Can I Go Back to Unders After Having Overs for Less Than 1 Year?

10 years ago I had saline implants under the muscle. I'm 5'11" medium build 155 lbs A cup/left bigger. After several years my natural breast would distort when I flexed, eventually little movements would alter my breast. Very ugly. My surgeon advised my only choice was Silicon over the muscle. If it was under again, capsular contracture reoccurs. Now I won't let anyone touch me. Other than sitting or standing upright, the rippling and edges of the implant is horrible! Can/should I go back under?

Doctor Answers (8)

Replacement of Breast Implants in Submuscular Position

+1

Replacing Implants to Submuscular Position?

Thank you for the question.

In the event of capsular  contracture or severe breast implant rippling replacing implants in the sub muscle position is the best way to go in my opinion.  This may or may not be possible depending on your specific situation.

Generally, it is possible to replace implants under the pectoralis muscle (dual plane).  However, the major issue of concern is the overlying breast tissue and skin and whether further surgery will be necessary to achieve the aesthetic  results desired.  For example, some patients who have implants replaced into the sub pectoral space may benefit from breast lifting to achieve the desired goals.

This type of surgery does require some level of experience. It would behoove you to seek consultation with well experienced board-certified plastic surgeons well-versed in revisionary breast surgery.

I hope this helps.


San Diego Plastic Surgeon
5.0 out of 5 stars 759 reviews

Under muscle placement may not help rippling problem-consider Strattice internal bra

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It is certainly possible to put implants under the muscle after going over, but there will be some scarring on the muscle layer if you had them under to begin with so it is a decision to make in consultation with your surgeon. My concern is that your rippling is most apparent on the bottom of the breast, where the muscle doesn't add any coverage. Look into the use of a Strattice graft to make an internal living bra.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 26 reviews

Over or under?

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This is a tough question!! I am fascinated to see the great mayority of replies agree that the correction should be done with a dermal graft.  I don't have experience with them because of their prohibitive price, approx $2,000.00 for a usable sheet!  I have the feeling that you had distortion with muscle contraction because the muscle was improperly released at the time of your initial augmentation.  When your implants were switched to over the muscle you should expect some retraction of the muscle tissue and therefore a lot less muscle available to cover the implants next time around.  Judging by your photos I think your problem starts with your choice of size of implants.  They are too big for your body to be able to cover them naturally.  My solution is more in the order of accepting a smaller size of implants, do a lift (mastopexy) and possibly contemplate using fat grafting to thicken the already stretched out  breast tissue to improve the inferior pole rippling.  Regarding the placement of the implant I would definitely try to restore the under the muscle position splaying it to cover as much as possible of the upper pole but leaving a free edge to prevent  distortion.

Juan A. Brou, MD
Oklahoma City Plastic Surgeon
5.0 out of 5 stars 19 reviews

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Rippling with silicone breast implants

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Based on your photos it appears that you have relatively thin skin and minimal soft tissue (breast tissue). I would recommend placing your implants back under the pectoral muscle and adding an acellular dermal matrix (ADM) which is a synthetic skin (derived from human or pig) which will allow more coverage of your implant. This will minimize rippling and is needed to bridge the space between your pectoral muscle and your rib cage.

Best wishes,

Dr.Bruno

William Bruno, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 150 reviews

Rippling and revision breast augmentation

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The more visible rippling of your implants is due to several factors.  One is that your implants have less tissue covering them now that they are below the muscle and also you likely have little breast tissue (you were an A cup).  These lead to a more exposed and visible implant.  You can go back to under the muscle but this will not change the lower part of you implant.  To cover the lower implant visibility you should discuss the use of Alloderm with you PS.

Delio Ortegon, MD
San Antonio Plastic Surgeon
4.0 out of 5 stars 13 reviews

You can go back under the muscle.......

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You can definitely go back under the muscle as long as this wasnt' damaged with your prior implant removal or capsule removal.  Under the muscle will help to hide rippling of the implant, especially medially and superiorly. This may be of some help for the inferior ripples also.   I also agree that adding Strattice would be the best option to help cover and hide the ripples of your lower breast.   Under the muscle has less risk of capsular contracture, even with a revision, as long as the capsule is removed when compared to above the muscle.   But, I do agree, each time you have a revision your tissues will probably get thinner and your scar tissue potentially worse. 

Daniel P. Markmann, MD
Baltimore Plastic Surgeon
5.0 out of 5 stars 72 reviews

Implant rippling problesm

+1

You can't go back and forth above and below the muscle.  Eventually scar tissue and thinning prevent this from being a possibility.  You will always have ripples because you are so thin but Strattice may help cover it up.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 50 reviews

Rippling

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Rippling happens when the soft tissues thin out.  That is one reason to be under the muscle to cover the upper pole. For the lower pole you may need alloderm.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

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.