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?
Possible to Replace over Muscle Implants with Under Muscle Implants?
Doctor Answers (21)
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 relative protection to the breast tissue and skin from stretching and gravity. I hope this helps!
All the best,
Rian A. Maercks M.D.
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 to be subglandular or in front. Once you go under the muscle and then go in front you are pretty much committed. This is very unusual, because in most circumstances implants are taken from a subglandular position (meaning in front) and then are put behind. This is possible and works well.
Breast implant pocket position is changed often. I perfer under the muscle since the look more natural, in my opnion. This change shnould not be a problem
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Reopening pocket to reinsert implants under the muscle
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 American Society of Plastic Surgeons. From here, you know you are selecting from qualified surgeons. Most board certified plastic surgeons would suggest sub-muscular placement for better long term results.
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.
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 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 excellent option in the right candidate.
You need to be evaluated by an experienced certified plastic surgeon to help understand what can be accomplished for you at this time.
Under the muscle after over the muscle
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 importantly, you need to be evaluated by a board certified plastic surgeon and then discuss what you options are for surgery.
Make sure the surgeon has extensive experience in redo breast surgery or revisionary surgery. Sometimes, a plastic surgeon may advise no surgery if he or she feels the risks are greater than the benefits.
I wish you success in whatever decision you make.
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.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.