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

I do have 12 year old high profile textured silicone implants and have to change them for new ones. I have slight ribbling and my breasts are tender. I lost 10 pounds the last 5 years,I am 5"4,100 pounds now. I saw a surgeon for consult and he said he would not see a reason to change from Subglandular to Submuscular.And his nurse said, that there is more risk and they would have to close the pocket. I want to make the right decision for me for the next 12 to 15 years,not whats easiest for him

Doctor Answers (16)

Rippling and pocket change

+2

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.

Manhattan Plastic Surgeon
4.5 out of 5 stars 14 reviews

Breast augmentation revision: switching from subglandular or submuscular-choose the subfascial plane for the best results!!!

+2

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.

Web reference: http://www.rianmaercksmd.com/subfascial-breast-augmentation-miami.html

Miami Plastic Surgeon
5.0 out of 5 stars 29 reviews

Switching planes

+2

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!

Orlando Plastic Surgeon
5.0 out of 5 stars 19 reviews

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

+1

This is not particularly risky surgery. Any surgery on your implants poses some risk of developing capsular contractures, whether the implants are replaced above the muscle or moved below the muscle.  The main reason to consider changing to a subpectoral position is to get better tissue coverage and camouflage in the upper pole of the breast where rippling can be more of an issue. There will be no improved coverage in the lower or lateral part of the implant where the muscle does not cover.  Also, keep in mind that textured implants may show visible and palpable wrinkling more than smooth gel implants.  T/he disadvantages of changing to a subpectoral position are more discomfort for the first few days due to release of the muscle, and some visible distortion of the breast when you contract your muscles, usually only noticeable when your clothes are off and you contract your muscles.  Bottom line: if a patient needs the extra coverage due to thin tissue and visible wrinkling and upper implant edges, we go under the muscle and in works well. If they have a good result with no visible wrinkling and just want an implant change, there is no compelling reason to change to a subpectoral position.

Web reference: http://www.seattleplasticsurgery.com/breast-augmentation-surgery.html

Seattle Plastic Surgeon
5.0 out of 5 stars 66 reviews

Breast Implant Site Change

+1

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.

Web reference: http://www.drminniti.com

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 23 reviews

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

+1

It is not more risky and closing off the pocket takes a minute or two and a few stitches. We do it fairly often when patients come from elsewhere and are unhappy with their look.  It is definitely more painful but with the pain pumps many of us use that will control the discomfort. The current photo shows a very artificial look with the tops of the implants well outlined. The purpose of going under the muscle is to obscure the top of the implants to give a more natural flow to the contours.  It depends on which of the two looks you prefer. Just make sure your surgeon is well experienced in the operation. It is that experience that makes it go well.

Portland Plastic Surgeon
5.0 out of 5 stars 8 reviews

Pocket change

+1

Risky is not the right word. Risk is not increased when done by an expert. At your height & weight you do need your implants placed submuscular to look more narural. But some patients like the torpedo look. Tell him what you want and then go with his advice. He wouldn't do it if it was risky! The cost at Tahoe would be $4741 for saline and $5741 for gel.   Dr Foster

Sacramento Plastic Surgeon
3.0 out of 5 stars 11 reviews

Site change ro sub-muscular in revision breast surgery

+1

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

Las Vegas Plastic Surgeon
5.0 out of 5 stars 8 reviews

Sub glandular vs sub muscular exchange

+1

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?

Harrisburg Plastic Surgeon
3.5 out of 5 stars 8 reviews

Switching to submuscular breast implants

+1

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

Web reference: http://www.peterejohnsonmd.com

Chicago Plastic Surgeon
4.0 out of 5 stars 25 reviews

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.

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