Over to Under (Breast Implant)?

Hi! I have had over the muscle saline implants for quite awhile now. Can you go to under the muscle when you do a revision/redo? Thinking of silicone when I do to. I am also having issues with capsular contraction with the left breast. Hoping that can be resolved with the revision also. Thanks! Donna

Doctor Answers 13

Over to Under (Breast Implant)?

Removing the capsule you have around your present implant and replacing the saline with silicone by using the "No-Touch" funnel to insert the implant will mean less discomfort and less likelihood of biofilm occurance. This will decrease your chance of recurrent contracture without having to disturb your muscle. Submuscular implants can get capsular contractures. The rippling that occurs laterally with some implants occurs in an area that is not covered by the muscle in submuscular positioning - only the upper inner implant is covered by the pectoralis muscle 

Miami Plastic Surgeon
4.7 out of 5 stars 62 reviews

Over to Under (Breast Implant)?

Thank you for the question.
In the event of capsular contracture or severe breast implant rippling replacing implants in the sub muscle position is the best way to go in my opinion.  
Generally, it is possible to replace implants under the pectoralis muscle (dual plane). However, the major issue of concern is the overlying breast tissue and skin and whether further surgery will be necessary to achieve the aesthetic results desired. For example, some patients who have implants replaced into the sub pectoral space may benefit from breast lifting to achieve the desired goals.
This type of surgery does require some level of experience. It would behoove you to seek consultation with well experienced board-certified plastic surgeons well-versed in revisionary breast surgery.
I hope this, and the attached link, helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,500 reviews

Over to Under (Breast Implant)?

     Transition of the implant to silicone in the submuscular plane is a reasonable treatment.




Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Change of implant position and composition is a good strategy

In theory, the left breast should be addressed by open capsulectomy, placement of a drain, closure of the subglandular plane and reimplantation with a silicone gel implant in the subpectoral plane.  In choosing your implant, consider your chest wall diameter, desired "cleavage", elasticity of your skin brassiere and seek opinions from BC/PS whose practice focuses on revisional surgery.  Do recall that the projection of silicone implants may be less than saline.  Good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Over to Under

Both of your requests seem reasonable. Switching to submuscular will lessen the chance of CC, and most surgeons and patients prefer silicone. 

There are a number of considerations to discuss with your surgeon, such as management of the present capsule, possible benefit (and cost) of using acellular dermal matrix to further decrease chance of capsular contracture. 

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Breast implant revision

Thank you for asking about a revision of your saline breast implants.

  1. Every breast enlargement has pros and cons - discuss with your surgeon.
  2. Most implant capsules are from biofilm infections. So I recommend removal of implants 2-6 weeks before placing new breast implants.  
  3. Breast implants under the muscle are less likely to form capsules.
  4. Research shows that acellular dermal material may decrease capsules at first, but the effect is temporary. Best wishes.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Over or Under the Muscle

It is reasonable to switch to an under the muscle pocket.  With a CC, i would recommend a capsulectomy, submuscular placement and use of Acellular Dermal  material to hold the implant in place and reduce the chance of CC recurrence.  Make sure you choose a surgeon with extensive experience in revisional breast surgery.  Good Luck!

Brian K. Reedy, MD
Reading Plastic Surgeon
4.9 out of 5 stars 145 reviews

From Over to Under The Muscle

Technically speaking, yes the implant can be placed under the muscle. The over the muscle pocket is sewn up and a new pocket is made under the muscle. However, if the skin and tissues have been stretched it may be possible that a lift will be needed too.

Jeffrey Hartog, MD
Orlando Plastic Surgeon
4.5 out of 5 stars 60 reviews

Switching from above the muscle to under the muscle with an implant change

Switching from over to under the muscle is a reasonable choice especially if you are having capsulear contracture problems.  The operation can be technically challenging if you have a high ridding muscle.  The problem is keeping the implant from flipping back into the subglandular space.  I usually block this using some sutures to close down the old space.   Draining the old space also helps.  

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

Implant exchange

It certainly is reasonable to place implants under the muscle for several reasons including a lower risk of a capsular contracture and to provide more soft tissue coverage.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 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.