Mr Umar Khan of the Belvedere Clinic talks us through his surgical approach to breast augmentation and, in particular, his muscle-splitting technique in implant placement aimed at getting the most natural result
Breast augmentation is one of the most popular cosmetic procedures performed on women. The size and firmness of the breast is very important for one's self-confidence. This procedure is ideal for those who have not developed their desired breast size and for those who have perhaps lost breast tissue after breast feeding or weight loss.
The usual practice is to increase the breast to the desired size by inserting an implant either behind or in front of the pectoris muscle in the chest and different surgeons have different surgical approaches. I have developed a technique, published in the Aesthetic Plastic Surgery Journal in the USA, which places the implant both above and below the muscle in the breast.
The breast is uniquely shaped - it is flatter on the top and rounded at the bottom. If you put the implant totally behind the muscle this will affect the shape you can achieve because the muscle is completely flat. So it will pump out the breast rather than fill out the rounded bottom part of the breast. By putting the implant behind the muscle it is in a separate compartment that is not directly communicating with the breast tissue compartment.
The half and half technique means that in the top part of the breast where the muscle is merging with the flesh you can create lift by placing the implant behind the muscle and in the lower part the implant is placed in front of the muscle and then fills out the breast tissue directly for a more natural shape. An optimal natural shape is achieved in the lower part of the breast because you are not restricted by the shape given by the flat pectoralis muscle.
The muscle is composed of long fibres from the centre of the breast to the arm and I split it along the direction of the fibres. This is how the implant can remain behind the muscle in the upper part of the breast and at the same time sit in front of the muscle in the lower rounded part of the breast, directly behind the breast tissue.
This technique also has the capacity to adapt to normal breast changes that take place in everyone. Routine body weight, body fat and breast changes - especially seen after pregnancy - are tolerated better to give the breasts a natural shape for a longer period of time. I do all my breast augmentation procedures using this technique where the implant is placed through the breast crease and is partly covered by the muscle.
The recovery time is also much quicker because I'm going through the fleshy part of the muscle. A straight implant under the muscle means that you have to remove the muscle from the ribs which results in more bleeding and the need for drains. It is also much more painful doing it this way and movement is restricted for four to six weeks. By not detaching the muscle from the ribs most of the patients are able to perform routine activities within a week and exercises and jobs that involve heavy work or lifting are left just a little longer.
No rippling, lateral displacement, double-bubble deformity, or muscle contraction-associated deformities have been seen with this new procedure. The prosthesis is also adequately covered by the upper part of the pectoralis muscle so you are not left with an obvious implant which sometime occurs when the implant is placed above the muscle.
The results will be permanent, but further surgery may be needed if problems arise. It is important to remember that all breast implant surgery will leave some scarring. read more and see before and after pictures at www.belvedereclinic.co.uk
