I had a breast augmentation 10 years ago and had them removed 8 years ago. I would like to get them again and had 3 consults. Two of the doctors tell me that it's just as if I never had them before and starting from scratch. The third doctor tells me that after removal my muscle has most likely scarred and fused back to my rib cage - so I won't be able to go under the muscle again and will have to go over. All doctors are reputable in this area. Does anyone have experience with this?
Can I Get Implants (Subpectorally) Even Though I Had Implants Removed?
Doctor Answers (18)
Dual plane or subpectoral pocket is possible.
While I agree with your consultant who predicted scarring in the subpectoral plane, it hasn't been my experience that the extent of scarring prohibits the elevation of the pectoralis major muscle again, unless there has been loss of the muscle, due to surgical removal (debridement) or if the muscle is congenitally short. Often individuals who have abnormalities of the rib cage and/or breast bone will have "short" muscles. When trying to implant a large volume, high profile saline under a fibrotic, scarred muscle, it may occasionally "slip" and end up in the subglandular plane. Each case must be considered individually, but recall that if your breast tissue is thin, the dual plane pocket is preferable, to camouflage wrinkling and also to optimize mammographic surveillance.
Repeating submuscular breast augmentation
After 8 years, the scar tissue joining your muscle to your chest wall will have softened allowing your surgeon to place the implants under the muscle. Even if the scar tissue is prevalant, a new plane may be made between the muscle and the old scar tissue, in essence starting from scratch. In the vast number of cases, a subpectoral placement is superior therefore don't hesitate to go that route if your surgeon feels that's best for you.
Repeat placement of implants under the muscle
Placing your implants under your muscle may be a bit more tricky because of the scar tissue present as a result of your prior operations, but possible.
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Implants under the muscle
It is possible to place a new implant under the muscle. Secondary breast surgery does require more skill due to the expected scar tissue. Also important is which incision was used the first time, the armpit, areola or inframammary crease. Most of the time we can use the previous incision.
There may be pocket scar tissue between the muscle and chest wall that has to be removed. If this is too difficult to fix, the implant can be placed above the muscle.
If there are changes in the amount of skin laxity 8 years later, the skin envelope might need an adjustment as well.
Consider subfascial for repeat breast augmentation
There will definitely be some scarring under the muscle, and the problem this can pose is that the muscle may be stiffer from the scar tissue and not drape over the implant as nicely. As the others said, you don't know fir sure until you actually get in there. Another option is subfascial, which is above the muscle but under a tissue layer called the fascia which is in front of the muscle. We use this a lot for athletic women who don't want the implants under but need a little more support for the implants.
Implants can go below muscle after explantation
The area will be more scarred but it should be possible to go under the muscle. the best approach wuld be to attempt to go under the muscle but keep the door open to going above. to this end you should likely choose a gel implant.
Breast implants can go under muscle.
This is not a problem. Just takes a little experience. Breast implants can go under the muscle again, if that's what's best for your anatomy.
If you no longer have implants in, you can probably go in either plane ( under the muscle or over) for the same reasons that you would have if you never had them before.
Can get implants subpectorally
Yes of course. What makes you think you can not? Please see three boarded plastic surgeons in your area so you can determine from an in person examination what is best for you.
Using an old subpectoral pocket for new implants
If your implants were initially removed for infection or bleeding, the tissues may be very stuck down, and it may be impossible to open that area again for new implants. that being said, most surgeons in this forum have probably experienced the opposite situation as well, in which the pocket opened easily. It will impossible to tell until the time of surgery, so you may need to be prepared to wake up with implants either above or below the muscle depending upon what your surgeon finds. Good luck, /nsn.