Under Muscle Breast Implants Possible After over the Muscle Implants?

Can you get under the muscle breast implants after you have already had over the muscle implants?

Doctor Answers 13

Silicone Implant Conversion

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Yes, breast impalnts can be converted to under the muscle.  Conversion or "pocket-change" is done to improve the appearance if you have capsular contracture, rippling, or palpability (fancy doctor-speak for implants that can be felt through the skin). 

The old pocket (on top of the muscle) has to be closed down with either quilting sutures, other techniques such as using an artificial mesh.  If the old pocket isn't properly closed, the implants will tend to flip-back into the old pocket since it is the path of least resistance.

You have to close the original pocket

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I've had the opportunity to perform the procedure where I removed implants from a sub mammary positionand placed them submuscular. The original pocket has to be closed down in order to insure that the implant won't dislodge and fall into the original pocket. I've seen that happen. Usually it requires placing some sutures into the old pocket after cutting the capsule out. It's also important to cut some of the inferior fibers of the pectoralis muscle where it attaches to the breastbone and rib cage to allow more space underneath the muscle

Joseph M. Perlman, MD
Houston Plastic Surgeon
4.3 out of 5 stars 27 reviews

Change from "above the muscle" to "below the muscle" breast implants

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There are several important answers to the question of changing "above the muscle" implants to "below the muscle" breast implants.

The first is for women considering this procedure for the first time. This issue is no longer a "dealer's choice" option just as the volume of the implant should not be just whatever the patient or surgeon wants. My own experience and that of many plastic surgeons over decades clearly shows that overall and in nearly all cases, breast implants do better under the pectoralis muscle both short term and long term and for a variety of reasons that have held up with added experience. Of course this depends on the surgeon knowing how to properly position and implant under the pectoralis muscle. If it is not done properly it is not the fault of the under-the-muscle positioning but the surgical skill in getting the implant properly padded and protected under the muscle without defunctionalizing the muscle or detaching it in the wrong way. In general there is no good reason to place a breast implant above the muscle today knowing what we know from years of experience. If you put the implant above the pectoralis muscle you are essentially asking for it to be visible long term if not short term.

Today there are thousands of women with breast implants above the pectoralis muscle and it is still done. The solution if the result is unacceptable is to remove the previous implant and redo the procedure by positioning a properly sized implant in a new pocket below the pectoralis muscle. This is actually fairly similar to a procedure done the first time in the subpectoralis position and requires similar healing and risks plus potential problems with the old capsule above the muscle. This generally requires an incision in the inframammary crease if there is not one there already.

I'm not convinced that subpectoral muscle placement of breast implants prevents capsule contracture. I think avoiding periareolar incisions and the use of anti-microbial techniques is more important, but the muscle provides short term and long term padding and protection for the implant and partially separates the breast tissue from the implant for tests like mammograms. It is essential for saline-filled implants and any kind of natural looking result but not quite as essential for gel-filled implants at least short term.

Scott L. Replogle, MD
Boulder Plastic Surgeon

Under Muscle Breast Implants Possible After over the Muscle Implants?

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Thank you for the question. Firstly, you will need to communicate your goals clearly with a well experienced board-certified plastic surgeon who can demonstrate significant experience with revisionary breast surgeon. I find the use of goal pictures helpful during this communication process. During this process, you will receive advice regarding your goals; for example, whether or not you are a good candidate for the procedure of breast implant pocket conversion.
The procedure itself involves removal of the current breast implants, careful dissection of the sub muscular ( dual plane) space, and usually closing off the previously dissected space above the pectoralis major muscle. Closing off the existing breast implant pocket will help prevent the new implants from slipping from the sub muscular ( dual plane) pocket into the previous pockets.
Depending on the patient's anatomy and goals, sometimes additional work may be necessary to improve the outcome of the procedure. For example, additional manipulation the breast implant pockets ( such as capsulorrhaphy) or of the overlying skin envelope ( such as breast lifting) may be necessary. If the pocket conversion is being done because of breast implant rippling, the use of acellular dermal matrix may be helpful.
You may find the attached case demonstrating breast implant conversion (link) helpful to you.
Best wishes.

Under Muscle Breast Implants Possible After over the Muscle Implants?

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Yes - change in position is not uncommon either for patient choice, capsular contracture issues, rippling/visibility or implant, or revision reasons.  It is certainly a reasonable option for several patients.
Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Changing pocket position

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It is certainly possible to change the implant pocket from subglandular to submuscular.  This is done all the time.

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

Over the muscle implants changed to under the muscle.

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You can certainly change your implants to under the muscle.  Your plastic surgeon will advise you if you need a lift.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

It is possible to convert from a subglandular to a submuscular position

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In general, I prefer to perform most of my primary breast augmentation procedures partially under the muscle using a dual plane technique. This offers several benefits including nice superior pole slope, lower capsular contracture rates and an overall natural appearance. There are instances when one has implants in the subglandular position and may have significant rippling with saline implants or capsular contracture and they would benefit from a pocket conversion.

Sanjay Grover, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 243 reviews

Under the Muslce after Subglandular Implants

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Yes you can if you have not been under the muscle. I generally place the implants behind the muscle in women who have had their implants placed in front and have capsular contracture or for other reasons.

So it can be done but the space between the muscle and the breast tissue has to be closed off otherwise the implant can slip out and go back in front.

Good luck.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 88 reviews

Submuscular implant surgery after subglandular proceedure.

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Yes . To modify a phrase: one size or one placement doesn't fit all. An experienced board certified plastic surgeon may employe either proceedure OR a hybrid proccedure depending on the case.

Barry H. Dolich, MD (Retired)
Bronx Plastic Surgeon

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.