28 Yr Old Implants Rupture. Replace over or Under?

I am a very athletic active 59 year old 5' 4 1/2", 125lbs. Mammogram confirmed rupture. Older experienced BC PS recommends replacing w round high profile implants over in same pocket. Younger BC PS recommended take old ones out, leave out for at least a month and then replace under. I am considering Silimed High -Strength Cohesive Silicone Gel smooth rounds over. Will those look /feel fake? Want natural look for old age.

Doctor Answers 8

Consider site change and new implants

It is not unusual to seek a site change when replacing implants.  The development of a neopocket is ideal in your situation since the existing capsule is left in place and a new pocket is made under the muscle.  The   old capsule prevents the implant from rotating back up above the muscle.  

Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Breast implant explantation and implant placement

If you are happy with your current breast aesthetics, then I would recommend using the same pocket.  If you would like to improve your contour, then you may consider exchanging implant pockets to correct this silent rupture.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Replacing old, ruptured gel breast implants

There are a number of issues and options here and a direct consultation and exam is the best way to sort them out. 

If you were okay with the size and look of your breasts before the rupture was diagnosed, you could consider replacing them in the same pocket with the same size and type (modern gel-filled) implants assuming the capsule around the current implants is normal and the implants were properly positioned behind the breast.

You could also simply have them taken out along with any abnormal capsule and see how you feel about the look of your breasts at your current age. 

If you choose to remove them and replace them with a modern approach this would be a partially new pocket placement in the subpectoral position and you would have the usual current choice of implant types and forward projection (although the width of the implant needs to match the actual width of your breasts and with partial subpectoral implants of the same size you have you will not look as big). 

I do not have any personal/professional experience with the new Silimed/Sientra type gel implants but my impression is that they offer no advantages over modern gel-filled implants (Mentor, Allergan) for cosmetic purposes. The key to naturalness is sizing the implant correctly and positioning it properly below the pectoralis muscle for the upper half of the breast. 

I also see no reason to remove the implants and then replace them 6 months later other than to see how you feel about your breasts with the implants out. 

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review


i prefer the submuscular placement of the implants. It provides greater soft tissue coverage and a softer look.

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 14 reviews

Implant removal and replacement for rupture

Long-standing ruptured implants are a frequent scenario seen in most plastic surgery offices. Treatment involves implant removal and sometimes capsulectomy (scar tissue removal). There may be many appropriate breast contouring options at the time of implant removal.  It depends on your physical exam, namely the thickness of your overlying breast tissue and the degree of sagging you have experienced over the years in addition to the presence or absence of scar tissue (capsular contracture). I do prefer immediate or simultaneous re-augmentation rather than committing to 2 surgeries. Ideally, submuscular implant position is preferred in patients with thinner tissues in order to hide the implant. However, this requires a "non-saggy" overlying breast skin and tissue envelope, otherwise the loose skin (quite evident after implant removal) tends to sag above and beyond the level of the deeper implant. If loose skin and sagging is an issue, this can be corrected with simultaneous breast lift in appropriate candidates. If your breast tissue is thick and tone, a new implant in the same pocket may look nice. The high strength Silimed implants are great and feel natural. High profile implants work well in narrower individuals desiring more projection and exaggerated superior pole fullness. It doesn't hurt to continue to get a few opinions, so that you can make an informed decision. There may be many different options for you, depending on your breast tissue characteristics and your goals. The plan needs to make logical sense and you need to view before and after pictures to identify with someone similar to make sure your expectations are  realistic and achievable.

Hayley Brown, MD, FACS
Las Vegas Plastic Surgeon
5.0 out of 5 stars 87 reviews

Replace over or Under?

As a general rule, I prefer placing implants under the muscle. There are a number of factors that go into the decision, patient's anatomy being primary. Someone with a relatively large amount of her own breast tissue and who is getting a smallish implant is one in whom I would consider above the muscle placement. 

With a history of leak, I would generally prefer a site change, which would be under the muscle for you. I see only inconvenience to you to do your procedure in two separate operations. The newest "gummy bear" implants feel a bit stiffer and less natural than the current cohesive gels, on average. 

Thanks for your question, best wishes.You might want to consider a third in person opinion.


Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Replace implants over or under muscle?

Great question. There are a couple of considerations when deciding over vs. under the muscle in similar situations.

  • If you have thick breast tissues, no problems with capsular contracture and no other problems related to subglandular / over the muscle implant placement, then it may be reasonable to replace the implants in that same pocket.
  • If you have thin tissues, rippling, capsular contracture or other issues that may be improved with implants placed under the muscle, then this may be a good idea.

Whether a certain type of implant will look and feel natural is another issue. This generally comes down to size and tissue coverage.

  • The bigger the implants, the more you will feel them and the less natural your result will appear.
  • The more tissue covering the implants, the more natural they will look and feel-- this gives an advantage to implants under the muscle if you have thin tissues.

There is not a perfect answer in these situations, only principles that we apply based on individual circumstances. Make sure you find a board certified plastic surgeon to help you through the process.

Best wishes,

Michael Vennemeyer, MD

Michael Vennemeyer, MD
Southlake Plastic Surgeon
5.0 out of 5 stars 48 reviews

Breast Augmentation Revision and Implant Positioning?

Thank you for the question.

As you can imagine, it is not possible to provide you with precise device without direct physical examination and much more information. Generally speaking, if at all possible, I prefer the use of sub muscular (dual plane) breast augmentation and use this plane for revisionary surgery as well (if the specific patient's situation allows).

 I think this positioning of the breast implants tends to provide for a more “natural” appearance/feel, that you mention in your question.

If still in doubt, you may benefit from additional consultations in person.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,486 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.