Once under the muscle, is there a chance revision surgery should change to over the muscle?

I've already had a a previous switching of implants to smaller ones with a lift, however looking to do another revision surgery to go smaller (still too big) which would most likely include another lift. I do have some capsular contracture as well. Would the best approach be to still use the existing pocket & modify it to hold smaller implant, or to close up completely and create a new pocket over the muscle?

Doctor Answers 9

Implant Revision

Steps to consider regarding a revision: 1)  What do your breasts look like now and how do you want them to look.  Show your surgeon photos of what you want to achieve and let them tell you the best way to accomplish this (ie. secondary lift,  breast tissue reduction, smaller implant, different type of implant etc).  2)  Your history of capsule contracture - is this a recurrence or something new?  What implant type do you have - as this can affect the rate of recurrence?  3) Understanding the factors that can decrease the risk of recurrent capsule contracture - changing implant type (form stable gummy), submuscular, capsulectomy, intraoperative intrapocket corticosteroid,  acellular dermal matrix.    Not every patient requires every technique. 

Fort Myers Plastic Surgeon
4.5 out of 5 stars 25 reviews

Pocket revision

It sounds like you need some form of pocket change.  You would have to be evaluated in person to determine what might be best, based upon your anatomy and exam.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast implant revision with capsular contracture.

Thank you for asking about your breast augmentation revision.
  • This is a really complex question - so let me explain.
  • As a  rule, if you have a capsular contracture, the implant is placed in a new position -
  • For you, this would be over the muscle.
  • But to reduce the risk of capsular contracture, the implant should be covered with  ADM (acelllar dermal matrix) or other material to support it.
  • To make it more complex, a breast lift with an implant over the muscle is at a higher risk of infection.
  • So you need a consultation with your plastic surgeon - or a new surgeon if you wish - to discuss what you want and the best procedure(s) for you.
Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Redo breasts augmentation

Dear figirl,     Front and side view pictures would have been very helpful. Without pictures or examining you, it is difficult to answer your questions. If your crease location is good and the implants are not displace laterally, than you can just reduce the size of the implants. If you have capsule contracture, than capsulotomy (capsule release ) might be needed , in order to obtain soft and jiggly breasts that look natural. If the skin is loose and the nipples are droopy, a mini lift  (donut, Benneli ) most likely will be sufficient.    Since you had your disappointment from your previous surgeries, it might be prudent to get a second opinion from  experienced board plastic surgeons who have lots of experience with redo breasts augmentations. Check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking. Also, check the reviews on 'RealSelf' for reviews and positive experience reports.                                             Best of luck,                                                                          Dr Widder

Shlomo Widder, MD
McLean Plastic Surgeon
4.8 out of 5 stars 126 reviews

Breast augmentation revision with capsule contracture. Position of implant?

There is no definitive answer as to which procedure is best but like most my preference would be to perform capsulectomy and replace your new implants into the subpectoral position.  Bathing the pocket with antiseptic solution, use of a funnel for implant insertion and avoidance of exercise or blood thinning medications that can cause early bleeding during formation of the new capsule are some of the methods I find helpful to reduce recurrence of encapsulation.  I also treat my patients with an anti-asthma medicine that has some minor benefits in reducing the risk of recurrent encapsulation.  If your capsules were to unfortunately reappear than in the future I would consider recommending inserting acellular dermal matrix (ADM).
Discuss all options with your plastic surgeon and best wishes.
Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 31 reviews

Breast Revision?

It is always difficult when you have had multiple breast revisions, and still do not feel like you have achieved your results.  When you have capsular contracture, the issue is only compounded.  I generally do not recommend converting to the subglandular plane since this has a much higher contracture rate over submuscular.  Undergoing conversion to a neo-subpectoral pocket may be your best answer.  The best thing to do is to discuss this with your surgeon or go for a consultation with a breast revision specialist.  I hope this helps.

Christopher V. Pelletiere, MD
Barrington Plastic Surgeon
4.8 out of 5 stars 75 reviews

Once under the muscle, is there a chance revision surgery should change to over the muscle?

I am sorry to hear about the complications you have experienced. Capsular contraction can be a very frustrating complication for both patients and surgeons. In my practice, I have found the most success treating these difficult problems utilizing techniques such as sub muscular pocket conversion (if relevant), capsulectomy, use of fresh implants, and the use of acellular dermal matrix. Acellular dermal matrix is a biologic implant that carries the ability to become integrated into native tissue. It is made by taking a full thickness section of skin from a donor source (his human, porcine, or bovine in origin). 

Overall,  I think that there are many advantages of implants placed in the sub muscular space; I have converted  breast implant position from sub muscular to sub glandular position in only a very few cases.  
 Best wishes for  a complication free outcome that you will be very pleased with. I hope this, and the attached link (dedicated to revisionary breast surgery concerns) helps. 

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

Once under the muscle, is there a chance revision surgery should change to over the muscle?

Difficult question to respond to without the opportunity to examine you in person. I recommend many in person opinions.

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Pocket issues

Dear Flgirl 20Sorry that you have had your issues. The answer to your question depends on a couple of things. First, if your capsule is very thick and hard, then you would benefit from removal of the capsule. if you have had capsules two times with smooth round implants, it is time to consider biocell textured implants. Second, if you are unhappy with your breast "jumping" when you contract your chest muscles, and or there are various shape problems, then moving the implants back on top of the muscle is something I have done many times. As to the need for another lift, it would help to know if you have low profile implants. If your shape after the first lift remains good, a change to higher projection may be possible without a redo of the lift.All depends upon your physical exam. Thanks

Richard Sadove, MD
Gainesville Plastic Surgeon
4.9 out of 5 stars 24 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.