12 years ago I had a breast augmentation with 450cc saline supposedly sub-pectoral. Well, the time has come that I need to upgrade them due to rippling. I have had consultations with 5 different plastic surgeons and 3 of them say that my implants are sub-muscular and 2 of them say they are sub-pectoral since they move slightly when I flex my chest. I can feel the bag through my breast tissue... Is there anyway to tell without an MRI?
Any Way to Tell Whether My Breasts Are Submuscular or Subpectoral Without an MRI?
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Implant positioning and feel.
Submuscular and subpectoral mean the same thing. There are several ways to tell - old operative reports, palpable implant in the upper pole (clinical exam), or an MRI. Submuscular implants will move more with activation of the pectoralis as the capsule is attached to this muscle. The bottom line is that it doesn't matter all that much for an exchange.
It really is not that important.The best choice you are making is to go with silicone.This will make a big difference.
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Implant Pocket Sub Muscular vs Sub Glandular
Your implants are sub muscular because 5 plastic surgeons out of 5 said they were sub muscular (because sub pectoral means sub muscular). To double check this, stand in front of the mirror, look at your breasts, place your hands on both hips and push inward towards the hips. If the breasts distort, especially rising up, than they are sub muscular.
Changing your implants because of rippling is a great idea. Also, saline implants tend to leak, so switching to silicone would decrease the chance of rippling and also leakage. Pick one of the 5 plastic surgeons that you have seen, being sure the one you pick is Board Certified by the American Board of Plastic Surgery, that he or she has significant experience with breast augmentations/revisions. Once you have done your homework on your plastic surgeon's credentials, be sure the plastic surgeon you choose is someone that you can work with even if things don't go perfectly because revisionary surgery carries a slightly higher risk of complications.
Sub muscular or Sub glandular Breast Implants?
Thank you for the question.
Sometimes, it can be difficult to determine whether breast implants have been placed in the sub muscular or sub glandular physician based on physical examination alone. Either way, your plastic surgeon will be able to determine the location of breast implants in the operating room. If at all possible, if your breast implants are found to be in the sub glandular position, they should be replaced in the sub muscular position ( dual plane) given that one of your major concerns is the presence of rippling/palpability of the breast implants.
I would suggest that you choose your plastic surgeon carefully; ask to see lots of examples of his/her work. Communication of your goals will be critical.
If your implants move with flexion of the pec muscle it is likely that they are partially submuscular.
How to tell if implants are under or over the muscle
If flexing your chest muscles distorts your breasts then chances are the implants are at least partially under the muscle. Look at the medial aspect of the breasts near the upper pole: that will be the location for maximum distortion with pectoralis muscle contraction.
Submuscular or Subpectoral??
I believe all 5 surgeons are saying the same thing. "Submuscular" means under the muscle, and the muscle under which we place the implant is the pectoralis major muscle. "Sub-pectoral" also means under the pectoralis muscle. Your surgeon should be able to tell with high reliability (though not 100%) whether the implant is above or below the muscle.
A radiologist reading a mammogram can usually tell the implant position.
At any rate, if you are going to have your implants replaced, neither an MRI nor a mammogram is needed for your surgeon to plan the procedure that will be best for you.
If your are having surgery because of the ripples, your surgeon should discuss using silicone, and assuring himself or herself that the implants are under the muscle.
Changing from submuscular to subglandular breast implants
Chances are that both sets of doctors are correct. You may have a combination implant placement known as a dual plane, in which part of the implant is below and part above the pectoralis muscle. I would begin the consultation with the steps you can take to improve your breast implant aesthetics with regards to the current positioning.
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.