I Asked my Plastic Surgeon for Under the Muscle Implants, and He Put Them over the Muscle.

Question

Today I went to a P.S. to have a consultation about my breast implants, that did not come out how I wanted. I wanted to discuss maybe changing to silicon implants, from current saline(put in 2yrs ago). I thought maybe this would correct the droopy look my breast have, as I wanted the "fake" look. He confirmed my suspiscion that the implants were definently over the muscle, and just sagging in my breast. Is it common for platic surgeons to just lie and do what they want? What can/should I do now

Gerald Minniti, MD, FACS · Answer

Hello,

	It is possible but unlikely that any physician would intentionally give a patient misinformation, especially in this situation of your primary surgeon describing to you your initial surgery.  Much more frequently is the case where a second surgeon makes statements about your current condition that seem to refute previous information that you were given.

	The issue you are having is more likely implant dropout, which is what the second surgeon is describing.  This problem can occur in anyone, especially with large implants, but can be exacerbated by surgical overdissection at the time of implant placement.  In addition, submuscularly placed implants can also have another problem occur called 'window shading', where the pectoralis muscle is over dissected from the lower sternum causing the entire muscle to slide upwards, exposing the implant.  The combination of dropout and window shading will give you an implant that was once placed submuscularly but is currently in the subglandular position.  So its not so much that your implants are over the muscle now, but more accurately they have drifted below the muscle on your chest wall.

	Now, let me also clarify some bits of information that I believe you have a misunderstanding of.  Saline or silicone implants do not have a different impact on the appearance of your breast, and changing from one to the other will not make a difference in how you look.  One exception is the extremely overfilled saline implant that will look like a ball and give an obvious fake look, as well as a very firm feel.  In general, implants that are placed over the muscel will look more obvious (fake) than implants that are placed under the muscle.  Please note however, that if the implants dropout, than the fake look seems to go away, at least in the upper poles of the breasts.

	If you are unhappy with the appearance of your breasts, it is crucial that you consult with a surgeon certified by the American Board of Plastic Surgery, who specializes in revision breast implant surgery.  Together, you and your surgeon will discuss your best options for revision surgery and it is likely you will have an excellent improvement to the appearance of your breasts.

	Best of luck!

Otto Joseph Placik, MD · Answer

I am a little confused. You say you want a fake look and correction of droopiness. Generally this is better accomplished with over the muscle (rather than under) which is what you got. If you put the implant under the muscle, it will look less fake and you may be aware of more ptosis.

Martin Jugenburg, MD · Answer

Was your original plastic surgeon a plastic surgeon?  Cosmetic surgery is performed by many doctors, not all of whom are plastic surgeons.  Some of these doctors do not have the training to allow them to offer service at the level of a board certifiedplastic surgeon.
Also, sometimes if the muscle is released too aggressively, it will over time slip up and the implant that was originally below the muscle will then end up above the muscle.

Sincerely,

Martin Jugenburg, MD

Steve Laverson, MD, FACS · Answer

Subglandular (relative to submuscular) placement of implants more reliably produces the "fake" look you were originally after.  Also, understand that your final result reflects many variables, some predictable and others unpredictable.  For example, the interaction of the mechanical implant with your tissue is unpredictable in advance, the amount of skin stretching caused by the implant is impossible to predict, your skin elasticity and post surgical settling also hard to know in advance.  This is why a particular result is impossible to guarantee in advance.  Every patient and every situation is different.  Generally, plastic surgeons incorporate techniques most likely to result in the desired outcome.

	If there is an element or elements of your result you are dissatisfied with, discuss each of these with your surgeon.  It is unfair for me (or any surgeon) to comment on your problem specifically without more information, such as before and after pictures, a physical examination, and an understanding of exactly what was done during your procedure and after your procedure (post operative period).

Steven Wallach, MD · Answer

If your breasts are sagging, placing larger implants will not necessarily lift them.  Commonly a breast lift procedure should be combined to improve the shape as well.  I can not really comment on yoru other concerns because I did not do your original surgery and do not know exaclty what was done.

I Asked my Plastic Surgeon for Under the Muscle Implants, and He Put Them over the Muscle.

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I Asked my Plastic Surgeon for Under the Muscle Implants, and He Put Them over the Muscle.

Answers (8)

Answer: Breast Implants "Over the Muscle"

Answer: Breast Implants "Over the Muscle"

Answer: Implant choices

Answer: Implant choices

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Recommended reading

Everything you need to know about Breast Implants

Our mission is to create a world where every investment in modern beauty is Worth It.