What Cc Size is Going to Be Proportionate? BA Revision from Submuscular to Subglandular, and to a Smaller Implant Size. (photo)

I am 27 years old, 5'8 & 137lb. I got 420 cc silicone gel implants under the muscle in 2011. My muscles are pushing the implants apart and the implants are protruding on each side. Pre op I was a 34A and am now a 34D. I feel the implants are too large for my body. Soon I will get a revision surgery to put the implants subglandular. Is this the right approach? I will also change the implant size from 420 cc to 200 cc. Is 200 cc ok for subglandular placement? Pre op I had hardly any tissue.

Doctor Answers 4

Implant exchange

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I prefer to keep implants below the muscle because it give more superior pole soft tissue coverage.

New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Proportion is not the only issue to consider here

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I typically find myself going the opposite way in changing implant position in relation to the muscle, that is, I normally move from subglandular (above the muscle) to submuscular (below the muscle); I rarely go the other way.  This doesn't mean that you can't go the other way, it's just that typically there is more rationale to having the implants below the muscle.  Your risk of capsule contracture will likely increase by moving the implants to the subglandular position.  In addition, you are far more likely to see or feel the actual contours and textures ( ie, ripples) of the implant when it is above the muscle.  In addition, your current breast pocket accommodates a 420 cc implant, and a decrease of over 200 cc is quite substantial.  Thus, if you do drop your size down that much, there is a chance that without also performing a lifting procedure to tighten the loose breast tissue, your breasts will be more loose and sag.  Furthermore, if your lateral pocket is weak enough to allow the implants to drift laterally now, it will certainly allow it later too, regardless of the size of the implants you select.  You may need something done to reinforce that side of the pocket as well, such as sewing the capsule together or even using a type of graft material to reinforce the tissue that is there already.  Lastly, have you or your surgeon considered whether you will use a smooth or a textured implant, and what is the rationale behind your choice?  There are now very compelling reasons to consider textured implants in cases like this, and if you haven't discussed this option with your surgeon yet, it needs to be considered and discussed.  I have not even addressed your primary question of what size of implant would be proportional on you mainly because I think these other issues need to be considered first and foremost, as they might in some way influence the size of implant that you wind up with.  In other words, I don't think you should look at this situation as one in which you can simply dictate the size of your implants and everything will just fall into place with an excellent outcome.  That is a bit oversimplified, and I would encourage you to get at least one other opinion from a board certified plastic surgeon in your area who has extensive experience in reoperative breast surgery so that you are sure that you are taking the best approach in addressing your concerns.  Good luck.

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon

What Cc Size is Going to Be Proportionate? BA Revision from Submuscular to Subglandular, and to a Smaller Implant Size. (photo)

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The size will bring you to about half the enlargement you had, and if that is your goal it should be satisfactory.  I am not sure I understand the rationale for putting the implants above the muscle, though. There are advantages and disadvantages for each, and I would suggest reviewing those with your surgeon. All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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Smaller implants.

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Generally, I prefer to place the implants in a submuscular position for better coverage.  The concern of course would be visible implant outline or rippling.  Whether that occurs in subglandular position is determined by the thickness of breast tissue as well as the size of the implant.  Another option to consider would be to place the smaller implants in the same submuscular pocket, and then closing the pocket down laterally.  Good luck.

Perry J. Johnson, MD
Omaha Plastic Surgeon
4.8 out of 5 stars 19 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.