I have capsular contracture. My implants are placed above the muscle. Should I go under the muscle? Is that possible and will it look horrible?
Will Going Under the Muscle Look Horrible After Going Above the Muscle?
Doctor Answers (8)
Breast implant replacement under the muscle
I think that you will even better than on top of the muscle and a slightly lower rate of capsular contracture. This is a good choice.
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.
Replacing over the muscle implants under the muscle
The risks of going under the muscle are as follows:
More pain after surgery (muscle dissection hurts);
Longer recover (same reason);
Possible later "separation of volumes" leading to a "double contour" deformity as the breast falls with time and gravity and the implant stays high on the chest, isolated by the muscle layer;
Distortion of the implant by the muscle during exercise leading to weird breast motions.
A better bet is simply to place the new implants on top of the muscle but under the old capsule (or simply in the same pocket after removing the capsule).
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Replacing implants previously over the chest muscle in an under-the-muscle position is possible
While this maneuver does require a bit of experience, placing your new implants under your chest muscle is definitely in your best interests, lowering the risk of recurrent capsular contracture, and giving you a more natural, long lasting result.
The photo I have linked to is an example of just the maneuver you are asking about. We did her surgery over 5 years ago and she still looks this good.
Will putting breast implant deep the the muscle look horrible?
In the case of capsular contracture around a subglandular implant, removing the capsule and repositioning the implant deep to pectoralis major muscle is sound management. Submuscular placement will likely camouflage your implant better, and result in a slightly more natural appearing augmentation.
Capsular contracture treatment
Capsular contracture is one of the more troubling complications associated with breast augmentation. Some studies indicate that it is the most common cause for requiring secondary surgery (revisions). The treatment typically includes removal of the old implant, a total or subtotal capsulectomy, and the placement of a new implant. Capsular contracture rates do appear to be less for silicone implants when they are placed under the muscle. This is still a bit controversial though. When a pocket change is carried out with implants being removed from above the muscle and then subsequently placed under the muscle, the breasts can have a much different appearance. The implants can sit much higher, at least initially. There may also be skin excess requiring a breast lift. I agree with Dr. Minniti below, that it is probably best to get a few opinions before deciding on a particular board certified plastic surgeon.
Breast Implants and Capsular Contracture
Your best chance of minimizing the risk of recurrent capsular contracture consists of removing and discarding the implant, removing the entire capsule from around the implant, and placing a new implant under the pectoralis muscle. Depending on your anatomy, you may also require a breast lift as well. Done well, your results could look very pleasing.
Revision breast surgery is more complex and requires experience. You should visit a few surgeons that have an excellent reputation in revision breast surgery. These doctors will be not only certified by the American Board of Plastic Surgery, but also members of the American Society for Aesthetic Plastic Surgery.
Best of luck!
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.