Breast preservation procedures can be done to some degree for switching implants to an over-the-muscle position.
Augmentation has a breast implant placed under the muscle, above the muscle, or a dual plane partially under the muscle. No question, we can switch them to over-the-muscle, and this has become very common; especially when patients have concerns of the implant being lateral (or towards the armpit), they haven’t received the cleavage that they hoped or desired, or most commonly, when patients notice what we call “animation deformity.”
This is when patients’ pectoralis muscles, or chest muscles, flex, and they can see a distortion of the implant. That’s because the muscle is flexing, not that you’re trying to just flex your muscle, but you can see this change, and it moves the implant or creates some unnatural appearance of the breast implant itself.
The treatment for those patients often involves taking that implant out and then placing the implant in a new pocket above the muscle, after we have set the muscle into its anatomical position. The muscle will be freed and then placed back into its anatomical position and secured with sutures, and then we can create a new pocket.
In a traditional approach, we would create a subfascial pocket above the muscle. This gives the patient a fresh start, creates a new pocket where we have a lot of control, and can often be combined with the internal bra.
When doing a modified breast preservation procedure above the muscle, what we can do is limit that dissection to take that implant out, reset that pectoralis muscle back into its natural anatomical position, and then use the breast preservation procedure to preserve all the ligaments that are still intact above the muscle and create that new pocket.
The benefits of this are going to be that you’re still maintaining whatever ligaments are in place, typically medial and lateral toward the midline, and preventing the implant from going toward the armpit.
Some of the inferior bottom ligaments probably have been cut from the initial breast augmentation, but I still think there’s going to be a lot of benefits, especially in certain situations where patients are looking for some fullness but not overly big.
I think for patients who have symmastia, this is going to be a great treatment for them. I also think for patients who are looking just for more stability of their breast implant — they don’t want it to fall towards their armpit — they want it to stay in a better position so they can get more of what I call “functional fullness,” or fullness on top of the breast, without placing an extremely large implant.
So, I do think you’re going to see more modifications of the breast preservation procedure, especially in secondary breast procedures, where we can harness some of the benefits of the procedure. However, we’re not going to be able to completely preserve the natural architecture or breast tissues, as some of these may have been cut or mobilized in the previous breast augmentation surgery.