Switching Breast Implants from Subglandular to Submuscular, Is this Risky? (photo)

You should absolutely not have a change of implants without a changes in planes.  Your current results are exceptionally good for a 12 year old sunglandular placement.  That being said, there are significant asymmetries and it appears that there is significant parenchymal thinning and skin stretching R>L.  The primary goal for your surgery should be to achieve a more aesthetically pleasing shape for your breasts and to make them last!  Maintaining the same plane severely limits any changes to the shape of your breast and insures that they will be shortlived.  There are not great risks associated with changing planes but I would strongly deter you from changing to submuscular!  A submuscular placement or dual-plane will leave over half of the implant uncovered and to make things worse, it is the lower half that is uncovered!  The superior half is covered by muscle that is continually exerting pressure on the implant and pushing it through your already thinned and stretched tissues.  I see many patients looking for revision subglandular or submuscular and I always recommend subfascial placement as I would with you.  I prefer to use a technique called 'cold-subfascial augmentation' that allows me to  preserve the strength of the pectoralis fascia without involving the pectoralis muscle.  This allows me to cover all or at least most of the implant with a strong structure that acts like a bra inside the breast.  I am in this manner able to shape a cohesive silicone implant into a tear-drop natural shape and give it relative protection against the forces of gravity and aging.  This allows placement in a case like yours, of a wider implant that creates a more beautiful larteral profile that tapers into your chest wall.  

 

I dont see many advantages in your case of having a surgery that maintatins the same plane as you would gain little to no improvement and are probably better off not having surgery.  I hope this helps!

 

 

All the best,

 

Rian A. Maercks M.D.

Like pretty much every decision in plastic surgery, there are pro's and cons to switching planes from subglandular to submuscular.

Pros:

-will improve rippling (if present) in the cleavage area

- may improve quality of mammograms somewhat

- may help to reduce recurrence of capsular contracture, if present

Cons:

- more soreness in 1st week post-op

-  motion of breasts with muscular activities

-  not good for patients with ptosis (droop), unless a lift is done

-  may limit placement of large implants

-  longer ( = more expensive) operation

 

So, here's how I would summarize it: if a patient has a great result with subglandular implants, and doesn't have ripples or capsules or other issues, it's quite reasonable to leave the implants in the subglandular plane.  If they need a revision because of those other factors, it's probably worth doing the change to submuscular.  

 

All the best!

Hello Susi,

It is very common for people to loose weight and suddenly feel their implants ripple.  If this is a problem for you, then you are a good candidate for a surgery that could minimize rippling.  Although I cannot tell by the photos, I would imagine that you have visible rippling on the inner and upper surfaces of your breast where people can see it most, as well as below the breast too.

A very common surgery is switching sites from a subglandular to a partial subpectoral position.  Not only is it a common surgery, the partial subpectoral position is the prefered location for a breast implant, and most surgeons perform this as an initial breast augmentation surgery.  Although dynamic postion and shape changes can potentially occur with implants below the muscle, the risk/benefit profile is considered better than a subglandularly placed implant by a majority of surgeons, including me.  In addition to a site change, you may want to discuss a change from textured to smooth implants.  Smooth walled implants have a thinner shell, and ripple less. Another thing to consider is utilizing a smaller, lower profile implant.  Although this is not entirely necessary, this will increase the likelyhood of a smooth, soft breast.

Although this surgery is common for experienced surgeons, there are many who have never done this type of surgery, and might caution those with your issues against it.  It is important that this surgery be performed by a well seasoned surgeon to minimize your risk of complications. Needles to say, certification by the ABPS and membership to the ASAPS are requisite.

Best of luck.

Switching pockets for breast implants is common and the order you are going... sub glandular too sub muscular is the most common.  In my opinion, the sub muscular position give the more natural looking results and also give more of your own tissue to cover the implant.

 

Good Luck.

Not sure why you feel that you "need"  to have your implants removed. Not sure where the rippling is - difficult to see on photos. If it is in the upper part of your right breast, than I think you have to have the implants changed to the submuscular position. I suppose you try some acellular dermal matrix, but it will cost a lot and is not as predictable over a long period of time. 

If you have superior pole rippling a submuscular approach would probably help this.   An exam in person would be essential to determine what would be best.

It would not say the procedure is riskier to change to a sub-muscular position but it is certainly technically more difficult to do. Having said that it can lead to a marked improvement in a woman's breast shape and softness by providing better upper and inner coverage to soften the breast implant edges. Every case is different and warrants a careful and comprehensive evaluation with your board-certified plastic surgeon. I hope this helps.

Dr Edwards

There are positives and negatives to the two implant positions. The operation of changing from sub mammary to sub muscular would be riskier but you would need to assess the degree of risk vs what you are trying to achieve. Ultimately why are you changing the implants?

Breast implants are often placed in a submuscular position to reduce thinning and visibility of the upper edge, and to reduce capsule problems. If you are concerned that the implants have worn and need replacement the surrent pocket should work out fine as you are used to the look and feel of the breast. The submuscular placement is not risky, though there are more risks, such as bleeding, and flexion deformities. If the last 12 years were good ones, keep the replacement simple.

Best of luck, Peter Johnson, MD

The photo of your breasts look great. Why are you going for more surgery. Remember the enemy of good is better. I don't see any rippling and other than a minor asymmetry, I think your breasts look teriffic. One day, if and when one deflates you will have to have surgery. Until then, leave best alone.

But then that is only my impression based on 30 years of experience.