Thank you for the question. Often, it is possible to perform the operation you are considering in a single stage (possible to convert sub glandular breast implants in to the sub muscular (dual plane) position). Successful results do depend, to some degree, on the surgeon's experience. Therefore, best to make sure that your plastic surgeon can demonstrate significant experience helping patients with this type of revisionary breast surgery.
Sometimes, patients undergoing conversion of breast implant positioning from the sub glandular to the sub muscular space benefit from additional maneuvers such as breast lifting (depending on the position of the breast skin envelope in relation to the position of the sub muscular breast implants) and/or the use of acellular dermal matrix for lower pole support and/or treatment of breast implant rippling. Closing off the existing breast implant pocket is a technique utilized to help prevent the breast implant from moving back into its previous space.
I hope this, and the attached link demonstrating many examples of revisionary breast surgery cases, helps. Best wishes.
There probably is no single correct answer however I prefer having implants submuscular so with your contracture and thinned skin I would obliterate the subfascial plane with sutures and a drain and simultaneously place new implants subpectorally. You will probably need a somewhat larger implant and may need a subsequent uplift (if necessary). Please understand that this is only based on your description and not on a face to face examination.Good luck....
Jon A Perlman MD FACS
Certified, American Board of Plastic Surgery
Extreme Makeover Surgeon ABC TV
Best of Los Angeles Award 2015, 2016
Beverly Hills, Ca
In my practice I routinely do this procedure as one step. Removal of the sub fascial or sub- glandular implant, obliteration of that space with sutures, placement of a new sub muscular implant, sometimes adding a piece of Strattice that will disallow the newly undermined muscle from window shading upward pushing downward on the implant giving a chance to go back to the old space. After that procedure is done, at the same time, a breast lift can usually be done. I would try and find a plastic surgeon with a great deal of experience in revision breast surgery. Good luck.
Without pictures only general recommendations can be made. In my revision breast practice I commonly perform removal and replacement at the same time as changing to a partially sub-muscular position (site change) followed by a breast lift (mastopexy). I recommend you seek consultation with a board-certified plastic surgeon with revision breast surgery experience. A staged procedure is also a choice if that is what your plastic surgeon feels most comfortable with.
I hop,ethics helps.