Can You Change Implants from Over the Muscle to Under the Muscle?

Question

I currently have over the muscle saline implants. I have the normal wrinkling but when I lay down one goes under my arm and is uncomfortable. Would like a more shapely round looking breast. Can I move them to under the muscle after having them over the muscle?

William Bruno, MD · Answer

To convert a subglandular (over the muscle) to a subpectoral (under the muscle) position, is easier said then done.  It does depend on how long the implants have been in place.  If they have been in for several years, what happens is the pectoral muscle becomes attenuated or thinned out making it very difficult to elevate and create any type of significant muscle coverage.  When the muscle is elevated if often displays a "window-shade" phenomenon where the muscle migrates upwards, effectively not covering the implant at all.

	It is possible to do, but depends on the particular patient and her anatomy and duration of current implants.

	You should consult with a board certified plastic surgeon prior to scheduling this type of breast surgery.

	Best wishes,

	Dr. Bruno

Jeffrey J. Roth, MD, FACS · Answer

Yes.  This is done for a variety of reasons.  The advantages of under the muscle include a more natural look as there is more tissue coverage, and less capsular contracture.  If you have large implants on top of the muscle, you may have redundant skin that may need to be addressed with a breast lift pattern technique.  As far as your implant moving.  the creation of a new pocket may help this.

	As with any procedure, especially a "Re-Do" or revision, there are benefits and risks.

	Best to see a board certified plastic surgeon for evaluation and possible treatment.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Implants can be placed beneath the muscle if they were once over the muscle.  This would decrease the visible wrinkling and decrease the potential for capsular contracture.  Concerning the implants falling into your armpits this is a function of creating a pocket that is not too wide.  

	Dr. ES

Otto Joseph Placik, MD · Answer

The surgery you require consists of multiple steps and interventions involving many choices such as capsulectomy, capsulorrhapy, suture fixation, saline to silicone transition, etc. This is a complex operation that can and should be performed by an experienced board certified plastic surgeon. You may want to obtain multiple consultations in this regard. You will be at higher risk for complications such as "window shading" and/or the need for a touch up.

Hayley Brown, MD, FACS · Answer

Of course it is possible to change implant pockets from over to under the muscle. It is also desirable to do this when rippling is visible. However, loose breast skin may need to be tightened in the form of a breast lift, to establish a normal, attractive breast contour.

Christopher V. Pelletiere, MD · Answer

It is very common to change the implants from subglandular to submuscular, since it provides better coverage over the top of the implant. This can also help hold the implant in a more centered position and keep it from falling. It does require some work internally, and you need to close off that pocket above the muscle so that the implant does not flip back above it in the post-op process. This is easy to do with some internal sutures, but requires a little finesse. I hope this helps.

Jeffrey Claiborne, MD · Answer

Certainly. The surgeon can create a new pocket beneath the muscle and switch you to a silicone implant. This will usually dramatically improve wrinkling/rippling. A gummy-bear type implant will even further prevent wrinkling/rippling. I hope that this helps.

Tom J. Pousti, MD · Answer

Thank you for the question.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 conversion of breast implant positioning is especially helpful in the event of capsular contracture or severe breast implant rippling.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.

Francesco Campanile, MD · Answer

Yes. This procedure is relatively common, especially in patients that have recurring issues with capsular contracture. Placing the implants underneath the muscle will help to mask the wrinkling and rippling, and will also contribute less to breast sagging over the years as compared to implants placed over the muscle. If your breasts are falling into your armpits when you lay down, it is possible that you have issues with the pockets created during your initial surgery. Placing the implants under the muscle will allow the surgeon to create new pockets, which could give you a more ideal cosmetic result.

Steven Wallach, MD · Answer

Changing the implants from over the muscle to under the muscle is quite common.  This is often done to camouflage the upper pole of thr breast.

Can You Change Implants from Over the Muscle to Under the Muscle?

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