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

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!

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.

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

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).

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 am sorry for your predicament but your situation is NOT common. Plastic Surgery is a super-specialty; the vast majority of Plastic surgeons have trained in and certified in other surgical fields before training in Plastic Surgery. In addition, upon completion of their training, as condition of membership Plastic surgeons undergo a rigorous selection system which focuses on clinical competence, safety and ethics. This does not mean that we do not have issues with ethical misconduct or incompetence in our ranks BUT those are quite uncommon and when they happen these members are punished and the entire membership is made aware of them andtheir actions. More common are instances of doctor-patient miscommunications and misunderstandings where the doctor or his/her patient did not explain or fully understand the other party.
In YOUR case, sagging breasts are not treated by breast implants. They are best treated with a Breast Lift Surgery. But, we all see women who pressurte their surgeons into performing a breast augmentation with large implants to "avoid" a scar on the breast. What then follows is a misguided placement of a breast implant with temporary, partial lifting of a sagging breast. In short order, as you have experienced, the sagging comes back but is accompanied by the obvious rippling of an underlying implant.

You may see what the surgeon did on his/her operative note but I am not sure how it would help you except to confirm the size / type of the implants and that they were placed over the muscle.

Hope this helped.

Dr. Peter Aldea

Marykathryn,

I am sorry to hear about your problem. To answer your question, no it is not common for plastic surgeons to lie to their patients and do what they want. Based on the experience you describe, I would suggest you request a copy of your operative report. This way you can read exactly what was done. It will also be of benefit for any future surgery you may have to have your operative report available for your new surgeon.

Best of luck.

A Board Certified Plastic Surgeon has been cleared by a very strict standard to be competent and ethical.  This doesn't mean they all are all the time or that they might not change.  You need to understand that lifting of your sagging breasts would not be accomplished by putting the implants above the muscle.  You should get the notes from your surgery, the preop and op notes and find out what happened.  It would be good for you to track the discussions that are documented in the record and see why there may have been a miscommunication between you and the doctor.

Also, it is not malpractice for a doctor to make a change of plans during surgery but in the case of above and below the muscle implants, these decisions are made before surgery and intraoperative findings almost never change these plans.