry about injuring the implant, you cannot cause a rupture with these breast exercises.
Press the breasts slowly and maximally inwards (towards your breast bone) and hold for 10 seconds, then release.
Repeat 4 times.
Press the breasts apart slowly and maximally outwards and hold for 10 seconds, then release. Repeat four times.
Repeat for downward movement.
Repeat for upward movement.
Perform these exercise two times per day after your surgery. Your surgeon will keep a close eye on you. If your surgeon thinks that one breast is not softening normally, only then will a treatment regime that includes massage, prescription medication, and several supplements be recommended.
The purpose of breast massage after augmentation exercises is to keep the scar tissue that forms around your breast implants following surgery as soft and pliable as possible. You can help soften the internal scar, minimize the risk of significant capsular contracture and maximize the likelihood of a soft, natural feel and appearance to your breast. However, since we are able to achieve beautiful, natural-looking results and our rate of capsular contracture is so low, you do not need to do any massage unless your surgeon tells you so. 99% of our patients are advised not to massage, a recommendation we have been giving for over eight years.
After 10 days to two weeks
The ends of sutures may be trimmed if necessary. Some patients may receive extra support from a tensor bandage, wrapped around the chest at the top of the breasts. This bandage would be worn for the first two weeks.
By the end of two weeks
Most bruising and swelling will resolve by this time. You may also feel discomfort and pain, which is generally well controlled by pain medications. Most patients experience a moderate degree of discomfort for up to 7-14 days.
After two weeks
You will be able to submerge yourself in a bath, swimming pool, or whirlpool after two weeks. If you have been wearing a tensor bandage wrapped around your chest, it will be removed.
After three weeks
You may begin your regular exercise routine 3 weeks after surgery, except upper body weight training. You will also be able to resume sexual activities at this time.
After six weeks
You may being upper body weight training and push-ups. Particularly when implants are placed under the chest muscle, upper body weight training before 6 weeks could cause bleeding and subsequent hardening (capsular contracture).
After eight weeks
It’s essential you wear a soft cotton sportsbra, without underwire, to provide support for your breasts throughout the first eight weeks of recovery. You should wear your bra day and night. This prevents the implants from falling to the sides or “bottoming out” (when the implants move unfavourably downward). Although this complication isn’t common, some patients develop weaker scar tissue, providing less internal support for the implant. Surgeons are unable to determine who is at risk for this issue until implant displacement occurs, which would necessitate revision surgery (capsulorrhaphy). Wearing a bra helps to provide extra support during the healing process.
Underwire bras can cause unnecessary complications and should be avoided for the first two months following surgery. These complications include irritation caused by the wire rubbing against the skin (something that you may not notice due to possible numbness). Patients who have an infra-mammary incision should be especially careful as an underwire bra is capable of displacing the implants if it is worn too often or too soon. The underwire is often improperly shaped and provides inadequate support of the breast shortly after surgery.
Once it’s time to begin shopping for new bras, patients will find that they have to greatly adjust their previous size and style choices. Many bras no longer fit comfortably after breast augmentation due to the changes in shape that come with implants. On the other hand, many bras that didn’t work for you before may now look great! When picking a bra, women should keep a few key fitting tips in mind:
- A band that rides up in the back is a sign of a poor fit. The band of the bra should remain at the same level as the front.
- Bra straps should not have to be shortened in order to lift the breasts. If this is the case a smaller size may offer a better fit.
- Any excess space between the nipple and the cup of the bra is a sign of a bad fit.
- Patients may want to consider being re-measured to find out their perfect fit.
After three to four months
By this time, your breasts will have “dropped and fluffed”. “Drop and fluff” refers to the gradual movement and change in shape that occurs to breast implants following surgery. As your body accommodates to your new implants, you’ll notice that your breasts will gradually look more and more natural–the way you hoped they’d be! Over the course of about three to four months, your body creates new skin to accommodate the additional volume of your implants. This natural process is called “tissue expansion”, and relieves the tightness you may be experiencing. It allows for the implants to settle more into a better position with the help of gravity. A gradual redistribution of volume from the upper to the lower breast occurs, resulting in an enlargement and rounding out of the lower breast.
Although it’s often called “dropping”, it is more like “redistribution”. The “fluffing” part refers to the impression that the lower breast enlarges and that your skin softens with the creation of new tissues. The extent to which this occurs depends on several factors, including the implant size, the tightness of your skin, and your body shape.
Patients who experience this phenomenon at a higher rate typically:
- have a smaller body frame
- are tighter skinned
- haven’t had children
This is in comparison to a larger breasted, post-partum woman. Patients who have had implants placed in the sub-muscular position may find that their dropping and fluffing is more dramatic.
Follow-ups and monitoring for anything unusual
The quality of your results may be compromised if you fail to return for any scheduled post-op visits, or follow the pre- and post-operative instructions and breast augmentation recovery tips provided to you.
Don’t hesitate to report any unusual or concerning changes while healing. If you are unable to contact your plastic surgeon and you have an urgent post-operative concern, contact the plastic surgeon on call through the hospital paging system, or, proceed to your local emergency department.
Implants do not cause cancer but may obscure its detection. Mammograms should be performed at a facility familiar with the special techniques needed for implants. You will need to let your mammogram technician know about your augmentation during future check-ups. Though the implants won’t interfere with your mammograms, it’s important to inform your technician so he or she can use a special technique that provides accurate readings.
Following surgery, scars are red and a little raised, but over three to six months they usually get lighter in colour and flatten out, becoming silvery thin lines that are barely noticeable. For all incision placements, the breast augmentation scars are usually very well hidden within the natural contours of your body.
You’ll probably be highly satisfied with the results of your procedure. To maintain beneficial results and be sure of your complete safety following the treatment, be sure to attend all the follow-up examinations with your surgeon.
The price of your breast augmentation, broken down
The prices for breast augmentation surgery can vary widely depending on the five W’s:
1. Who is going to perform your surgery.
2. What type of implant you’re going to receive.
3. When you’re going to get the surgery done (some places may increase your cost of breast augmentation in Canada if you were quoted a while ago).
4. Where the surgery is scheduled (at a hospital or private clinic).
5. Why you’re going to have the surgery (is it your first time or will this be another one to correct results from a previous surgery?).
And the how: How is the surgery going to be performed (sub-mammary or sub-muscular, infra-mammary or peri-areolar, etc.).
As a result, you’ll notice huge variations in price even for surgeons within a single city, a difference that may be marked by the thousands of dollars.
There are many factors that contribute to the cost of your surgery. Generally speaking, some specific factors include the following:
Breast implant prices
This is the cost of breast implants in Canada only. Currently, there are two breast implant manufacturers in Canada that offer Health Canada-approved implants: Allergan and Mentor. Both companies actively participate in the improvement of breast implant design, cooperating with the FDA to achieve higher standards of safety for consumers. There are a wide variety of breast implants available to you, including Allergan’s INSPIRA® range, an innovative line of 300 implant options that offer you a customized fit to enhance the natural looking results. Usually, the only factor that may increase the average cost of breast implants in Canada is if they are cohesive gel or anatomical (tear-drop) shaped implants. This is a premium that is applied by the manufacturer, rather than the surgeon.
Other features of the implants, namely their size and shell texture, do not influence breast implant cost. So, for example, a 400cc implant won’t be more expensive than a 300cc implant of the same type–size doesn’t matter when it comes to the price of breast implants in Canada!
These fees cover the cost of the anesthetist, whose presence is required during and immediately after your surgery, and the anesthesia administered.
Hospital or private surgical facility fees
These fees cover the cost of where your surgery is scheduled to take place.
In addition to your actual surgery, these fees also cover all pre-operative and post-operative follow-up appointments with your surgeon.
Medical tests and other related miscellaneous costs
Miscellaneous costs include the compression garment and any supplies you’ll need while you recover (such as sterile bandages).
When you receive a quote for surgery, make sure that all of these costs are included in your quote and that there are no other fees associated with your surgery. This will enable you to know exactly how much you need to pay.
Please note that you’ll also need to purchase prescribed medications at a drugstore to help you through your recovery.
The cleavage you can expect following your breast augmentation
Cleavage is the term used to define the distance (or gap) between the breasts. What we typically think of as attractive cleavage is called “narrow”, with the breasts naturally closer together. Many women who choose to undergo breast augmentation desire narrow cleavage, but this cannot always be accomplished if the breasts are naturally widely separated.
Your cleavage after surgery
- Depends on your natural, pre-surgery cleavage.
- Can be enhanced but not by too much to prevent complications.
- We perform techniques to help enhance cleavage while still maintain a natural-looking improvement.
Post-operative cleavage will always be determined by the natural distance that exists between the inner edges of a woman’s breasts and the distance between her nipples. When performing surgery, although your surgeon can cheat the implants closer together a small amount, your implants must be centered more or less beneath your nipples. Placing them elsewhere will lead to an unnatural appearance. This means that patients will have cleavage similar to their natural state even after their augmentation results become visible.
The problem with overly close implants
It may seem like narrow cleavage could be achieved by placing the implants closer together, but this isn’t the case. If the implants are positioned too close to one another (or too close to the vertical midline of the chest) in a patient with naturally wide cleavage the nipples will end up pointing outward on the outer side of the breasts. Instead of helping to improve the patient’s cleavage this surgical approach would create an unnatural and aesthetically displeasing outcome.
Placing the implants too close together can also lead to implants that are visible through the skin or rippled in appearance. Slim patients will have the most dramatic complications in these cases since they have thin skin covering their midline chest bone and a lack of fatty tissue hiding the implant.
Finally, when the implants are placed under the chest muscle (sub-pectoral), there is only so far the implants can be placed closer together because the muscle actually inserts along the entire edge of the chest bone (sternum) and can’t be completely stripped off (you need the pectoralis muscle to move your arm!).
The problem with overly large implants
The placement of large implants meant to close the distance between wider cleavage can also create unpleasant results. If overly large implants are used the inner edge of the product will rest underneath the chest bone’s thin skin and can, again, become visible or look rippled. Patients, especially those with narrow chests, will also be troubled by implants that extend too far into the outer edge of the breast. This leads to the breast bulging in the underarm area.
The proper approach to breast augmentation and cleavage
Our plastic surgeons are skilled at enhancing the breasts of women with both narrow and wide cleavage. During the consultation, your surgeon takes chest and breast measurements that allow them to place the implants as close together as possible without causing the kind of complications described above. The end goal of a breast augmentation is always to create beautiful, natural results and this cannot be accomplished by improperly placing implants. Because of this, your surgeon is always careful to centre the implants underneath the areola. They will also offset the implant distance in women with nipples that are naturally far apart or facing outward on the chest. Proper implant placement is also dictated by how the muscles attach to the breast bone since the devices must be inserted underneath the muscle.
Not every patient will have the same cleavage depth and width after their augmentation is finished. Your surgeon is typically able to predict the surgical outcome before the procedure by assessing various factors. Cleavage will depend, in large part, on breastbone prominence, the shape of a patient’s chest wall, the amount of fatty tissue covering their sternum and the softness of the contour that joins the sternum and breasts. Pre-operative nipple positioning, breast orientation and separation also play a key role in predicting the results that augmentation can provide.
While it’s a myth that implants will always create noticeable cleavage, some women may see improvement if they have an average chest wall size. Just the same, your surgeon cannot guarantee enhanced cleavage for every one of his patients since personal anatomy varies between every person.
Your results: do you want to look natural or obviously enhanced?
If you’re interested in breast augmentation, it’s likely that your primary concern is exactly how you will look once all is said and done. Depending on the approach taken by your plastic surgeon, your breasts can appear either natural or noticeably enhanced. The difference between these two looks is caused by factors such as implant size, type and placement.
What makes natural-looking results
- A size that doesn’t appear too large for a woman’s overall figure—it should be proportionate.
- A properly contoured shape that, rather than being perfectly round, mirrors the “teardrop” shape of a natural breast.
- Skin that is free of any “rippling” effect.
- Hidden and/or properly healed incision scars.
- Proper breast spacing, height, and realistic looking cleavage.
What makes obviously enhanced-looking results (“fake”)
- A chest that appears too large in proportion to the rest of the body.
- Unnaturally wide breast positioning.
- Breasts that are positioned too high on the chest.
- Overly prominent cleavage (especially while wearing a bra).
- Overly rounded breasts that look “bolted on”.
The right breast implant type
Choosing the right implant size is one of the most important parts of the breast augmentation procedure. Using a scientific formula known as dimensional breast augmentation, our plastic surgeons combine your desired results with a careful assessment of your body type to select a range of implant sizes for you. The implant should be picked in accordance with your figure and the natural limits of your chest size in order to create an aesthetically pleasing outcome that appears as natural as possible.
Of course, if you prefer to look obviously enhanced, then you are free to choose a size that goes beyond what has been suggested.
The shape of the implant must also be considered. Various implant profile types (high, moderate, or low profile) can be used in order to create the type of look best suited to your figure. Generally speaking, higher profiles tend to make your breasts project more from your body while lower profiles create a softer, more natural look.
The right breast implant placement
Where the implant is placed in the body also has an enormous impact on the end result. In order to create the most natural appearance possible, your surgeon typically chooses to place the implant behind the pectoral muscle (sub-pectoral/sub-muscular) in patients who are naturally thin and/or have little of their own breast tissue. This approach allows the chest muscles to partially cover the implant, better hiding the device for a more natural look. The implants will also be placed at an appropriate internal height and horizontal position in order to achieve your desirable enhancement.
Placing the implants under the breast itself (sub-mammary) gives a rounder “faker-looking” breast augmentation. It’s important that if a sub-mammary pocket is chosen, you have enough upper breast tissue to cover the implant properly so that you don’t see an obvious upper edge to the implant.
Natural looking results will avoid creating an abnormally wide space between the breasts. It will also ensure that they are not positioned too high, a position that tends to create an overly full, artificial appearance.
The importance of balance for natural-looking results
The most important factor contributing to natural-looking results is maintaining a sense of balance.
See before & after photos