Where Are Breast Implants Placed?

The breast implant may be positioned beneath the pectoralis major muscle in the chest (subpectoral, or submuscular position), between the breast tissue and the muscle (subglandular, or pre-pectoral position), or in a “dual-plane” position which is a combination of the two. Also, the implant may be placed high in the chest, low, toward the sides or toward the middle.

It is important for a woman who is considering breast augmentation in Columbus, Ohio to carefully examine herself, and to think about where she desires more fullness, what amount of cleavage, possible improvements in symmetry from side to side. Dr. Donaldson considers this information essential to his discussions with patients about their goals and expectations, and he uses it to customize his decisions about implant position for each patient.

A decision to go above or below the muscle is often determined by several factors: the incision, the implant type, and the shape and quantity of natural breast tissue. If the incision is made in the armpit, the submuscular position is generally preferred because it is a simpler surgical plane. If the implant is filled with saline, the submuscular position may also be preferred to improve the natural feel and to disguise the edges. A large amount of natural breast tissue often makes a subglandular position desirable; whereas a breast that has dropped some from breastfeeding may respond well to a bi-planar position to encourage fullness toward the neckline. When augmentation is combined with a significant breast lifting procedure, it may be advantageous to protect the implant under an extra layer of muscle.

While some surgeons are only trained to place implants in one position, and others tend to fall into a rut using the same technique for every patient, Dr. Donaldson approaches each patient uniquely in Columbus, Ohio; breast augmentation results can vary remarkably depending upon the implant position.

Considering a Breast Augmentation?

There has been a great amount of study, speculation and debate about breast implants over the past decade. The most important questions: are they safe? What material is best? What size? What shape?

Safety: First and foremost, breast implants are safe. The FDA has approved both saline-filled implants and silicone implants for breast augmentation after considering a vast amount of scientific data, patient experiences and doctors’ statements. There is no increased risk for certain illnesses or cancer, although the surgery itself carries some risk of bleeding, infection and other complications.

Materials: Most breast implants in the United States have a very thin silicone shell — the difference is what’s inside. Some are filled with saline (salt water), and others are filled with silicone gel. Some surgeons feel strongly about using one style of implant every time; Dr. Donaldson offers both types of implants, as he believes there are specific reasons to choose one or the other to match each patient’s body type and goals during breast augmentation.

Columbus, Ohio patients recognize in a side-by-side comparison that silicone feels more natural than saline — one is like a water balloon, and the other is like a breast. But in certain circumstances — such as when the implant is placed behind the chest muscle or beneath a large amount of natural breast tissue — it is often quite difficult to tell the difference.

Size: The most frequent reason for re-operation after breast augmentation is to change the size. To avoid this dilemma, Dr. Donaldson works hard with his patients to determine their goals and expectations in advance. Each person is different: some want a discreet enhancement that is only obvious when naked or in a bathing suit, others want a maximum impact that is obvious even in winter clothes!

Implants are sized according to their volume, which is usually measured in cubic centimeters, or cc’s. The typical range from small to large is 150 to 500cc’s, although they are made even smaller and bigger when necessary for women in Columbus, Ohio. Breast augmentation measurements to consider also include projection (distance projecting outward from chest) and width (distance from side of chest to middle of chest). The shape and size of a person’s chest and torso help determine which implant measurements will ultimately provide the best fit.

Shape: “Teardrop” or “anatomical” shapes are available, but Dr. Donaldson generally prefers smooth, round implants because they have a pleasant appearance from every angle. Also, if they turn in place, they will still look the same!

The first decision in breast augmentation is where to place the incision. How long will it be? Will it show?

One option is to hide the incision in the fold beneath the breast. This location tends to blend in well over time, but the position must be precise so that it does not rise up onto the lower part of the breast or sink down to the upper part of the abdomen. It is easy to make this incision longer if necessary to accomodate a larger implant.

Another option is to place the incision along the curve of the nipple/areola, in a half-circle that hides between the lighter skin of the breast and the darker skin of the areola. This approach makes sense if changes in the shape of the areola are desired, a small “lift” is planned or the fold under the breast is too exposed. The length of the incision is limited by the size of the areola.

Finally, for many women in Columbus, Ohio, breast augmentation is only desirable when there are no incisions on the breast at all. These patients opt to have their implants placed through the axilla or armpit. The small scar fades fast, and it is best for saline implants that are placed under the pectoralis muscle. It requires specialized endoscopic equipment and training to achieve optimal results.

Many surgeons learned one way to perform breast augmentation, and they still use the same incision every time. For breast augmentation, Columbus, Ohio surgeon Dr. Jeffrey Donaldson trained with leaders in the field nationwide, and he is comfortable offering each patient a personalized, customized approach. He will help you choose an incision that suits your individual needs and preferences.

Just this past weekend, an online advertisement encouraged patients from the United States to have elective breast surgery in India. The ad suggests that these operations are offered “at a fraction of world costs with comparable success rates and service levels.” This type of medical tourism has begun to flourish in Asia and South America as well.

Dr. Donaldson has helped to teach plastic surgeons from India, Turkey, Japan, Columbia, Mexico and New Zealand, and he has a great amount of respect for international plastic surgery; however, he does not recommend traveling to a foreign country to save money on breast augmentation. Columbus, Ohio residents are fortunate to have world-class options right at home.

There are many reasons to avoid medical tourism: any savings from surgery are spent on travel; surgeon reputation and patient outcomes may be difficult to determine; language barriers can hinder communication between doctors and patients about goals and expectations; pre-operative testing and post-operative care is abbreviated or eliminated in order to get patients home more quickly.

Dr. Donaldson’s patients enjoy personalized consultations, medical examinations and pre-operative clearance in Columbus, Ohio. Breast augmentation surgery is then followed post-operatively with careful observation and encouragement by Dr. Donaldson and his staff. Any concern that may arise is handled with compassion, immediacy, and great expertise — without the need for boarding a plane!

About The Author

Jeffrey Donaldson, MD is a board-certified plastic surgeon in Columbus, Ohio. He has more than 20+ years of experience helping local, national and international patients feel their absolute best through cosmetic surgery procedures. Outside of the operating room, Dr. Donaldson has put an immense emphasis on post-operative care to help patients feel more comfortable and supported throughout the recovery process. 

Paces Plastic Surgery Oculoplastic and Aesthetic Fellowship in Atlanta, Georgia

It was a distinct honor and pleasure to complete the 6-month oculoplastic and aesthetic fellowship at Paces Plastic Surgery and Recovery Center in Atlanta, GA from July through December 2008. The faculty is world-renowned, the facilities are comprehensive, and during my tenure I was always treated by my mentors as a valued colleague.

The teaching staff is comprised of Drs. Rod Hester, Foad Nahai, Sonny McCord, Mark Codner, Farzad Nahai, and Kristin Boehm. Their leadership, finesse, and skill both inside and outside the operating room create the backbone of this fellowship—it was a privilege to work with these fine people each day. The lone fellow may “cherry pick” among this group’s daily cases and office visits, with a strong emphasis on maximizing educational benefit.

The majority of the experience is hands-on in the operating room, 5 days per week. At least one full day per week is devoted to oculoplastic surgery, while cosmetic facial procedures, breast refinement, and body contouring fill the remaining time. I particularly enjoyed learning midface lifting with Dr. Hester, intricate lid procedures and anatomy with Drs. Codner and McCord, and advanced brow and autologous fat grafting with Dr. Nahai. Transaxillary endoscopic breast augmentation, central mound and vertical reduction mammaplasty/mastopexy, combination-modality body lipocontouring, and primary/secondary rhinoplasty were highlights as well. Patient office visits may be attended at the fellow’s discretion, and formal didactics are provided individually as well as integrated with weekly Emory plastic surgery residency conferences. Medical students, visiting faculty, and international guests regularly circulate through the surgery center.

The facilities are sophisticated and spacious, including 3 accredited operating rooms, 5 overnight suites, multiple procedure and examination rooms, a dedicated photography studio, and a luxury spa. Ancillary services include lasers, peels, and a high volume of injectables and fillers. During the 6-month term, the fellow is accommodated in a Paces-owned condominium that is within a 2-minute walking distance from the OR and office suites.

“Scut work” is not part of this fellowship. The attending surgeons are well-staffed with nurses and administration, so that the fellow may concentrate on clinical and academic interests. Responsibilities include daily assistance in the operating rooms, nightly post-operative checks and patient care in the overnight suites, local privileges at Piedmont Hospital, contribution to scientific literature, and Emory resident and student teaching. I spent time in the Emory cadaverlaboratory, attended the 2008 American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) meeting that was held in Atlanta, and participated in multiple industry-sponsored educational events. I also found time to study for the American Board of Plastic Surgery (ABPS) Written Examination and to manage the details of my solo practice start-up in Ohio.

The practice is located in Buckhead, which is an attractive and affluent section of Atlanta. There are many nearby restaurants, shopping areas, and outlets for nightlife. The city has warm weather, professional sports, and active cultural arts. There are numerous parks and recreational facilities for families as well.

Fellowship application and prerequisites include satisfactory completion of plastic surgical residency, letters of reference, curriculum vitae, and personal interview. Selections are frequently made more than 18 months in advance. A sincere and demonstrable interest in oculoplastic and advanced aesthetic surgical techniques is encouraged.

Jeffrey H. Donaldson, MD
Donaldson Plastic Surgery
Columbus, OH