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 11

Silicone Implant Conversion

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.

Changing pocket position

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
4.0 out of 5 stars 22 reviews

Over the muscle implants changed to under the muscle.

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
5.0 out of 5 stars 64 reviews

You have to close the original pocket

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
4.5 out of 5 stars 16 reviews

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

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 155 reviews

Under the Muslce after Subglandular Implants

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 62 reviews

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

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
4.0 out of 5 stars 1 review

Submuscular implant surgery after subglandular proceedure.

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
4.0 out of 5 stars 1 review

Implant placement

Yes, it is possibleto convert over the muscle implant position to behind the muscle position. This is usually easier than the other way around since the muscle is often displaced and attentuated when implants are placed behind them and then it is more difficult to maintian the implants in a pure, above-the-muscle pocket. However, it is important to determie your reasons for going from one location to the other and the subsequent risks involved. Patients often end up what I call "chasing the imperfections" since breast implant surgery is an imperfect operation. You have to decide on what imperfection are, or are not, willing to accept.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 10 reviews

Converting implants from on top to below the muscle

I used to spar with my late father, who was also a Plastic Surgeon about where breast implants belong. He pointed out that the submuscular plane was associated with "dancing breasts", on certain movements of the chest muscles. I countered that the rate of capsular contracture is higher and the appearance of a "rock in a sock" unappealing. As a surgeon who trained in the 90's when silicone gels weren't widely available, I've tended to counsel my patients about the advantages of the submuscular plane: 1) better superior pole coverage; 2) greater resistance to infection; 3) easier mammographic surveillance; 4) lower capsular contracture; 5) potentially less gravitational displacement.

The only women I don't insist on implanting in the submuscular plane are those who have: 1) adequate (>2inch pinch in the superior pole) breast tissue and still want an implant; 2) tubular breast (narrow base with long skin brassiere and excessively large nipple.

A caveat: in converting a subglandular (on top of the muscle) to a dual plane (below the muscle), it's important to assess how much skin will contract because your PS should advise you whether you will need a breast lift, as well, especially if you don't want too large an implant to take up the slack. good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 54 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.