Will I be able to get saline over the muscle? (Photo)

Question

I had my breast augumentation about 10 months I went from 32B to 32D ago and my breasts are bottominng out. I currently have saline moderate plus 350 shell over filled to 375 under the muscle. I will be getting my surgery to correct my bottoming out situation and I wanted to know if it would look good if I went over the muscle ( I do like the "fake" implant look) with saline implants.

Alejandro Nogueira, MD · Answer

It is okay if you like the round fake look, but do NOT get again smooth implants, do get them of highly adherent properties, which are the macrotextured or, preferably in bottoming out treatment, the biovelco ultra adherent polyurethane coated implants, either anatomical or round.

Harry T. Haramis, MD, FACS · Answer

Usually, salines are not placed over muscle as they have a higher risk of rippling and capsule. Higher filled gels can go over the muscle with less risk.An exam and consultation with a plastic surgeon is recommended to discuss your options and expectations.

Jed H. Horowitz, MD, FACS · Answer

There are some studies that report a lesser incidence of firm capsules with placement behind the pectoralis muscle. If you developed firm capsules and your implants were submammary (behind the breast tissue) then conversion to a #submuscular position should be considered. This #placement is particularly better for the very thin patient who has little breast or fat in the upper part of their chest. In most circumstances, those patients with #ptosis (#sagging) require placement above the muscle in a #submammary position or under the muscle combined with a mastopexy (breast lift) for #contour purposes. It's best to consult with a board certified plastic surgeon in person to better learn your options. Deciding on additional #elective cosmetic #surgery is a personal #choice. Your procedures should always be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery. You will then greatly improve your chances of getting the result you desire, and, without the need for a revision surgery. It is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.

Kevin Tehrani, MD, FACS · Answer

Thank you for your question. It is difficult to tell from your pictures, however, in general placing implants over the muscle required textured implants to decrease the chance of capsular contraction. Currently the only textured implants available in the US market ar silicone. You would need a consultation for precise recommendations.

Steven Wallach, MD · Answer

I prefer to keep most implants below the muscle to maintain soft tissue coverage over the upper pole.

Tom J. Pousti, MD · Answer

I am sorry to hear about the complication you have experienced.   A well executed capsulorraphy procedure should help improve your outcome. I would suggest that you maintain the breast implants in the sub muscular position;  I think you will likely be happier with the long-term outcome doing so.
  Generally, I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position. This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).
The submuscular positioning also tends to interfere what you got the bonus with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.
On the other hand, sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants seen with flexion of the pectoralis major muscle) that can be seen with breast implants placed in the sub muscular position. You may find the attached link helpful to you as you learn more about this type of revisionary breast surgery.
Best wishes.

Will I be able to get saline over the muscle? (Photo)

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