Can the muscle above your implant be torn and cause implant to go above it?

Question

i was recently told I have a staff infection in the right breast, put on antibiotic. Now the doc did an U/S and said that he cannot see the muscle between implant and nipple?? Thinks I should have implant removed - can muscle tear once implant is on top?

Robert Cohen, MD · Answer

If a breast dissection if performed for the first time in the submuscular plane in the proper fashion, it would be almost impossible for implants to slip out from under the muscle to a plane over the muscle as all of the attachments from the muscle to the overlying breast tissue should be intact. There are techniques called a Dual plane 2 and Dual plane 3 where the lower portion of the muscle is detached from the overlying breast tissue in order to allow for more expansion of the lower breast. Even with these techniques, the muscle is still mostly attached to the overlying tissue and  should not be able to tear free. In some cases, if the muscle is extensively dissected it can retract in an upward direction where it does not cover much of the implant anymore. I have seen plenty of cases where patients had implants supposedly placed below the muscle, but by the time I saw them the majority of the implant was not being covered by the muscle because of muscle retraction or due to inferior migration of the implant due to skin stretch. Also, some patients I have seen for revisions have been both over and under the muscle, and in these cases it is possible for implants to shift back into the subglandular (over the muscle) position if that space was not effectively closed out when the implants were switched to an under the muscle position. In cases where muscle coverage is suboptimal, reinforcement material such as Strattice can be used to help bridge the gap and better support the implants.

Christian Subbio, MD · Answer

An implant tearing the muscle from below would be quite uncommon.  More common, depending upon how long ago your implant was placed, is that the pressure from the implant caused atrophy of the muscle and thinning, thereby making it much thinner than before, and potentially more difficult to view on an ultrasound.  Regardless, the infection is the more pressing issue, as it puts your implant at risk.  This is a complex decision and needs to be discussed with your surgeon.Best of luck!Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

Nelson Castillo, MD · Answer

Thank you for sharing your question and experience. I am sorry to hear of your staph infection.  If the infection has reached your implant the best course of action is to have it removed to eradicate the infection.  An implant can be replaced 3-6 months after the infection is cleared.  It is uncommon for your chest muscle to tear any more than what was released during surgery so your surgeon is your best option at discussing what may have taken place with the muscle to cause it not to be seen on ultrasound.  Hope this helps and best wishes!

Hisham Seify, MD, PhD, FACS · Answer

I am sorry to hear about your current situation.  To answer your question, the muscle usually
does not tear but the implant can slip to a position above the muscle.  I have seen this in secondary cases where
implants were above the muscle and then are placed under the muscle.  It can also happen in situations where the
muscle is small and the implant is big, then slippage can occur.  But, I do not believe that the muscle has
torn.  I hope this helps.

Steven Wallach, MD · Answer

If you have an infection then it is essential to treat that appropriately. You may lose your implant.  As for the muscle, if implants are placed under the muscle, the muscle is usually selectively cut to allow the implant to sit appropriately.

Vasdev Rai, MD · Answer

Yes it is possible for muscle to tear apart from pressure of implant.  Muscle can slide up on the implant in other cases.  Such events are likely to need revision surgeries.

Brooke R. Seckel, MD, FACS (retired) · Answer

More commonly the pressure of the muscle pushes the implant out through the lower muscle incision that was used to place the implant under the muscle during inserttion. An MRI might show the muscle. If your implant is infected it needs to be removed.

Can the muscle above your implant be torn and cause implant to go above it?

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