Which Placement Type is Optimal for Gummy Bear Implants?

My doctorr says I have sufficient breast tissue and is recommending sub-fascial placement. I worry about increased capsular contracture risk and increased sagging when I have kids in future Any anecdotal recommendations from those who have worked extensively with Allergan 410s/gummy bear breast implants?

Doctor Answers 6

Dual Plane is usually, but not always the best...

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I have extensive experience with the 410 in a variety of pockets and have attended international meetings and lectured overseas on it.

While its resistance to ripple makes subglandular placement more viable than with standard silicone, even these implants benefit substantially from having the additional coverage of the muscle. Most international surgeons experienced with these implants go behind the muscle.

There are a number of plastic surgeons in Brazil who tout the subffacial placement for these implants, citing better coverage than submammary placement and less complications than submuscular.

But the additional tissue coverage of the fascia is miniscule, and the problems from being behind the muscle are minimized when a precise dual plane technique is utilized. The number of patients in the subfacial studies are all fewer than in submuscular studies, and the follow-up in the published studies is not long enough to prove that the results hold up as long as submuscular placement.

So, subfacial is a totally accepted, bonafide, and reasonable way of doing this procedure. But in my opinion, unless a patient has very thick soft tissue, they still are better off behind the muscle.

Los Angeles Plastic Surgeon
4.6 out of 5 stars 49 reviews

410s are not currently available for everyone's use

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The Allergan 410 implants have not yet been released for general use yet but there are some surgeons on this site that have a lot of experience with this implant. One that is commonly on line is Dr Teitelbaum. Regards placement, you will get different opinions from different plastic surgeons. I prefer a submuscular placement in virtually all of my patients because I try to provide the thickest coverage possible and I feel lifting the muscle, for the most part, yields a longer term support to the upper breast. Best of luck

Dr Edwards

Placement of Gummy Bear Breast Implants: Above or Below the Muscle

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The answers to this question have not been updated for some time. Things have changed. The highly cohesive silicone gel implants or gummy bear implants that are now available from all three companies come with either a smooth or a textured surface and many surgeons in the US are now using textured over smooth implants.

The reason that textured implants are preferred by many surgeons is that the textured implants have a much lower capsule contracture rate. Capsule contractures, or hardening of the breast implants is the most common delayed complication of breast augmentation.
“Below the muscle” is a bit of a misnomer since only the upper 1/2 to 1/3 is actually below the muscle. The textured implant has a similar capsule contracture rate when placed above or “below” the muscle although the evidence to date shows that it is slightly higher if placed above the muscle or in the sub glandular plain.

There are decided advantage to putting the implant above the muscle. These include:
  • Less bleeding which can cause capsule contracture.
  • No loss of the muscle power that result from cutting it to put the implant in place.
  • No risk for animation of the breast or excessive motion of the breast when the muscle is flexed.
In the end, with the new textured implants offer a big advantage over the older style implants and the shaped implants help with getting the shape you want. Above or below the muscle becomes almost a coin toss as to what is best and it often comes down to your goals as well as the size and shape of the implant that you chose. They are soft, almost indestructible, feel natural, look natural and have far fewer complications than breast implants used to have.

I hope that helps.

Best regards.

Brian Windle, MD
Kirkland Plastic Surgeon
4.9 out of 5 stars 64 reviews

Your goal should be to maximize the about of tissue covering the implant

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 Your goal should be to maximize the amount of your own tissue covering the implant.  Regardless of implant type, I feel this gives the most natural results.  Under the muscle gives the most coverage.  Good luck with your surgery.

410's in the US

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410 implants are not in general use in the US. They are only being used in experimental protocols.  The word out is that the implants are a bit firmer. They require a larger incision to place them in the pocket.   

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

Sub fascial placement of Allergan 410

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I understand your confusion. There is significant variation in the recommendations by different surgeons.This is a very difficult question to answer and due to the relatively limited information available on these implants and relatively recent introduction of this style, it is difficult to draw and conclusive recommendations.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 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.