Good Or Bad Idea to Switch to Over-The-Muscle Implants After a Lift?

I had 480cc's of saline high profile implants placed under the muscle. However, I worry that when I go to the gym to work out, I'll have issues with doing push ups or working my arms since they are currently under the muscle and they tend to move around a lot. I will be having revision surgery for lateral displacement & cc in the near future. Would over-the-muscle implants make my skin that was lifted sag? I may even switch to silicone. Professional opinion please? Thanks! :)

Doctor Answers 9

Pocket switch with breast implant change

Thank you for your questions. When significant pocket work is necessary to correct implant position or size change, then yes, somtimes a switch to over the muscle can be a reasonable choice. This also helps keep the implant sfrom jumping during expercise. However, you need enough of your own breast tissue to pad (cover) the implant, otherwise, you will have an increased chance of rippling and tissue thinning.  To be sure, see two or more board-certified plastic surgeons in your area for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery.  I hope this helps.

Nashville Plastic Surgeon
5.0 out of 5 stars 182 reviews

Changing breast implant position remedies excess animation.

If one of your main concerns is excessive animation with muscle contraction then switching to a subglandular position will correct it.

You can still "change the pocket" if you are correcting lateral displacement or removing excess scar tissue.

It should NOT make the skin which was lifted previously look any more droopy.

Richard H. Fryer, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 271 reviews

Above or below the muscle in breast augmentation revision

Generally, at Gayoso Plastic Surgery, I do not recommend changing an implant position above or below the muscle unless the patient is having an issue, such as excessive animation, palpable implants edges etc. While it is true that submuscular implants can appear to be more animated with exercise, that is not always the case. A modest increase in size may not cause your implants to suddenly become animated with movement or exercise. Conversion to over the muscle and increasing the size of the implant may put you at higher risk for sagging because you no longer have muscle to help support the weight of the implant. I do feel strongly that silicone implants provide a more aesthetically pleasing breast.

Antonio Gayoso, MD
Saint Petersburg Plastic Surgeon
4.9 out of 5 stars 32 reviews

Lateral implant support

It is hard to give you an answer without an examination but if you already have 480 cc implants in place below the pectoralis muscle I would see little reason to switch to above the muscle.   As long as you are not a body builder most toning exercises will not change your breast appearance.   In my experience lateral migration of a large implant is more common with submuscular placement but other complications such as capsular contracture are less.  Most likely you will get the improvement that you desire with a capsular repair.  You may also consider Strattise to support the implant laterally.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Pocket change with impalnts

If you do not have alot of soft tissue coverage, then moving the implants above the muscle may not be a good idea.  Larger implants put more pressure on the skin and may cause premature sagging.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Best Implant Position

The answer to your question is it depends... if your submuscular placement caused your lateral displacement, then going over the muscle would eliminate this.  But as the prior posters have mentioned, you do give up some benefits from submuscular (or I prefer dual plane as its only partially submuscular) placement including the rock in a sock look, a greater risk for contracture, and in my experience, a greater risk for drooping. 

I am a believer in dual plane techniques and my patients have been very pleased with their long term results.  My patients all know in advance that they should not be planning on pectoral exercises such as push ups, bench presses and pec flys and life remains good for them.  If having the strongest muscles are your primary concern, then you have to go above the muscle and again, accept the risks that come with that.

Best wishes in achieving what you desire.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Breast implants above vs. below the muscle

From the limited information in your post it is impossible to say what would be best for you. In general very fit physically active women have trouble with implants under the muscle. If you are bench pressing heavy weights the firing of the muscle squeezes the implant and tends to displace it. There is no muscle over the outer edge of the implant hence the lateral displacement. I am aware of a case where the bodybuilding patient's muscle squeezed the implant so hard that half of it came in front of the muscle while the other half stayed behind it forming a U-shape. These patients have very little body fat so although above the muscle is a better option it is still not optimal because the edges of the implant even if it is silicone tend to become visible. Sagging issues of course are greater with implants over the muscle and so it is better to go with smaller implants in that position to lessen the risk. The bottom line is there is no free lunch and every procedure has its pros and cons that the patient needs to weigh before proceeding with surgery.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 1 review

Converting implants from under to over the muscle

Distortion from muscle contraction does happen with submuscular implants especially if not enough of the muscle was released. Since it appears you will be having more surgery at some point discuss this option with your surgeon. Converting to a subglandular can accelerate breast sag and lead to a rock in a sock look. I was never a fan of high profile saline implants and converting to gel implants will likely enhance your results! Good luck!

Marcel Daniels, MD
Long Beach Plastic Surgeon
4.8 out of 5 stars 23 reviews

Breast Implant Position Change?

Thank you for the question.

Although breast implants in the sub muscular ( or dual plane)  position may experience “distortion” with muscle movement (workout) I still think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).

The submuscular positioning  also tends to interfere with mammography less so than in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 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.