Over the muscle silicone implants?

I had a prophylactic bilateral mastectomy in June 2016 (early last month). I currently have expanders in and will be having them removed and the implants put in, hopefully soon. The last time I saw my plastic surgeon he said that they will be cohesive silicone implants placed over the muscle. I am confused as to why they would be over the muscle if I no longer have breast tissue to help the look and feel of the implants. Is this a normal or expected practice? Thank you.

Doctor Answers 2

Good question.

The theoretical advantage of placing a textured implant over the muscle is that it will stay in place, and you will avoid peculiar movements of the breast when you move your arms, which do NOT occur in the normal breast. Depending on how thick your layer of subcutaneous tissue is, there is a risk of visible rippling. The advantage of over the muscle is less discomfort following your surgery, but your plastic surgeon is the best person with whom to discuss any and all of your concerns. Best of luck to you. 

Mount Pleasant Plastic Surgeon
4.8 out of 5 stars 24 reviews

Over the muscle implants

Thank you for your question.

In the past few years, plastic surgeons have been placing tissue expanders and implants over the muscle. With the new cohesive gel implants, advances in mastectomy techniques, use of dermal matrices, and with the advent of fat grafting, we are able to offer this option. Over the muscle implants prevent animation deformities (moving your breast implants while flexing your pectoralis muscle), which can be quite distressing with under the muscle implants. Over the muscle implants do look natural, too. It is an excellent option in the right patient. If you have concerns, you may want to ask your plastic surgeon about the upcoming surgery. Best of luck! 

Manish Champaneria, MD
Portland Plastic Surgeon
5.0 out of 5 stars 55 reviews

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