Should you stay over the muscle when changing out implants that were originally placed over the muscle in first surgery?

Changing from Saline to Silicone. Implants are over 20 yrs old. No issues, shape is still great. There is a little more skin and they are lower but not considered saggy or really needing a lift. Thanks in advance for your advise.

Doctor Answers 11

Pocket change with implant change

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In general if you have been happy with the saline implants on top of the muscle (subglandular), that means that you have adequate breast volume and soft tissue coverage to prevent palpability and rippling issues. You should be happy with replacement in the same pocket with silicone gel implants. Good luck with your revisional surgery. 

Houston Plastic Surgeon
4.7 out of 5 stars 16 reviews

Changing the Implant Pocket

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Absent any problems, I would leave your pocket where it is.  Going under the muscle introduces a longer recovery and even some possible new problems !  That said, if you have visible rippling or capsular contracture I might consider a switch.

John LoMonaco, MD, FACS
Houston Plastic Surgeon
5.0 out of 5 stars 276 reviews

Pocket change during explantation

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Thank you for your question.  Photos can be helpful here.  The answer really depends.  If you have adequate breast tissue to cover the implants, then you can consider using the same pocket.  If you have thin breast tissue or a significant capsule contracture, then you may consider a site change and place the implant under the muscle.  Each implant pocket has advantages and disadvantages and the right answer is often individualized for each patient based on their clinical and physical findings.  Discuss the pros and cons with your surgeon.  Good luck. 

Pocket Exchange

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If there is no  evidence of capsular contracture, nor significant reveling, Then in my opinion, it would be prudent to replace the new silicone gel implant in the old sub glandular pocket. The old adage for this would be "if it ain't broke don't fix it". Best of luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 58 reviews

No pocket change if no problems

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In general if you are not having any problems with over the muscle placement then there is no reason to change. Under muscle has benefits but also risks such as animation deformity. The real question is why you are changing the implants if you are not having any issues; if you are making  a size change for example that can change the equation.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Pocket change

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If you are not having issues with the sub glandular pocket, you do not absolutely have to undergo a pocket change. 

The main indicators for a pocket change include, capsular contracture, and visibility of the implants in the SG space. Implants in the SG vs the SM space do have a higher contracture rate in my experience. Placing a textured device may give some protection in the SG space.

Last option is to leave the saline implants alone- but it sounds like you are being proactive.

Good luck!

Sam M. Sukkar, MD
Houston Plastic Surgeon
4.6 out of 5 stars 40 reviews

Implants above or below the muscle for revision surgery

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Hi  and thank you for the question. These days most surgeons are placing implants and below the muscle. This typically gives a more natural look, and is associated with a lower risk of capsular contracture. When a patient comes to me with implants above the muscle, I always give them the option to put them below. If you like the way your breasts look, and they are still soft 20 years later, I think it's not unreasonable to leave the implants there. Your surgeon can use textured implants to reduce the risk of capsular contracture.  If you want to improve the appearance of the upper pole of the breasts, you should consider having them plants moved blow your muscle. I think it will be easier for your surgeon to explain the neuances of one style over the other during a consultation. Good luck. 

Dr West

Justin West, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 30 reviews

Sub glandular or sub muscular augmentation for breast surgery?

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 Thank you for the question.  There are no "absolutes" when it comes to care for patients who presents with your clinical situation;  I  individualize recommendations case-by-case.

  In other words, careful physical examination,  careful communication of goals, and careful  communication of pros/cons/risks/complications associated with each option  should be considered.  There is actually a lot to discuss…

 Most important will be: careful selection of plastic surgeon and careful communication/education process.  Working together you will come up with a good plan to achieve an outcome that you will be pleased with.

 Best wishes.


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Generally in my practice, I use the same pocket whenever possible unless there are reasons to switch to the submuscular plane.  The main reason to switch it is ripping in the upper part of the breast with your existing implant.

Hope this helps.

Dr. Ali Mosharrafa

Ali Mosharrafa, MD
Phoenix Plastic Surgeon
4.9 out of 5 stars 16 reviews

Usually switch to below the muscle

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Thanks for your question. I think you will be very happy with silicone implants. I don't think you are "obligated" to have implants placed in a submuscular position if there is no existing problem. Statistically however there is less incidence of capsular contracture and mammograms are more reliable if implants are behind the muscle. It is my practice to convert to a submuscular position for the above reasons. Best of Luck!

M. Scott Haydon, MD
Austin Plastic Surgeon
4.8 out of 5 stars 93 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.