Replacing submuscular implants placed over 10 years ago - Dual plane or subfascial? (Photos)

Dear Nadia_,

I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

If you are a weight lifter then subfascial is better, but since you now have dual plane the muscle would need to be re-attached. The type of implant makes a difference with subfascial. Consider Motiva. However, if you are not experiencing any animation deformity or muscle weakness now then it may not be worth it.

Hi Nadia_, based on what you are describing and what I can tell from the photos, it is a difficult situation with a couple limiting factors. First, now that the nipple position is asymmetric, it is nearly impossible to attain symmetry without some form of a lift, even if just a small donut-type lift. Secondly, you desire more cleavage but currently have implants under the muscle which can push them away from center and make more cleavage difficult. Lastly, it seems that you are rather fit and don't have much fat elsewhere that would be available for fat transfer to the breast. Sometimes doing a little fat transfer just to the inner and upper breast can help with that last little bit of cleavage. I do agree with the opinion that a transition to subfascial would help improve cleavage and be less detrimental to your weightlifting. However, you need to be careful because the more you push the implants toward the middle, the more the nipple position can be displaced outward. Something has to give in this situation, and it is up to you and your surgeon to discuss these pros and cons and decided what meets most of your needs.

I would suggest staying under the muscle, but go lower in profile. The cleavage thing is related to your bony anatomy and it cannot be changed. Keeping the implants behind the muscle gives a smoother contour, but separates the breast more. With a dual plan, more implant is visible, but breasts can sit a little bit closer..

Subfascial conversion will lower the implants ,give more cleavage and eliminate animation deformity
Dual plane will still cause animation