Switching from submuscular to subglandular? (photos)

Question

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 ?

Gerald Minniti, MD, FACS · Answer

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!

Afshin Parhiscar, MD · Answer

Dear sbxoI agree that switching to a subglandular plane will likely resolve your lower pole deformity and your flexion motion deformity. Keep in mind that your upper pole transition might become more noticeable and discuss that issue with your surgeon.

Richard Baxter, MD · Answer

You have an unfortunately common problem caused by the dual plane technique for submuscular placement. Because the muscle is detached, it heals onto the scar capsule where it pulls causing both the double bubble and the flexion deformity. I prefer to correct this by converting to the split muscle plane, which restores muscle function by re-attaching it behind the implant, but leaving the upper portion of the muscle in front so that the contour is more natural. If you decide to have it corrected by placing the implants subglandular (subfascial is another option) then be sure your surgeon re-attaches the muscle. There are several examples and articles about the split muscle procedure on my website.

Burr von Maur, MD · Answer

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.

Randy Proffitt, MD · Answer

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.

Malcolm A. Lesavoy, MD, FACS · Answer

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.

Lisa Cassileth, MD, FACS · Answer

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.

Sean Kelishadi, MD · Answer

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

Frederic H. Corbin, MD (license restricted) · Answer

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 evaluatedDr Corbin

Arian Mowlavi, MD, FACS (license on probation) · Answer

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;

Switching from submuscular to subglandular? (photos)

Answers (12)

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