The Beauty Standard with Dr. Roy Kim

Breast Implant Placement: Above, Below, or Under the Muscle

• Dr. Roy Kim

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Uncover the secret to achieving a natural, long-lasting look with breast implants as acclaimed plastic surgeon Dr. Roy Kim joins us to unravel the complexities of implant placement. With a deep dive into his YouTube insights and a revealing blog article, Dr. Kim uncovers why the choice isn't just a matter of above or below the muscle. Listeners will learn the critical role of the pectoralis major muscle and how its anatomy drives the decision-making process. Discover the difference between subglandular, subfascial, and dual plane placements, and why these nuanced choices impact not only the aesthetics but also the longevity and feel of implants.

Dr. Kim shares his preference for the subfascial placement, lifting the veil on why it could be advantageous despite not being everyone's go-to method. We weigh the pros and cons of subglandular methods, known for their swift recovery but potential aesthetic downsides, and explore the dual plane approach for a comprehensive understanding. Whether you're contemplating implants or simply curious about the surgical intricacies, this episode promises eye-opening insights into the art and science of breast augmentation. Join us for a thorough exploration of how anatomy and technique interplay to craft the perfect result.

Thank you for tuning in to this week's episode of "The Beauty Standard" with Dr. Roy Kim! If you enjoyed this episode, please make sure to subscribe, rate, and leave us a review on your favorite podcast platform. Your support helps us continue to bring you the latest insights in aesthetic medicine and beauty trends.

Connect with us on social media on Instagram - @drroykim - or X - @drroykim- for more exclusive content, behind-the-scenes looks, and expert advice from Dr. Kim. Feel free to submit your questions or suggestions for future episodes – we'd love to hear from you!

Join us next week as we explore another fascinating topic in the world of beauty, and remember: your body, your choice, your standard!

Speaker 1:

Welcome to the Beauty Standard with Dr Roy Kim. All right, let's dive in. We're tackling breast implant placement today.

Speaker 2:

Oh yeah.

Speaker 1:

Specifically, where do these implants actually go? Okay, and why does it even matter?

Speaker 2:

Right.

Speaker 1:

We've got two sources. You guys sent us A YouTube video by Dr Roy Kim.

Speaker 2:

Board certified plastic surgeon.

Speaker 1:

That's right. Got to make sure they're legit.

Speaker 2:

Absolutely.

Speaker 1:

And then also a blog article that's comparing different techniques for placement. Got it so jumping right in. I've always thought it was like above or below the muscle.

Speaker 2:

Right.

Speaker 1:

But looking at these sources, yeah.

Speaker 2:

It's way more to it A lot more nuanced.

Speaker 1:

Yeah, so much more nuanced.

Speaker 2:

Yeah, there are a lot more options and things to consider.

Speaker 1:

Than I even realized.

Speaker 2:

For sure. I mean, it makes sense when you think about it, right?

Speaker 1:

Okay.

Speaker 2:

The placement really does have a huge impact on how the implants actually look and feel, yeah, and even how long they last.

Speaker 1:

Wow, I didn't even.

Speaker 2:

So we need to like break this down a little bit.

Speaker 1:

Yeah, let's break it down.

Speaker 2:

Okay. So first things first. We need like a little anatomy lesson. Okay, I'm ready, all right, so think about your chest muscles. Okay, specifically the pectoralis major, the pecs, it's a big muscle right like fan-shaped. Okay, but it's not this uniform sheet that's covering your whole chest you know, it gets thinner as it goes out towards your armpit.

Speaker 1:

Interesting.

Speaker 2:

So there's a portion of your chest wall that's less covered by the muscle. Okay, and this is important because when people talk about below the muscle placement, Right right. It's not really possible to put the implant completely under the muscle across your whole chest.

Speaker 1:

Oh.

Speaker 2:

The anatomy just doesn't allow for full coverage like that.

Speaker 1:

Okay, so it's not actually below the muscle.

Speaker 2:

Right.

Speaker 1:

So then, what are the actual options?

Speaker 2:

Yeah, so Dr Kim's video talks about a few sub glandular, sub facial and dual plane.

Speaker 1:

Sub what.

Speaker 2:

Sub facial.

Speaker 1:

Sub facial. Okay yeah, now hold on. What even is fascia? I remember seeing that word, oh yeah.

Speaker 2:

Fascia. Think of it like a thin strong covering.

Speaker 1:

Like hovering what?

Speaker 2:

It's connective tissue. It surrounds your muscles and organs.

Speaker 1:

Oh, okay.

Speaker 2:

You know, when you see a piece of raw chicken and there's that thin white kind of tough covering on it.

Speaker 1:

Okay, yeah.

Speaker 2:

It's kind of like that.

Speaker 1:

Okay, I'm never eating chicken the same way again, sorry. No, it's fine.

Speaker 2:

But it gives you a good visual. It, does it yeah subfascial, that's the implant going under that fascia, above the muscle.

Speaker 1:

So you've got subglandular, which?

Speaker 2:

is the simplest.

Speaker 1:

Yeah.

Speaker 2:

That's just directly under the breast tissue, above everything.

Speaker 1:

Okay, so that's the easiest, I guess.

Speaker 2:

Easiest usually means quicker recovery.

Speaker 1:

Yeah.

Speaker 2:

But there are downsides.

Speaker 1:

Well, yeah, there can be. Okay, you have a higher risk of things like rippling, okay, and rippling is like when you can see or feel the edges of the implant.

Speaker 2:

Oh, okay.

Speaker 1:

And it might not look as natural.

Speaker 2:

Gotcha. So it's like a trade-off then.

Speaker 1:

Right.

Speaker 2:

What about subfascial, then? Dr Kim really seemed to like that one.

Speaker 1:

Yeah, he did. He actually called it his favorite.

Speaker 2:

Hmm, interesting. And this is the fascial one, yep, above the muscle under the fascia.

Speaker 1:

Okay, and if it's his favorite, why isn't it more common?

Speaker 2:

That's a good question. I think the blog article mentioned something about needing enough breast tissue to cover the implant properly.

Speaker 1:

Right, so maybe not everyone's a good candidate for that.

Speaker 2:

Exactly that could be a limiting factor.

Speaker 1:

Okay, makes sense.

Speaker 2:

But when there is enough tissue coverage, it seems like subfascial can give you a really good balance of benefits.

Speaker 1:

Okay, I'm seeing the appeal.

Speaker 2:

Yeah.

Speaker 1:

So then we've got dual plane.

Speaker 2:

Right.

Speaker 1:

And that's the one the blog article called the gold standard.

Speaker 2:

Yeah, so dual plane is kind of a compromise. Oh okay, it goes partly under the muscle.

Speaker 1:

Okay.

Speaker 2:

And partly under the breast tissue.

Speaker 1:

So it's like the best of both worlds.

Speaker 2:

Kind of yeah, it aims for a more natural look and feel and it can reduce the risk of some complications like capsular contracture.

Speaker 1:

Okay, wait, capsular contracture I don't think we've talked about that yet.

Speaker 2:

Oh right, so that's when scar tissue forms around the implant and it can make it feel hard or distorted.

Speaker 1:

So dual plane helps with that.

Speaker 2:

It can. Yeah, it uses both the muscle and the breast tissue for support.

Speaker 1:

Okay, so I'm starting to get a better picture of these techniques. But how does a surgeon even decide which one's best for a particular person?

Speaker 2:

Yeah, that's where it gets really interesting. We've got to move beyond just the technique itself and look at the individual person. Gotcha.

Speaker 1:

We'll still the individual person Gotcha. We'll still get to that. Let's do it. We're going to take a quick break and we'll be right back.

Speaker 2:

Sounds good. So it's not just the technique itself, it's got to match the person right so many factors. Yeah, it's really personalized. Both sources talk about that.

Speaker 1:

Yeah.

Speaker 2:

Surgeons. Consider your anatomy, your lifestyle, what you want to get out of it.

Speaker 1:

And Dr Kim specifically mentioned activity levels right.

Speaker 2:

Oh yeah, Especially for people who are like really into fitness, weightlifting and stuff.

Speaker 1:

Makes sense. So if you're working those pecs all the time, that's going to affect things.

Speaker 2:

For sure, Like if you're putting the implant directly under the muscle, which is what you do in the dual plane. It might not be the best if you're constantly contracting and releasing those muscles.

Speaker 1:

I can see that.

Speaker 2:

Yeah, it's putting a lot of stress on the implant.

Speaker 1:

Even though they're durable. I guess that repeated squeezing Exactly.

Speaker 2:

Over time it can change how they look and feel.

Speaker 1:

So maybe in those cases it's better to go above the muscle Right, like with sub, sub glandular or sub facial. More freedom of movement? Yeah, exactly, okay, that makes sense. And then what about just visually, like dr kim talked about cleavage, oh yeah, that's a big one for a lot of people absolutely and he was saying that submuscular placement like dual plane.

Speaker 2:

Sometimes it can make it harder to get that really defined cleavage oh interesting.

Speaker 1:

So if someone's going for the more noticeable, look yeah, if they want that cleavage, then oh interesting.

Speaker 2:

So if someone's going for the more noticeable look, yeah, if they want that cleavage.

Speaker 1:

Then maybe the sub glandular or sub facial.

Speaker 2:

Yeah, that's what Dr Kim suggests.

Speaker 1:

Might be a better fit.

Speaker 2:

But you know, it's not just about placement.

Speaker 1:

Of course not.

Speaker 2:

For getting a natural look right. It's also the size of the implant, the shape.

Speaker 1:

Yeah, yeah.

Speaker 2:

And then your natural breast tissue, to begin with.

Speaker 1:

And how good your surgeon is.

Speaker 2:

Exactly, experience matters a lot.

Speaker 1:

Definitely so many factors.

Speaker 2:

Multi-layered equation.

Speaker 1:

And I remember both sources talking about having enough padding.

Speaker 2:

Oh yeah.

Speaker 1:

Over the implant. That's super important and that's not just for like how it looks.

Speaker 2:

Right.

Speaker 1:

It's how it feels too.

Speaker 2:

How it feels when you touch it.

Speaker 1:

Mm-hmm, that makes sense. More padding equals more natural looking and feeling.

Speaker 2:

Exactly, and Dr Kim even mentioned using fat grafting sometimes.

Speaker 1:

Wait, really. So you can use fat grafting with implants.

Speaker 2:

Yeah, it's not just for augmentation on its own.

Speaker 1:

I thought it was.

Speaker 2:

You can use it to kind of fine-tune the result. Oh, that's cool yeah, especially for people with thinner breast tissue.

Speaker 1:

So it's like a combo approach.

Speaker 2:

Yeah, you can get the volume from the implant.

Speaker 1:

Okay.

Speaker 2:

And then refine it with the fat grafting.

Speaker 1:

That's pretty amazing, honestly, and I remember both sources mentioning this thing called rippling Right. Wrinkling, something like that. That sounds kind of scary.

Speaker 2:

It can be noticeable.

Speaker 1:

Yeah.

Speaker 2:

It's basically when you can see or feel the edges of the implant through the skin.

Speaker 1:

Oh, I see.

Speaker 2:

And it happens more often in people with less breast tissue.

Speaker 1:

Right.

Speaker 2:

And when the implant's placed above the muscle, like subglandular.

Speaker 1:

Oh okay, dr Kim mentioned using overfilled silicone implants. Yeah, I don't know what that means.

Speaker 2:

So it just means they put a oh. I see that in a standard implant, so it's a bit fuller.

Speaker 1:

Okay.

Speaker 2:

And that extra fullness creates more tension.

Speaker 1:

Inside the implant.

Speaker 2:

Yeah, which makes it less likely to wrinkle or fold.

Speaker 1:

So it's kind of a way to reduce that rippling effect. And subfascial placement can also help with that.

Speaker 2:

Yeah, because that fascial layer adds another layer of smoothing, you know.

Speaker 1:

It's all about layers.

Speaker 2:

So it's like a combo.

Speaker 1:

Right.

Speaker 2:

You know it's all about layers, so it's like a combo. Right, the implant itself was placed, and then you can even add fat grafting on top of that.

Speaker 1:

Wow, that's a lot to consider.

Speaker 2:

It is. That's why it's so important to talk to a good surgeon.

Speaker 1:

You know for sure, Someone who can really assess your situation.

Speaker 2:

Right, because there's no one size fits all answer.

Speaker 1:

Absolutely. But speaking of things to consider, yeah. Dr Kim said something pretty interesting in his video.

Speaker 2:

What's that?

Speaker 1:

He said subfascial placement is the future.

Speaker 2:

Oh wow Really.

Speaker 1:

Yeah, he thinks that's going to be the big thing.

Speaker 2:

That's a bold prediction, mm-hmm, because, like the blog article was saying, dual plane is the gold standard right now.

Speaker 1:

Exactly.

Speaker 2:

Interesting, though, when you think about some of the things Dr Kim was saying.

Speaker 1:

Like what.

Speaker 2:

Like how subfascial is more comfortable for patients.

Speaker 1:

Yeah, and faster recovery.

Speaker 2:

Right, and people are all about getting back to their lives quickly these days.

Speaker 1:

It's all about the quick fix.

Speaker 2:

And didn't he also say he prefers subfascial for cleavage?

Speaker 1:

He did. Yeah, that was a big point for him.

Speaker 2:

So you've got less pain, quicker recovery, maybe better cleavage. And then he said it lets him create a more precise pocket for the implant.

Speaker 1:

Oh right.

Speaker 2:

So potentially a better overall result.

Speaker 1:

Sounds like subfascial has a lot going for it.

Speaker 2:

Yeah, it does, so why isn't everyone doing it already?

Speaker 1:

That's the question I guess the blog did mention. Not everyone's a good candidate.

Speaker 2:

Right not enough breast tissue.

Speaker 1:

Maybe that's the thing holding it back.

Speaker 2:

Could be, or maybe it's just a matter of time, you know.

Speaker 1:

Yeah.

Speaker 2:

More surgeons need to get on board.

Speaker 1:

Yeah, and refine the technique.

Speaker 2:

It'll be interesting to see what happens Absolutely Five years from now. Who knows?

Speaker 1:

Totally different landscape.

Speaker 2:

Maybe everyone will be doing subfacial.

Speaker 1:

Well, we've covered a lot today. We have All the different types of placement, why it matters how surgeons decide, and then even this glimpse into the future.

Speaker 2:

Yeah.

Speaker 1:

I feel like I know so much more now I do Than I did before.

Speaker 2:

Me too.

Speaker 1:

It's been an eye opener.

Speaker 2:

It has.

Speaker 1:

And I think for anyone listening it brings up a really important question.

Speaker 2:

It's that.

Speaker 1:

If you were thinking about getting implants, yeah, what would be like your top priorities, right? Would you want to be back in the gym ASAP?

Speaker 2:

Like quick recovery.

Speaker 1:

Yeah, quick recovery. Or is it more about the look?

Speaker 2:

The cleavage.

Speaker 1:

Yeah, like how much cleavage do you want?

Speaker 2:

Exactly, or is?

Speaker 1:

it more like long-term.

Speaker 2:

Longevity.

Speaker 1:

Yeah. And minimizing the risks, the complications, all. Longevity, yeah. And minimizing the risks, the complications, all that Right.

Speaker 2:

Those are all valid things to think about.

Speaker 1:

Definitely, and there's no right answer. Yeah, yeah.

Speaker 2:

It's totally personal.

Speaker 1:

Yeah, depends on the person.

Speaker 2:

One person might care most about recovery, someone else might be all about the aesthetics.

Speaker 1:

Totally different priorities. Exactly that's why talking to a surgeon you trust is so important.

Speaker 2:

Yeah, that's why, talking to a surgeon, you trust is so important.

Speaker 1:

Yeah, communication is key.

Speaker 2:

They can really help you figure out what's best for you. Absolutely yeah, so big picture.

Speaker 1:

Yeah.

Speaker 2:

What do you think are the main takeaways from all this?

Speaker 1:

I think the biggest thing is just realizing there are so many different approaches to placement.

Speaker 2:

Right, it's not just one thing, and they all have pros and cons. So there's no magic bullet.

Speaker 1:

Nope, no magic. So there's no magic, bullet, nope no magic bullet.

Speaker 2:

You got to weigh the options.

Speaker 1:

It's all about finding the right fit for you.

Speaker 2:

Exactly, and we've really gone beyond that simple above or below the muscle idea.

Speaker 1:

Totally Sublandular subfascial dual plant. Yeah, a lot more nuanced, and we've also seen that surgeons don't just pick a placement randomly.

Speaker 2:

Oh, definitely not.

Speaker 1:

They're thinking about so many things.

Speaker 2:

Anatomy activity level what the patient wants. All of it, and even what's trending in the field.

Speaker 1:

Yeah, it's a whole process, so it really shows you need to find a good surgeon.

Speaker 2:

Someone board certified, who knows their stuff? Someone? You feel comfortable with, absolutely who can guide you through all of this.

Speaker 1:

I feel like this deep dive has given everyone a really good foundation.

Speaker 2:

Yeah, a starting point.

Speaker 1:

But keep learning, don't stop here.

Speaker 2:

Right, there's so much info out there.

Speaker 1:

Online professional organizations.

Speaker 2:

Talk to surgeons.

Speaker 1:

Get consultations the more you know. The better.

Speaker 2:

You'll be able to make a good decision.

Speaker 1:

A decision you feel good about.

Speaker 2:

For sure.

Speaker 1:

Well, this has been fascinating.

Speaker 2:

It has.

Speaker 1:

Thank you so much for joining us on this journey.

Speaker 2:

Yeah, this is a good one.

Speaker 1:

Into the world of breast implant placement.

Speaker 2:

Love it.

Speaker 1:

It's been a pleasure.

Speaker 2:

And for everyone listening, keep learning, keep asking questions.

Speaker 1:

Yes.

Speaker 2:

And trust your gut Absolutely. It's your body, your choice.

Speaker 1:

That's right.

Speaker 2:

Until next time.

Speaker 1:

Happy diving body, your choice. That's right until next time. Happy diving. Thank you for listening to the beauty standard with dr roy kim. Make sure to follow for future topics and episodes.