Are Submuscular or Subglandular Implants Better with Bleeding Disorders?

Am very active, and have VWD (low factor VIII and VWB factors.) PS feels have ample tissue to cover implant (34C/D), plus why cut into the muscle and cause more trauma when there is already anticipated bleeding complications. Working with a hematologist as well. Know many prefer submuscular, but does the situation warrant subglandular? Ever perform submuscular on a person with a known bleeding disorder?

Doctor Answers 12

Bleeding disorder

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Yes, I have performed a variety of breast surgeries on patients with various factor deficiencies.  I don't believe the sub-muscular versus subglandular approach would matter.  Your bleeding times should be corrected prior to surgery and a hematologist should be involved.

New York Plastic Surgeon
4.9 out of 5 stars 42 reviews

Breast augmentation and bleeding disorders

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Hi Franney,

I would recommend having sub-muscular implants for two reasons. One, you will have less incidence with capsular contractions and less inferior displacement of implants. Two, the sub muscular plane is avascular (less vessels). As long as your hematologist is on board, you should not have any problems. Best wishes, Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Bleeding disorders and placement of breast Implants

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First your bleeding disorder should be managed with the help of your hematologist during the perioperative time before any surgery. Once this is managed, then there is no difference what technique or placement is used for your implants. You should be fine with either submammary or submuscular placement.  There is about the same amount of blood loss doing submammary or submuscular placement and this is usually very minimal.  The decision on which location to place your implants in should be  made by your board certified plastic surgeon taking in consideration the physical characteristics of your breasts and body and the result that you want to obtain.

A. H. Nezami, MD
Jacksonville Plastic Surgeon

Breast augmentation in patients with bleeding disorders

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Once the blood deficiency is corrected sufficiently for you to undergo surgery you should under that surgery as if you did not have a bleeding disorder. That is the decision on whether to place the implants above or below the muscle should be based on the end result not on the bleeding disorder. To be extra safe you should have your surgery in a hospital where blood products are immediately availabe rather than an office or free standing surgery center.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Breast implants and bleeding disorders.

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If I am going to perform sugery on a patient with a bleeding issue, The workup is key and I work closely with a hematologist.  I then choose the pocket which I think is appropriate for the patient.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Are Submuscular or Subglandular Implants Better with Bleeding Disorders?

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If I was the surgeon I would opt for sub muscle. But no photos posted. Also I would do ONLY in hospital setting with Heme present, appropriate blood available. 

VWD and BA

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Your VWD alone does not "warrant" a subglandular placement of the implant.  As long as your bleeding disorder is managed with the help of your hematologist you should be fine with either placement.  The decision on which position to place your implants in should be made on the basis of the physical characteristics of your breasts.  There are pros and cons to each which a board certified plastic surgeon will discuss with you.  I can understand why you might think that cutting into the muscle would create more bleeding, but actually there is about the same amount of blood loss doing subglandular or subpectoral placement.  Remember, the hematologists job is to correct the clotting factors around the time of surgery so that your blood loss should be the same as a person whose clotting factors are normal all of the time.

Lori H. Saltz, MD
San Diego Plastic Surgeon
4.3 out of 5 stars 29 reviews

Bleeding Disorder and Breast Augmentation

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With over 33 years of experience and having operated on patients with VWD, there is no indication to change my preferred approach to breast augmentation. In the vast majority of cases implants are placed in the submuscular position. With both approaches there is minimal blood loss usually less than and ounce. i have never found the submuscular approach to produce more bleeding and it has many advantages over submammary placement including more tissue coverage and decreased capsular contracture. With input from your hematologist you should do fine.

Richard Linderman, MD
Indianapolis Plastic Surgeon

Von Willys and elective BAM

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 I agree with your surgeon, Just yesterday I operated on a middle aged women with VWD, we had her come in an hour earlier than normal, we coordinated her dose of DDAVP with her hematologist. She sailed through her surgery and today is feeling good. I chose to go OVER her muscle for the exact same reason your surgeon related to you. Good Luck

Charles Virden, MD
Reno Plastic Surgeon
5.0 out of 5 stars 70 reviews

Breast augmentation with Medical Conditions

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Yes, surgery is possible with appropriate pre-operative planning and management of the bleeding disorder.  Consult with your hematologist to evaluate the appropriateness and/or timing of surgery.  Of course, pick your surgeon carefully based on training and experience.  Good Luck.

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.