Why today's breast augmentation is better than ever [Dan Zegzula, MD, Portland]

Dr. Zegzula (00:00):
Dan Zegzula. I'm a plastic surgeon, Portland, Oregon at the Portland Plastic Surgery Group.

Eva Sheie (00:07):
Along with size, there's a bunch of other decisions that patients often think they get to make themselves, but it doesn't always work that way does it? There's several approaches and then there's all these placements, and if you're on social media kind of looking around, there's all this debate above the muscle, below the muscle. What is dual plane? And people are really opinionated who may or may not actually know what they're talking about.

Dr. Zegzula (00:32):
Right, right. And as the science of breast augmentation evolves, our decisions in how we do these surgeries evolves too. It used to be dual planing implants was considered to be the gold standard. Dual plane one, dual plane two, very rarely dual plane three. Interestingly, at this aesthetics meeting, one of the leading experts in the field, one of the podium speakers, was like, I almost never dual plane my patients anymore. They feel that they were getting more breast animation, that is when patients flex their pectorals muscles, how the breast will change shape, and they didn't feel like the dual planing was helping in terms of overall results. So that patient was using a technique where pretty much the muscle was completely intact, and so you're not allowing that muscle to retract up over the implant. Another speaker got on the podium and was almost a hundred percent of the time putting the implant in front of the muscle.

Dr. Zegzula (01:33):
And then another lecturer said the same thing, that they were trying to put implants in front of the muscle as often as possible. They both said that in those situations, the skin isn't quite as able to hold the implant in the right position as the muscle is. And so they were using mesh for those breast augmentations. So if you asked five different plastic surgeons in town, their preferred way to put an implant in, I bet you would get five different answers because it's always changing and it's always evolving, and a lot of it has to do with personal experience and seeing patients over time. Lots of times patients come in with lots of questions regarding those things, above the muscle, below the muscle, where's the incision going to be? Am I going to use gel implants? I'm I going to use saline implants? And hopefully in the course of a good breast augmentation consultation, you're going through all of that data, all of that information, and coming up with a really solid plan for your patients. But everybody's different and everybody gets a different plan.

Eva Sheie (02:31):
So what do you do?

Dr. Zegzula (02:31):
My thoughts about breast augmentation have evolved, and I'm definitely putting more implants above the muscle than I used to. I put it actually underneath the muscle fascia. So this is what we would call sub fascial breast augmentation, where you leave the muscle down, muscle's undisturbed so patients can exercise, use their arms, do pushups, do bench presses, rock climb, all the activities that patients like to do. And the fascia goes above the muscle. That gives a little bit more protection and camouflage for the implant, and it also separates the implant from the breast tissue, cuz there's some thought that the breast tissue that the glandular tissue in the breast can lead to, when that's in contact with an implant can lead to higher capsular contracture rates. So using that barrier of the fascia between the breast implant and the breast, but leaving the muscle down, you kind of tend to get the best of both worlds.

Dr. Zegzula (03:26):
You're getting no muscle animation and no muscle pain when you use the muscle, but you're getting protection for the implant. The caveat there is for my very slender patients, they might not have enough tissue to camouflage the implant adequately, that is, you have to have kind of a natural B cup or larger to have enough breast tissue so that when you put the implant above the muscle, you don't see the implant, you're not seeing rippling or the edges of the implant. For those natural A cup breasts, very slender, very thin patients, those are situations where I'll still go under the muscle. Most patients are very happy ultimately with their augmentation, really no matter where you're putting the implant. But I think a well thought out plan and a well-executed plan leads to patients being happy with their results, and that's where part of that conversation has to happen.

Dr. Zegzula (04:22):
You could go above the muscle or below, I think we should go above because of A, B and C. And especially if patients are active, they like to be in the gym and they don't want to risk losing strength, that's a strong argument for staying above the muscle. But for the patients who are smaller breasted and they really worry about looking natural and they don't want the implant to be visible, then we'll talk about going under the muscle. So in my practice, it's probably two thirds of the time I'm above the muscle and one third of the time under. Yeah.

Eva Sheie (04:53):
On this podcast, we bring you directly to the doctors who are where before meets after Links to our guest's website and contact info are in your show notes. Follow us on Instagram @wherebeforemeetsafter. Where Before Meets After is a production of The Axis, the podcast agency for aesthetics, theaxis.io.