Switching from submuscular to subglandular? (photos)

I had my ba done 12 weeks ago and have had problems since 2 weeks out. I had a double bubble and muscle flex deformity. I was working as an exotic dancer at the time and have not been able to work since because requires me to get naked and they look so ugly. Would over the muscle solve these problems and be a better placement for me ? If so which doctors specialize in this kind of revision ?

Doctor Answers 14

Switching From Submuscular to Subglandular?

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So, in looking at your photos it appears that the two sides are very different. Your didn't mention anything about this but it can have some important implications. One implant looks much higher and no double bubble is evident. On the other side the implant is much lower and you have an obvious double bubble. Looking carefully at the DB side it is evident that you had a very tight elevated inframammary fold and the distance from your nipple to the chest wall was quite short. This situation makes an augmentation challenging. If the implant is placed so that it is no lower than your existing fold, then the implant will look quite high and your nipple will rotate downwards (as in you non-DB side). On the other hand, if the implant is placed (or descends) below the level of the fold so it is centered behind your nipple, then the nipple will point straight ahead, but you are then at risk for getting a double bubble. There are ways to manage this problem through modification of the skin and lower pole breast tissues but in patients with extremely tight inframammary folds it can be difficult to completely eliminate the suggestion of a DB. A third alternative can be do a breast lift to lengthen the distance from nipple to fold but that requires additional scars on your breast - not a solution most women would prefer. 

Flexion or animation deformity is a potential problem whenever an implant is placed under the muscle, although for the vast majority of patients it is rarely a major problem. Unfortunately for dancers it can be far more noticeable. The problem of flexion deformity is worse with saline implants, smooth surface implants, and larger implants. It is also dependent on your specific muscle anatomy. In patients with a high fold the muscle is usually oriented so that greater release of the muscle is required to properly position the implant and this can predispose you to more severe flexion deformity. I would assume that the flexion deformity is worse on the side with the DB. Your surgeon should have discussed of these issues with you before the surgery so that you understood the challenges and potential tradeoffs. You photos show that you went with a quite a large implant for your frame, but that significantly raised your risks of having these problems.

Putting the implant on top of the muscle can solve the flexion deformity problem but with a large implant you will end up with significant thinning of your tissues which will put you at risk of palpable/visible implant and visible rippling over time. Probably the simplest solution for you would be to raise the implant on the DB side so it matched the other side without the DB and consider switching to a textured surface highly cohesive gel implant which will help reduce the flexion deformity. The other alternative would be to consider the split muscle technique but that may be difficult with a large implant. 

Switching from submuscular to subglandular?

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From your photos, it appears that the double bubble crease needs extensive release and probably consider  repositioning of the implant to the submammary plane from the sub pectoral plane. This has been helpful in my practice when such discrepancy is a problem.

Burr von Maur, MD
Orange County Plastic Surgeon
4.6 out of 5 stars 22 reviews

How can I get rid of the FLEX deformity from my breast implants?

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  I do many revisions fortunately not too many on my patients and it can be corrected by switching to on top of the muscle. You should be able to help the problems you are having with my neopocket of placement.

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 28 reviews

Double Bubble

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Yes one of your options is to switch from submuscular to subglandular position of the implants. Any good breast surgeon certified by American Board of Plastic Surgeons should be able to do that. I have done this on a couple of instances for the same reason and it solves the problem.  I would recommend you have form stable silicone implants for this.  You don't have a lot of soft tissue coverage and a saline implant will probably show ripples.

Randy Proffitt, MD
Mobile Plastic Surgeon

Under or over the muscle

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I understand your concerns, and it is a common one that when implants are placed under the pectoralis muscle, there sometimes is a "double bubble" deformity, and the breasts move unnaturally with muscle movement.  I agree (and have published) that changing the implants from under the muscle to above the muscle frequently solves this problem.

Malcolm A. Lesavoy, MD
Beverly Hills Plastic Surgeon
3.9 out of 5 stars 11 reviews

Multiple Problems

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Hello,It appears your breasts were different in appearance from each other before surgery, with one with a higher inframammary crease and tighter tissue envelope. That is why one has a double bubble and the other doesn't but instead has suboptimal nipple position. Changing to a subglandular position may or may not help, but you can expect new problems like rippling and implant palpability. If your surgeon isn't a ABPS certified/ASAPS member surgeon who specializes in revision breast surgery, you should seek out a second opinion with a few who are.Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Fixing double bubble

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Only your one side (with your arm down in photo... Let's call it the right) has a double bubble. That's because your implant is lower on that side. If you want the bubble gone, your surgeon needs to bring the pocket together at the bottom, called a capsulorrhaphy. Then both breasts can look like the left. If you hate your muscle flex deformity, you can fix your pec and have the implants moved, which has some disadvantages as well, such as implant visibility and greater risk of capsular contracture.

Lisa Cassileth, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 16 reviews

Pocket switch

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Thank you for the question and photos and the implants can be easily switched if that is what you desire.  So go on some complimentary consultations with experts in the area and be evaluated
Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 65 reviews

You have several options

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Hello and thank you for your question.  I prefer to keep implants under the muscle as a) the breasts look more natural and b) decreases your chance for long-term problems like capsular contracture. If the animation deformity is too bothersome to you, it is ok to place the implants on top of the muscle as long as you understand the above disadvantages.  Most importantly, I think fixing the double bubble is important and doable at this point in time. Please make sure to seek consultation with a board certified plastic surgeon with expertise in aesthetic breast revision surgery.  I hope this helps!Sincerely,
Dr. Sean Kelishadi

Sean Kelishadi, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 32 reviews

Double bubble deformity

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You are demonstrating a double bubble deformity which is created when the inframammary crease is released to accommodate an implant that is larger than what your breasts can accommodate. What you should have done is either a breast lift to get your nipples higher to accommodate a larger implant or had a smaller implant placed that would fit on your breasts without having to release your inframammary crease;

Arian Mowlavi, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 106 reviews

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