From over the muscle to under the muscle. (photo)

I have 345 implants over the muscle and I would like to switch to under.I can feel edges of the implant.I have dimple on the upper (inner) right side of my left breast and when I lay down my left breast is falling on the side towards my armpit.If I want to switch to under the muscle shall I get the bigger implant to avoid having loose skin and have better result?Can I get rid of that dimple if I will switch to under the muscle?Can I have cut under my breast in the same place?

Doctor Answers 9

Over Muscle to Under?

The multiple issues that bother you are all reasons why most surgeons most of the time recommend placing implants under the muscle or in the so called "dual plane" location. Your skin looks quite elastic so it would be unlikely for you to have loose skin, but you could potentially up size a bit if desired. You don't want to push the size thing too far though as at a certain point you can thin the muscle as well and face some of the same problems you are having now. The problem of lateral displacement on the left side will also likely need to be addressed by some internal suture tightening of the pocket (capsulorrapy).

Yes you should

Switching to under the muscle would eliminate all the issues your having except for feeling ripples on the side and at the bottom of the breast because there is no muscle and very little breast tissue there.  Switching to bigger implants is an option only if you want to have bigger breasts otherwise you should not do it.  Also, note that with age the breast implants will become more visible and you should only have the next surgery if you are not happy with the look.

Andre Aboolian, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 55 reviews

Breast Implant Revision/Breast Augmentation/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision Surgery

I appreciate your question.

The best way to determine implant size is based on chest wall measurements that fit your body.  Once we determine that we can choose the profile based on what you want or need to achieve.  

Implants under the muscle, there is less risk of capsular contracture.  Anatomic implants tend to give a more natural shape with more nipple projection.

The best way to assess and give true advice would be an in-person exam.  Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Board Certified Plastic Surgeon



Change from over the muscle to under the muscle?

Thank you for your question.  Yes, it is not uncommon to "re-assign" the pocket or implant from over the muscle to under the muscle.  This can be done through your existing incision.  This is done for a myriad of reasons, one being the implant being too easily seen or felt.  

Brian C. Reuben, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 28 reviews

Plane switch procedures for breast implant revision #plasticsurgery

Implant position can be changed from sub-glandular to sub-muscular using the existing infra-mammary incision. I would plan on waiting a few months before doing this procedure after recent augmentation surgery. Implant folds and wrinkles are generally more concealed when implants are placed behind the muscle.

From over the muscle to under the muscle.

I think that the greatest potential for improvement of all the details that you describe is by transfer to a partial subpectoral plane accompanied by lateral capsulorrhaphy.  Going larger in implant size only challenges your tissues to support an even heavier implant and risks repeat lateral displacement.  DIscuss your options carefully with your surgeon before committing to proceeding and my advice would be to wait six months following your surgery before undergoing revision.

Jon A Perlman MD FACS 

Certified, American Board of Plastic Surgery 

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016 

Beverly Hills, Ca 

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 29 reviews

Moving an implant from on top to under the muscle

Thank you for your question. In your photo it appears you still are very early post-op from your procedure. My suggestion would be to wait at least 3-6 months before discussing any revisionary work. Moving the implant to the submuscular position would give a softer appearance. You should feel the implants less, however even with the submuscular placement (dual plane), the lateral bottom1/3 of the implant is not covered by the muscle. You may still feel the edges in this area. The dimple may improve placing the implants submuscular. You may consider a textured implant to avoid the bilateral implant shift which is common with smooth implants. You may also consider ADM to secure the implant and for more coverage where you are having rippling. Your surgeon should be able to use the same incision without a problem. As far as size, this should be determined at your consultation as there are many factors involved. You may do just fine with the same implant size. Give yourself some time to heal from your first procedure before considering a revision. Good luck to you.


Placing the implants behind the muscle can give a more smooth appearance. Your surgeon should be able to use the same incision. Going bigger is not always best due to the weight on the tissue. Please discuss all your concerns with your doctor.

Connie Hiers, MD
San Antonio Plastic Surgeon
4.6 out of 5 stars 13 reviews

Breast implant revision

Thank you for your question.  If you're considering breast implant revision, wait at least 3 months from your last surgery before getting a better idea of your result.  Placing the implant under the muscle reduces implant edge palpability and also reduces the risk for capsular contracture.  Be careful about getting a bigger implant as this may lead to ongoing implant edge palpability or thinning of tissue and skin.  Good luck.

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 14 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.