Fig. 27.1
Breast Anatomy demonstrating implant positioning Subglandular implant placement (left image) and subpectoral implant placement (right image) are options for breast augmentation
Whilst there is no published guidance on compression force used, typically, a reduced force in this context would be approximately 6–8daN’
Subglandular Placement
In subglandular placement, the implant is positioned posterior to the breast parenchyma and superficial to the pectoral muscle [3]. The subglandular position in patients with thin soft-tissue coverage is more likely to show ripples or wrinkles of the underlying implant.
Subglandular placement can make breast augmentation surgery shorter and reduce recovery time. A possible disadvantage could be having breast implant edges more visibly noticeable under the skin. Imaging during a mammogram can also be more difficult when breast implants are placed by this method (Figs. 27.2 and 27.3).
Fig. 27.2
Subglandular implant obscuring breast tissue in the medio-lateral oblique view
Fig. 27.3
(a) Subglandular implant obscuring breast tissue in the cranio-caudal view but demonstrating both medial and lateral borders as far back onto the chest wall as possible. (b) Subglandular implant with the Eklund view employed to displace the implant posteriorly onto the chest wall and apply compression to the anterior breast tissue to demonstrate this glandular tissue in more detail
Subpectoral Placement
In subpectoral placement, the implant is placed under the pectoralis major muscle and over the pectoralis minor muscle [3]. This technique is most commonly used for maximal coverage of implants used in breast reconstruction.
Subpectoral placement may reduce the chances of breast implants being felt through the skin, and it may help reduce the chance of scar tissue hardening around breast implants. It will also make it easier to image breast tissue during a mammogram. Possible disadvantages of this placement choice could be a longer surgery and recovery period (See Figs. 27.1, 27.4 and 27.5).
Fig. 27.4
Subpectoral implant seen in the medio-lateral with minimal breast tissue obscured
Fig. 27.5
Subpectoral implant seen in the cranio-caudal view at the posterior margin of the breast with minimal breast tissue obscured
Implant Displacement: Eklund Views
Implant displacement views, or Eklund views (Fig. 27.6), are used to adequately image breast tissue in women with implants. These views are achieved by pulling breast tissue forward, away from the implant. At the same time, the implant is displaced posteriorly against the chest wall so that it is out of the field of view. The radiographer then applies compression force to the tissue in front of the implant [5, 6]. Standard cranio-caudal and mediolateral oblique views are typically taken first. The implant displacement view provides improved imaging of the tissue at the front of the implant, while the standard views provide images of the tissue behind and underneath the implant, as well as the lower axillary area [3]. However, implant displacement views increase the amount of radiation that is delivered during a mammogram procedure and may increase the risk of implant rupture [1, 7].
