Going from submuscular to subglandular
Since your goal is to achieve more of an unnatural look, going subglandular will help. There will be less of a slope superiorly, more upper pole fullness and more distinction in terms of implant edges being visible. Since you have capsular contracture, capsulectomy combined with changing the implant plane/position from submuscular to subglandular should help for now although it poses a higher risk for capsular contracture overall long-term. Be sure to consult with an experienced plastic surgeon certified by the American Board of Plastic Surgery. Good luck!
Hello and thank you for your question. There are several key differences when going from a sub-muscular pocket to a sub-glandular notably the higher rate of capsular contracture (CC) with the sub-glandular pocket position. You may have a good result in the near term with a large, sub-glandular implant placement, but over time problems may develop especially since you already have had CC with your sub-pectoral placement on the left. There are several adjuncts (ADM, FG, textured implants... to name a few) that can reduce CC and assist in providing a great sub-muscular result as well. I wish you the best in finding the
right answers as there are a lot of great answers and information on this forum. Remember, it is best to see a Board Certified Plastic Surgeon who can in
person examine you, take key measurements and go over with you your specific
aesthetic goals. Bringing several photos of your "ideal" look
can be helpful as well. Best of luck.
Benjamin J. Cousins M.D.
Board Certified Plastic Surgeon
Trade off is probably not in your favor in switching to over the muscle IMO
Thanks for your question and the photos. The capsular contracture that you have experienced is certainly more common with larger implants. It is also more likely with placement above the muscle. Your desire to have larger implants that are above the muscle puts you at higher risk of complications and need for revision. Personally, I would suggest using Strattice and use what I call a neosubpectoral pocket (still below the muscle). I would consider fat grafting the upper pole. No guarantees as to outcome but this certainly gives best odds of less problems. Best of Luck!
Are there any complications or concerns going from submuscular breast implant placement to subglandular?
Yes, there are many more risks in subglandular placement with larger implants. Initially, they will look great! However, with time - they will descend faster than your initial implants because they will be heavier and will not have the support of the muscle. Other risks are but are not limited to: chronic pain, nipple numbness, skin stretch deformities, CC, irreversible soft tissue damage, malposition, etc.
Please seek an in person second opinion.
Best wishes and kind regards,
Gary Horndeski M.D.
To get a fuller upper pole
To get an unnatural look, I would recommend a larger implant. The subglandular position has a higher rate of capsular contracture and over time it causes the breast tissue to thin out according to a recent study.
Size is more important than pocket placement for having a dramatic or unnatural appearance, as are your preoperative tissue characteristics. Its unlikely the placement has given you this appearance, and more likely it was the size and what you looked like prior. Implants make your breasts bigger, they cant change them (augment alone) from having some drop to zero drop.
Going larger and above the muscle will increase the weight and strain on your tissues in the future meaning you will end up with "drop" in the future and at some point need a lift. I would simply go larger and not change your pocket dramatically, aside from correcting the capsule of course. Being subglandular puts the implant closer to the skin and will make any capsule more obvious.
Are there any complications or concerns going from submuscular breast implant placement to subglandular
I think the biggest issue is that of a higher risk for capsular contracture with the above the muscle placement. Along with that is the potential for more visible and palpable ridges of the implant when placed above the muscle
In the case of capsular contracture, the correct course of action is to remove the implant from its initial position, so in your case from the sub muscular, and change it to the sub glandular procedure. Also, all the capsule will need to be removed, typically the anterior capsule. New implants are then placed. Patients who develop capsular contracture are always at a high risk of developing capsular contracture in the future. Placing the implant in the sub glandular position in your case will give you more fullness in the upper pole because the muscle will not flatten out your upper pole. There is some evidence to suggest that the use of acellular dermal matrix or ADM's in these cases can reduce but not completely eliminate the risk of capsular contracture in the future. There is a cost to the use of these materials and can typically run an extra 3,000-4,000 $.I suggest you seek the consultation of a board certified plastic surgeon who specializes in secondary breast procedures to examine you , and discuss your options. Remember that your breasts will never be exactly the same, but significant improvements can be made in the shape and any pain you may be experiencing.
Dr. Ravi Somayazula
Placing a large implant in the subglandular space requires enough breast tissue to camouflage it. An implant of this size in the subglandular space may place you at a high risk for significant capsular contracture and bottoming-out of the implant. You will likely have a good immediate result, but may have long-term poor outcome. Additionally, treatment of these long-term issues is notoriously difficult. It is important to discuss these issues with your surgeon prior to your procedure.
Thank you for your post, and I admire that you have made your decision and acknowledge that the look your prefer is not necessarily the "natural" look. Changing to the subglandular plane (above the muscle) will help you get to your goal. The taller profile implants also help in that regard. You are accepting some additional risk in terms of long term skin stretch, capsular contracture, and overall longevity of the operation. You will likely need additional procedures down the road. But, if you are accepting of that, it's not unreasonable. Best wishes.