confused on if I should get subglandular gel implant with my lift which my ps is recommending or ask for submuscular. I am 42 lost 80# in the last two years now through healthy diet and exercise I am now 5'3and 155# 34C sagging breasts extra skin loss volume. I want to be a full D or DD again and high and tight. I thought under the muscle would be better? Even though it sounds more painful. I'm worried about capsular contraction Gettingtummy tuck too March 14th. Any advice
Sagging Breast w/ Skin Tissue and Volume Loss - Submuscular or Subglandular Gel Implants w/ Lift?
Doctor Answers (13)
Weright loss and subglandular vs submuscular
Your skin quality is the main determinant of location and so the best person to answer this question is your plastic surgeon. In my practice a majority of women get submuscular implants and especially in those women who have lost weight. The skin has lost volume and elasticity and as such cannot bear the weight of the implant.
Breast Implant Positioning?
Thank you for the question.
In general, I think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” sub muscular position. This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).
The submuscular positioning also tends to interfere with mammography less so than in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.
I hope this helps.
I would recommend a submuscular implant with a full mastopexy/lift. This technique is the the most widely used and will give you the most coverage of the implant with the least complications. I think a tummy tuck will also do wonderful for you. Good luck.
Neil J. Zemmel
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Breast lift with Implant
There are several good reasons to have the implants placed below the muscle which is my preference.
1. Less likely to see rippling in the upper pole of the breast where most women have lost volume from either weight loss or having been pregnant.
2. Better visibility of the breast during mammograms.
3. Diminished capsular contracture rates.
I too would caution with having too large of an implant placed. The skin of patients who have lost a large amount of weight tend to lose their elasticity and tend to sag sooner and may require more revisions.
Good luck with your Mommy Makeover !
Brian Joseph MD, FACS
I prefer the submuscular approach.
I prefer the submuscular approach. I have found that the submuscular location results in: 1)more tissue covering the implant for a more natural look 2) improved mammograms when compared to the subglandular implants and 3) decreased rate of capsular contracture.
Over or Under the Muscle with Breast Augmentation and Lift
I would recommend a submuscular placement for several reasons. 1) If you are having a lift at the same time there is less disruption of the blood supply by going under the muscle. 2) The incidence of capsular contracture is less. 3) You will have a higher chance of rippling down the line with a subglandular implant.
That being said, I would caution you about your expectations as far as "high and tight". Typically women with massive weight loss tend to have thin, inelastic skin. Not only is going very large with the implant going to increase the risks of a complication when doing a combined implant/lift surgery, but also your inelastic skin won't be able to support the size and weight of the implant which would affect the final shape.
Hope that helps and good luck!
Dr. Babak Dadvand
Lift and augmentation later under the muscle would be the best and safest way
The combination of the mastopexy and augmentation has a high dissatisfaction rate due to the complexity of the combined procedure. The safest thing is to do the lift and augmentation later. If you decide on the combined procedure,submuscular placement is safest due to the preservation of the blood flow to the nipple.
Submuscular Implants Generally Have Lower Capsular Contracture Rate
Congratulations on your weight loss! I feel that implants placed submuscularly have a lower rate of capsular contracture. Since this seems to be an important consideration for you, you might ask your plastic surgeon his/her reasons for suggesting a subglandular placement.
Breast lift/augmentation and a tummy tuck
You will do well with a tummy tuck. Your breasts are harder to get a high, full and tight look because of the poor elasticity of your tissues. I'd advise a submuscular approach with a full lift. The large size you want maybe can't be safely done that same day as the lift though because the lift tightens you and the big implant stretches you.
Breast Lift and Implant Position
I would recommend a submuscular placement as well. Given your breast size and shape a subglandular approach is unlikely to give you the fullness in the upper part of your breast that you are looking for long term.
Keep in mind that the larger the breast, the more sagging that will occur over time. Therefore, the larger the implant, the more likely you are to need another lift in the future.