Any suggestions on over the muscle implants and potential sagging?

This is a good question. In general there are more benefits to placing the implant under the muscle versus over the muscle. Implants placed under the muscle have a less incidence of capsular contracture, mammography is more accurate, there is less chance of rippling and with more coverage over the implant the look and feel is improved. One of the benefits of going over the muscle however is greater filling of the lower part of the breast in patients with some breast sag. A dual plane augmentation would be a good solution for you. It would provide you with the benefits of both a submuscular and subglandular placement.When a patient presents with a small amount of breast ptosis (sag) a dual plane breast augmentation is a very effective technique to help avoid the need for a breast lift and still allow the implant to be placed under the muscle. When an implant is placed under the muscle and the overlying breast has some degree of sag the muscle will hold the implant back and not allow it to fill the loose tissue at the bottom of the breast The word dual means two and the word plane refers to the natural separation between two layers of tissue. In the breast there is a natural separation between the breast tissue and the underlying muscle. During a dual plane augmentation the breast tissue in the lower part of the breast is separated from the underlying muscle. The muscle is then released along its entire attachment at the bottom of the breast. The muscle then moves upward like a window shade toward the nipple. With the restriction of the muscle in the lower part of the breast removed the implant is then allowed to fill the loose sagging part of the lower breast. This is a very effective technique to help prevent the need for a breast lift in a patient with a small amount of sag and still have a benefits of an implant placed under the muscle. Good luck

HI jgmj,  Subglandular implants do not prevent skin sagging and in fact, implants beneath the breast tissue can make this condition worse by stretching the skin more than if the implants were under the muscle. The muscle, especially in a dual plane type of augmentation, helps to keep the implants in a more youthful position for a longer period of time.  Submuscular placement of  implants also decreases the incidence of capsular contracture  (Hard scar tissue around implants) by 30-40% as shown in many studies. Explanations for this are not firm, but it could be that the muscle moves the implants all day and/or that muscle always allows for better healing of any surgical wound.    Submuscular placement also allows for better visualization of breast tissue in radiologic breast exams and this is another very important reason to place breast implants in this position.Hope this helps.Best,Dr. Rodgers 

Thank you for your question.  Placing implants above the muscle (sub glandular) will not prevent sagging of the breasts.  The breast will continue to age as you do.  Implants above the muscle do have higher rates of capsular contracture, which can lead to earlier revision surgery.  They do not necessarily make mammograms more "difficult" when above the muscle…with digital mammograms now days, mammographers can see the breast quite well.  They do like to have the muscle interface between the implant and the breast tissue as is the case with sub muscular implants. When placing implants above the muscle, I do think that the shaped "gummy bear" implants will provide a better longer lasting result because of the shape, texturing of the shell and the thicker gel being more resistant to deformation of the implants by scar tissue.  Best to talk to your plastic surgeon who can go over all your options.