Complete Submuscular Placement? Scared.

I am having breast implant surgery on Feb 8th 2013. My surgeon wants to do complete underst not just pectoral. I am having 625cc's and I worry that they will sit too high. Or is it because of the large implants that it will be fine? I am 5'4, 130, medium frame. Can I ask my surgeon to do partials on the day of surgery? My nipples are low and he says they will always be low without a lift but wouldn't the sub pectoral help fill the lower pole? Is my implant too large for the sub pectoral?

Doctor Answers 18

"Submuscular" Implants

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Your surgeon must mean a dual plane procedure? Meaning partially sub-muscular. It would be difficult if not impossible to place this size implant under the muscle. AT 5' 4" and 130 lbs. If your nipples are low they will stay low and risk being even lower with such a large implant unless there is a lot of skin between the bottom of the areola and the infra-mammary fold. Is the big implant an attempt to fill out a very deflated breast? When a patient needs a breast lift I will not substitute a large implant for this. I will just fall out later on. I recommend a second opinion. Do you want a huge breast? This size of breast implant on such a small woman like yourself sounds problematic to me. I can't give you a definitive answer without at least good pictures and even an exam. Do your homework; look at my discussion posted yesterday to the woman in Bothell Washington about choosing a plastic surgeon. I am concerned for you. 

Complete Muscular Breast Implant Placement Concerns?

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Thank you for the question.

 I think that you will benefit from additional time spent with your plastic surgeon in the office days prior to surgery. I would suggest that you not wait on having these types of conversations until the day of surgery.

 Although I do not know your situation precisely enough to give you specific advice, my concern with “complete” sub muscular augmentation is the increased risk for animation or flexion deformity;  these  terms describe the  significant change in shape or position of breast implants that may occur when the pectoralis major muscle is utilized (for example during exercise).

 I think that your concern about filling the lower poles of the breasts is also legitimate concern.

 Again, best to clarify your concerns prior to surgery date;  if still confuse/concerned consider seeking additional in-person consultations.

 Best wishes.


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If you need a lift unless you have pseudo ptosis then you will still need a lift afetr breast augmentation

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon

Complete submuscular breast implants

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I wasn't aware that anyone was still even trying to use total submuscular implant placement in cosmetic breast augmentation. That was tried back in the day when it was thought that there was something magic about being under muscle that prevented capsule contracture. The technique doesn't work and certainly not with large implants. I suspect 625 cc implants are too big for even under the pectoralis muscle with a dual plane release and that they won't fit or look right. To fit and fill out the lower pole of the breast, the implant diameter must match the internal width of the breast and the pectorals muscle is released out of the lower pole to allow it to expand and minimize the "animation" trade-off. This gives a lift "effect" but doesn't actually raise the breast or nipple-areolas up the chest but rather out from the chest. I'd suggest starting over with the planned augmentation. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Breast implants

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Those are pretty big implants and will not be a provide suitable lift, if that is actually what you need.  The sub muscular issue is an entirely separate one altogether.  I do prefer the sub muscular placement but I don't think there is much if any difference between the so called partial versus the complete muscle coverage.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Submuscular vs subpectoral

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there are many issues to resolve before sugery:

  1. this is a large implant  how big do you want to be
  2. submuscular would be tough
  3. biplanar sould be considere
  4. a small lift to reposition the areola may be worthwhile

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Complete Submuscular Placement? Scared

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I would be scared too. I honestly don't think it is possible to get full muscle coverage of an implant so large in a patient of your size. 

The day of surgery is not a good time to change plans, as some thought and consideration will be required of both surgeon and patient. Now is the time.  Without a photo, I cannot comment on the issue of nipple position.

Call your surgeon today to discuss. Thanks for your question, all the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Submuscular implants

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Hello Minky,
You must have been mistaken (I hope) about what your surgeon said to you regarding a full submuscular pocket.  You simply cannot place anything more than a very small implant completely under the muscle in one surgery.  Aside from the large and capacious pectoralis major, the other muscles required to make a true submuscular pocket (pectoralis minor, serratus anterior, and rectus abdominus)  don't stretch that much, and trying to do so will simply tear them.  True submuscular placement of implants was traditionally used for reconstructive purposes, and would require a tissue expander to create enough space under the muscle to place an implant at another surgery- a two step process.

Aside from implant placement issues, why are you having a breast augmentation without a lift if you need a lift?  If this is in fact true, you will not be happy with the outcome, I guarantee you.  Very large implants will not make the situation better either, and they will just sit high, and your breasts and nipples will remain low, regardless of implant placement. 
I would step back for a moment and contemplate these important issues.  You should visit a few surgeons expert in all aspects of cosmetic breast surgery, not just implants.
Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Complete submuscular placement is not done for breast implants.

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1)  There may be a miscommunication. Complete sub muscular placement is only used for post mastectomy breast reconstruction.  And you are right that the implants would sit higher.

2)  You did not ask this, but we never use breast implants larger than 500 cc's for breast augmentation.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Completely submuscular breast augmentation

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Your concerns are legitimate and due to these issues, I would highly recommend further consultation with your plastic surgeon again, prior to your surgical date.  I am concerned that implants of that large of a size would fit in a completely submuscular pocket, especially in the body habitus you describe - a clarification of the definition of "submuscular" should be discussed.  In my experience, implants truly in the submuscular pocket do "ride high" since the insertion of the muscle is anatomically higher than the true inframammary fold and contraction of the pectoralis major muscle forces the implant in this position.  Also, a discussion about a breast lift should be entertained if it is known that your nipples are not in an appropriate position, in order to give you the best result and avoid having your breast tissue droop over your breast implant.  Hope that this helps!  Good luck!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

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