Implant Exchange - Am I a Good Candidate for Smooth Silicone Subglandular w/ Lollipop Mastoplexy?

I'm an Athletic Yoga Teacher. I Want to Trade my Saline (Under Muscle) for Silicone (Over Muscle) and Shrink/even Up my Areolas. I got saline submuscular implants & crescent lift nine years ago. Initially I was happy with the result, as it was a big improvement. I've now had two more babies that I nursed (briefly) & some significant weight fluctuations. Now I'm in great shape but hate the way my implants SQUASH down when I flex my chest & feel way too firm/fake. I also hate my areolae, they're asymmetrical and WAY bigger than I'd like. Am I a good candidate for smooth silicone subglandular w/a "lollipop" mastoplexy?

Doctor Answers 10

Breast Revision

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One risk of the crescent lift is that the areolas stretch out again over time.  You also have capsular contracture (bad scar tissue that forms around the implant) which can be repaired by removing the capsule - that will make your breasts look and feel much more natural.  From your pictures, it looks like you would be a candidate for the lollipop or vertical breast lift.

Subglandular silicone implants

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I think you are a good candidate for subglandular implants to avoid the malposition that happens with flexing your muscles. Silicone would be my first choice. You may also benefit from a capsulotomy as you appear to have capsular contracture. Because of your weight fluctuation you may have stretchy skin so you could benefit from a vertical lollipop mastopexy. Best of luck

Dana Khuthaila, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 77 reviews

Implant exchange and pexy

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I would not recommend placing the implants under the gland.  You have loss of suppoort causing ptosis.  The muscle gives the best support long term.  I would recommend larger diameter implants, perhaps low profile implants or moderate profile implants plus a full mastopexy. 

There are always compromises and I believe that long term under the muscle is the best way in this instance.



Changing implant position

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You could get a much better look with new implants.  If you go above the muscle, go with gel for sure.  Either way, you need a much wider implant than you have to close the huge gap in the middle.  Maybe just a periareolar lift will be all you need to shrink the areola because you don't look like you have that much extra skin and much of that will be draped over the bigger wider implants.

Breast augmentaiton and Lift

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Yes changing your implant position and type are a good idea.  You may be tempted to just change the implants and forego the mastopexy.  In my experience that results in breast that sit lower on you chest wall and not really the perkiness that an athletic person wants.  I do therefore recommend the masopexy.

Implant exchange

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By placing your implants in a position above the muscle, you may get more cleavage so your breasts will not look as far apart. Smooth silicone implants are a good option for you as you appear to be thin. Depending on the size you choose and the position of the implants, you may not need a breast lift  with a vertical scar if the areolas are being reduced. Your surgeon may make a decision during surgery based on how things look.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews

Reaugmentation with Silicone

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Breast reaugmentation with subglandular implants is the only way to maintain your current breast size and also avoid the animation deformity from pectoralis activation. There is the possibility of decreasing the animation deformity with a "dual plane" augmentation, which is partial submuscular, partial subglandular implant placement. The issue with a subglandular implant is that there is an increased risk of capsular contracture (scarring around the implant) with a smooth silicone implant in this position. A textured implant is a better choice to avoid this problem. The other disadvantage of a subglandular implant is palpability and rippling. In thin patients with little breast tissue, even silicone implants can show evidence of rippling when placed as "overs".

With regard to a lift, a circumvertical incision (lollipop) is the best way to keep the areolar size from stretching over the long term.

So, in conclusion, either a smooth silicone implant in the dual plane or a textured implant subglandular with a lollipop mastopexy will achieve your goals.

Breast implant revison

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There are definitely advantage to each location of the implant. How that will look will depend on the quality of the soft tissue and skin of you breast.

David L. Abramson, MD
New York Plastic Surgeon

Peripexy with Breast Implant Exchange

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It is not uncommon to need a little perk up after 2 pregnancies. I definitely would keep the implants under the muscle as I agree that the muscle gives long term support and prevents bottoming out. Silicone implants also seem to "bottom out" less long term. If you want to reduce the nipple-areola size, you will need at least a periareolar incision; an incision all the way around the nipple-areola complex. This can devascularize the nipple so it may not be prudent to devascularize the submammary plane at the same time by exchanging your implants from behind to in front of the muscle.

Revison lift

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Based solely on your photos, I would probably exchange them to silicone and keep them under the muscle and just revise your circumareola lift.

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