Once over the Muscle. Can I Now Go Under Muscle?

As you may know, the submuscular approach is generally the preferred placement of implants.  When compared to a subglandular pocket, these submuscular implants are associated with a more natural appearance, a lower incidence of capsular contracture, and less palpability (you can feel the implants less).  There are a few options in this scenario.  One is to remove the implants and allow the breasts to heal back down to the muscle.  After 4-6 months, the implants can be replaced in a submuscular plane.  Most patients understandably prefer to avoid a staged procedure.  In order to remover the implants, an incision in the periareolar region or inframammary fold is required.  Silicone implants can then be placed in the submuscular plane.  However, this creates two breast pockets.  To maintain the implant in the submuscular plane, a dermal matrix implant such as AlloDerm or surgimend may be required.  This is sutured on the lower aspect of the muscle and over the implant to maintain the implant in the submuscular plane.  This can be accomplished with a good aesthetic outcome and no overlying skin issues.  Hope this helps.

If you have D sized implants on top of the muscle, and you take the same volume and go under the muscle, you could have issues with the overlying skin. In an over the muscle situation, the implant is within the breast itself and fills it up. The under the muscle pocket is high and the implant sits along the ribs and pushes forward. If there is any redundant skin or sagging, the skin may not be filled out properly, and could be loose or sagging above and beyond the level of the implant. And no, you would not be happy with that look. Sometimes in that situation the skin needs to be tightened in the form of a lift. Your plastic surgeon will tell you if you are a good candidate for a pocket site change, and whether or not you would require any type skin tightening procedure.