Augmentation mammaplasty: retropectoral versus retromammary implantation

Although the weight of evidence generally indicates that improved contracture rates with retropectoral placement of the prosthesis and excellent aesthetic results can be obtained with this approach, there remains a significant cadre of surgeons who believe their own retromammary results are equal to or better than the alternative. Our experience with retromammary augmentation since 1963 indicates that fibrous capsular contracture around the implant is a persistent sequela. By placing the prosthesis behind the pectoral muscle, we believe we have achieved a significant decrease in this occurrence. Whereas there are a variety of hypothetical explanations for this observation, it may be that interposition of additional soft tissue between the implant and the observer may disguise the otherwise apparent problem, thus making its correction more apparent than real. Whatever the explanation, however, we have had fewer patients requiring fibrous capsule release and a higher incidence of patient satisfaction by placing the prosthesis behind the pectoral muscle.