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Possible to Replace over Muscle Implants with Under Muscle Implants?

asked 2 years ago by anon
Latest answer by Robert L. Kraft, MD
Question viewed 3,341 times
Tags: under muscle, over muscle, placement

I had silicone implants for many years under the muscle, had them replaced with over the muscle and don't like the look. Now I want to get them put back under the muscle, but I heard that once you get breast implants over the muscle, you can't go back to under the muscle. Is this true?

20 answers to Possible to Replace over Muscle Implants with Under Muscle Implants?

Breast Implants and the Muscle

You situation is very complicated and you definitely need to be see by a board certified plastic surgeon that has experience in breast revision work. Having said that, you have been behind the muscle and now are infront and want to go back under. Easier said than done. It is not a technically difficult task but anatomically it may not be possible. The muscle has probably window shaded up wards and you will likely not get any coverage of the implant any more. So really you are still going... more

Farbod Esmailian, MD
Orange County Plastic Surgeon

Reopening pocket to reinsert implants under the muscle

In my experience, the pocket probably hasn't scarred down. Pockets persist longer than you might think. If this is the case, then gong back under the muscle is a matter of finding the edge of the muscle again, incising the capsule again and then inserting the implant below the muscle. It is a matter of careful dissection and I would expect the procedure to be longer than a primary breast augmentation but it is not contraindicated or highly complicated.

Robert L. Kraft, MD
New York Plastic Surgeon

Changing position of implants to subfascial

After multiple planes and surgeries there is only one technique that will deliver a beautiful shape and lasting result in my opinion, subfascial placement. I commonly use a technique called 'cold-subfascial placement' to correct undesirable results of multiply operated breasts with beautiful results. this technique allows the use of strong structural tissue in your body to create an internal brassiere to hold and shape the implant in a tear drop form. It also gives... more

Rian Maercks, MD
Miami Plastic Surgeon

www.rianmaercksmd.com

Going back Under the muscle

Without examining you, it's difficult to say exactly what can/ cannot be done but generally, I would think that it wouldn't be a problem to go back under the muscle. I don't usually recommend sub-glandular (over the muscle) placement - I would be curious to see why you switched. Do your research regarding the surgeons you visit - make sure to choose a surgeon who is certified by the American Board of Plastic Surgery (not cosmetic surgery) and a member of the... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

www.poustiplasticsurgery.com

Going back under the muscle may be difficult

When your implants were moved above your muscle, the prior submuscular pocket has problly scarred down and the muscle length has probably shortened. You have heard right, it many not be possible to back under the muscle and the muscle coverage alone may be very inadequate.

Vishnu Rumalla, MD
Dallas Plastic Surgeon

Revision breast augmentation

This is unfortunately a problem we are seeing more often as the era of breast implants extends. Yes, it would be possible to transpose the implant back under the muscle however it may be challenging to elevate this plane and the muscle likely will be thin. There are porducts available that could help reinforce that submuscular plane that are commonly used in breast reconstruction that are acellular dermal matrices. That may be indicated in your procedure, but they are expensive.... more

Andrew P. Trussler, MD
Dallas Plastic Surgeon

More challenging but possible

Now that both spaces have been created the anatomy of teh breast has been altered significantly. Understanding what you are trying to achieve is going to be the most important aspect of successful surgery.if you are thin and the implant is visible through the upper pole skin going to a submuscular position will help if your pectoralis muscle can be mobilized. A new technique which uses dermis to hold the pectoralis in place and support the implant and the lower pole of the breast is an... more

Robert W. Kessler, MD
Orange County Plastic Surgeon

Under the muscle after over the muscle

Dear Mimi54 You had implants under, then switched them to over now want them under again. In my practice I have seen this quite frequently. The implants can be placed under the muscle but a lot depends on what is found at the time of surgery. Of course, not having examined you, I can't make a professional opinion. Sometimes, the muscle is thinned out and other times it may be thicker and more difficult to work with due to a previous capsule under the muscle that was not removed. Most... more

Steven Schuster, MD
Boca Raton Plastic Surgeon

www.schusterplasticsurgery.com

Changing "Overs" to "Unders" can be Challenging

As the other doctors have pointed out, a lot can happen with the muscle inlcuding shortening after release. I have also seen it become very thin after an implant has been on top of it for awhile. You really don't know a lor until the actual time of surgery. Every case is different, and as long as you have a good reason to have the exchange, you should be able to get good results from a qualified surgeon.

John LoMonaco, MD
Houston Plastic Surgeon

Replacing Subglandular Implants with Subpectoral Breast Implants

Removing subglandular (under the breast only) breast implants and placing them in the submuscular position is somewhat straight foreword but does take some work. First the implants have to be removed along with the capsule. The implants can then be placed under the muscle. Often the problem is that the muscle wants to "window shade" or slide up and over the implant. To correct this the muscle has to be tacked down to the lower pole of the breast. There is always increased... more

Christopher L. Hess, MD
Fairfax Plastic Surgeon

You can change the breast implant pocket location

You can change the pocket location of your implants. However, you need to be examined, and have your history reviewed before making a decision. I can't help but wonder why you initially changed the position from behind the muscle to in front. Without clearly understanding your goals, it's hard to advise you and there may be an argument for leaving well enough alone!

Darrick E. Antell, MD
Manhattan Plastic Surgeon

Pocket change for implants

Changing back to under the muscle is relatively straightforward. But, there has to be a reason for the change which you did not really elaborate in your question. Really the only reason is if you thought that you needed more coverage in the upper pole.

Steven Wallach, MD
Manhattan Plastic Surgeon

Breast Implants under the muscle.

Hi! 1) First, you need to be sure that the reason you don't like your current look is that the implants are over the muscle. It might not have anything to do with that. There are several other variables, like implant size, implant profile, implant surface, and exactly how the pockets were made. 2) If an experienced plastic surgeon tells you that the problem really is that the implants are over the muscle, then a new pocket under the muscle can definitely be made. Because of your two... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Site change back to below the muscle

It is possible to reposition the devices below the muscle--but will be more difficult than the first time and may involve some "trade offs". Be very specific with your surgeon regarding your goals. You mentioned you didn't "like the look"--does that include a step-off in the upper portion of the breast, visible or palpable wrinkling in the lower portion or centrally? During your first operation the pectoralis muscle was partially released to allow the device to be... more

John E. Gross, MD
Los Angeles Plastic Surgeon

You can put breast implants back under the muscle

You can put the implants back under the muscle. This may take a little surgical work and the final result may not be as good as if you had left them under the muscle. However, it can be done.

G. Gregory Gallico III, MD
Boston Plastic Surgeon

Re-creation of submuscular pocket

Dear Mimi, Your exact circumstance is complicated, because the pectoralis muscle may be scarred and contracted upward. During your first operation, the muscle was released, which allows it to displace upward after the implant is placed (somewhat like a window-shade). After your second operation, the muscle was pushed back against your chest wall. This can attenuate the muscle and make it slightly more difficult to raise off the chest wall. Although it's definitely possible to but the... more

Sam Jejurikar, MD
Dallas Plastic Surgeon

Not true, the breast implants can go under the muscle again

You can replace the implants under the muscle again, but the doctor would need to know the reasons why they were replaced over the muscle. If you had a problem with the capsule or inframammary crease, that could affect you final result. The capsule or scar under the muscle may need to be partially removed during the procedure. Make sure your Plastic Surgeon has the whole story of your history before the next procedure. Good Luck!

David A. Dreyfuss, MD
Chicago Plastic Surgeon

Re-positioning of implants

Alot of the success is dependant upon the exact anatomical situation. Not all operations are performed identically and your surgeon will need to be prepared for various situations. The muscle can displace upwards after being released after you first operation and it may not be in the appropriate location, that is, it might be so far superiorly that going "under" is not significant (i.e. the muscle may only cover a small portion of the implant. The two pockets can easily communicate... more

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Breast Implants

Your case is more complicated because of the multiple surgeries. In general, there is usually no reason that the doctor can not change the implant site. It is more difficult at this time than placing the implant the first time under the muscle. The muscle must be lifted from the chest wall and then sutured to the overlying capsule or breast tissue. There is a chance that window shading of the muscle can occur. This means the sutures don't hold the muscle and the muscle retracts upward. In... more

Robert M. Wald, Jr., MD
Orange County Plastic Surgeon

Replacing implants under the muscle

It is possible to replace an implant under the pectoralis major muscle. This is a technique that involves recreation of the sub muscular pocket. In general I use the capsule as a cushioning shield and allow it to collapse upon itself. This creates a nice pocket and will not allow the implant to pop over the muscle. I have found this to be a safe and predictable operation. Placing the implants under the muscle offers better protection, better look, possible reduction of capsular contracture,... more