Preferred Placement of Silicone Implants - Sub Pec or on Top of Muscle, After Capsulectomy?

Dear Drs, thanks for your prof.opinion. I decided to have my 40 year old implants removed & replaced w/silicone gel.Present implants are on top of muscle. I was told that I have very little breast tissue. Will addtl breast tissue be lost w/capsulectomy? Would like to remain a "B", I'm petite and thin. Prefer top of muscle for easier healing,is there a chance that the implant would ripple or show? Would I get better results with under muscle or top of muscle placement? Thank you.

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11 Doctor Answers | Asked by roses7 in Vista

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Silicone Gel Breast Implants after Capsulectomy - Above/Below Muscle

Dear roses7, As with so many other issues in plastic surgery (and probably everything else) there are no absolute answers to this. There are some general guideline and then you have to see where you fit in to all of them. Here's a few thoughts: 1) Silicone Gel Breast Implants are generally softer and "more natural" and are certainly less likely to ripple than are saline implants. So to the extent that you have very little skin and subcutaneous... more

With silicone gel implants, placement above or below the muscle is acceptable.

I disagree with opinions that restrict the placement of the implants (silicone gel) under the muscle. In the case of saline, I agree. However, I don't think there is any aesthetic advantage with silicone gel. I don't have a problem placing them under the muscle, I just don't think that there is an aesthetic advantage unless the patient has almost no breast tissue.

New implants after capsulectomy best under the muscle

There will be some additional tissue lost with the capsulectomy, and if you are thin then going under the muscle will usually give a better appearance. Your surgeon should work with you on a process for choosong the best size and style of implant.

Implant position

I prefer to keep iimplants in the submuscular pocket( dual plane) because I think that is is better protected in this location.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Sub Pec versus Above the Muscle Breast Implant

Good question and a common situation. Typically, a small amount of breast tissue is incidentally removed with a capsullectomy, although not enough to make a cup size difference. If you have very thin breast tissue to start with, this may be important. Even though silicone rippling is uncommon, it can and does happen in some situations. Placing silicone implants above the muscle with thin overlying skin is a situation where you may have rippling (although it is not... more

Breast revision for subglandular implants

It is always a good idea to place implants under the muscle which provides them increased cushion and allows the pec muscles to continually message the implants. When undergoing breast revision surgery, it is a good idea to place the implants from subglandular to a subpectoral pocket.

Implat exchange

Usually, minimal breast tissue is removed with a capsulectomy. I prefer submuscular placement initially. However, if you have subglandular implants that have remained soft, and aesthetically acceptable for 40 years, it is less complex and may be the best plan to put it in the same pocket. Placing it under the muscle introduces possibility of need for pexy.

It all depends on the breast tissue left after implant and capsule removal

Under the muscle implant placement generally works better ,but in your case the muscle may not cover the most of the implant and you may get rippling. The rippling will be less with silicone gel implants. The other option that I offer to the patient with very thin breast tissue if fat grafting over the implant in a later date.

Kamran Khoobehi, MD

28 reviews

New Orleans Plastic Surgeon

Placing new silicone implants behind the muscle is the right choice

You are already thin and having a capsulectomy will result in an even thinner tissue layer which may also have irregularities. You would be much better served and have a better result on many accounts by having the implants placed behind the muscle. There will be better support of the implant, lower risk/extent of rippling and lower risk of capsular contracture as just some of the advantages.

Implant on top or underneath muscle?

Dear Roses, You will lose some breast tissue if a full capsulectomy is performed. If you do not have sufficient tissue to cover the implant, then submuscular placement would help. It is difficult to advise without examining you, so if you are happy with your surgeon, then take his or her advice. If you are not happy with your surgeon, seek a second opinion. Good luck.

Placement of Implants after Capsulectomy

You did not state reason for replcacement of your implants. If you have significant capsular contracture, the implants should be moved to a submuscular location. If you are simply doing "preventative maintenance", then you probably do not need to have capsulectomy and implants could be placed in current pocket.