I don't like the way the muscle feels over the implant. How will my muscles be affected if I had revision surgery?
Can I Go from Breast Implant Unders to Overs?
Doctor Answers (14)
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Implants are generally better under the muscle
In all of my primary breast augmentations, I place the implants under the muscle. In this position, they allow for more accurate mammograms compared to implants above the muscle, there is less capsular contracture, and the implants are less easily felt and look more natural long term. Moving your implants above the muscle is not only technically challenging in some cases but also loses all of the benefits listed above. Consider this carefully when making your choice and make sure you are working with a very experienced plastic surgeon.
Get evaluated by an experienced plastic surgeon first
Technically, changing the position of your breast implants can be easily done. There are advantages and disadvantages of placing the breast implants over or under the muscle.
But, is this what is best for you? To answer this question fairly, a thorough physical evaluation needs to be performed by an experienced plastic surgeon to determine your best options.
Changing implant placement is often a good idea
While over the past two decades, most implants have been saline filled implants and been placed under the muscle, I feel that now with the new cohesive gel implants most patients will have a much nicer more natural looking breast when they are placed through a peri areolar (around the nipple colored complex) and under the breast.
I have often moved sub-muscular implants and placed them under the breast with great results. This is especially true if they have a moderate amount or more of breast tissue. Even more so if they need a breast lift. While the others have seemed to advised against it, I find it a great change in the right patient with the right indications. Sounds like you are one. One caveat, you should only have silicone gel implants under the breast, not saline filled because of the incidence of wrinkles and visible fold of the implant sack.
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Under to over
Removing a breast implant from under the muscle and placing it over the muscle is a serious step.
First, the circulation between the pectoralis muscle and the breast is divided, forever. That means the breast and the nipple receive less blood. It makes surgery on the nipple riskier (of nipple loss, especially when a breast lift is performed, even years later).
Also, it subjects a patient to a much greater risk of capsular contracture (hardening of the implants).
There is also a chance that the muscle may have been detached from the sternum, and this might be the root of your problem, not the implant placement. Generally, the pectoralis muscle cannot be reinserted. This problem is especially prevalent with large implants. This can cause the pectoralis muscle to "jump" when the arms are used.
Finally, the implant may become much more visible, and rippling greater.
There are specific reasons to move an implant, but your board certified surgeon should be aware of these issues.
You may be able to feel tand see the implant more easily
Placing a breast implant above the muscle is certainly an option for some women seeking breast enhancement, but it should be done in the properly selected patient who understands the advantages and disadvantages of this approach.
Depending on your body type and build, you may see the ripples of the implant more easily and you may be able to feel it more easily. My advice would be to sit down with your surgeon and review your concerns, and give yourself plenty of time before considering a revision procedure.
Breast Implant Unders to Overs
While it is possible to change the implants from under the muscle to over the muscle, it should be rushed into. A thorough consultation to understand your motivation and objectives, and a physical examination would be necessary to confirm the proper recommendations for you.
Breast implants can be put over the muscle.
We have done this safely a number of times in New York City. With revision breast augmentation, a new pocket is made over the muscle, ant the muscle is then sewn back into place.
Going from under to over with breast implants is a bit more difficult because the muscle is detached. It can be done, but not recommended in very thin patients.
It is my opinion that under the muscle is generally the best way to go for many reasons. You may change position if you desire.
I would ask how long your implants have been in, and what type they are (silicone/saline, smooth/textured), as this will affect how they feel to you. Generally, if you wait a while, they settle and feel more natural.
Also, when you go over, the same variables apply. For the softest breast, you will want silicone, smooth implants. Every option you choose has pluses and minuses however.
Under to over is possible
I don't know if anyone else realizes that you are asking a question or 2 every day and that you are only 3 weeks out from your surgery. I think if they knew, the recommendations to wait and to follow up with your surgeon would probably stand. You can go from under to over the muscle, trading off certain advantages and maybe a few disadvantages that you have with your implants in their present position. Please follow up with your operating surgeon, who really knows what would best fit your body habitus and requirements and can best discuss the advantages and disadvantages of each location.