I Have Implants over the Muscle and Need an Uplift, Should I Have Them Moved Submuscular?.

I am a 32 f, should I ask for them to re aug them under the muscle? I want them to stay high so will this help? I also need an uplift, so will be having this at the same time. I had them originally done in 2004 and went from a 32c to 32e. I have since had a child (6 months) and breast fed.

Doctor Answers 10

Need a Breast Lift and already have Implants over the Muscle, Should I Have Them Moved Submuscular?

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Great Question. I am not a big fan of placing unsupported large breast implants under the breast glad (over the muscle) for the reason you demonstrate. They do not stay there very long. They rapidly sag after stretching the breast skin and nipple complex resulting in thinned out saggy breasts requiring repeated Breast lift procedures.

The question of what YOU should do is really up to you. There are no absolute answers.
- your breasts CAN be nicely lifted without relocating the large implants to an under the muscle position. It will result in a nice but temporary result because we have NOT addressed the prime reason for the sag large implants with less than great support. Another operation would most likely need to be done in 5-7 years at most.
- Another Option, is to relocate a (hopefully smaller) breast implant into the submuscluar pocket. Although this would reduce breast projection somewhat, it will have better support and a lower rate of capsular contracture as well as easier mammogram examinations. To give the implant more support and prolong the life of the Breast Lift a sheet of Strattice, a biological sling, could be added.

Good Luck in your choice.

Peter A Aldea, MD

Memphis Plastic Surgeon

Breast Lifting and implant position exchange?

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Thank you for the question and picture.

I would do exactly what you have described: exchange of implant position to the sub muscular position (dual plane)  and mastopexy surgery.  Another related question is whether these procedures should be done in a single or two staged fashion.

This is not a question agreed-upon by all plastic surgeons. There are good plastic surgeons who will insist on doing the procedures separately and there are good plastic surgeons who can produce excellent outcomes in a single stage.

The combination breast augmentation / mastopexy surgery differs from breast augmentation surgery alone in that it carries increased risk compared to either breast augmentation or mastopexy surgery performed separately. Furthermore, the potential need for revisionary surgery is increase with breast augmentation / mastopexy surgery done at the same time.

In my opinion, the decision  to do the operation in a single or two  staged fashion becomes a judgment call made by a surgeon after direct examination of the patient.  For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or  whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer).

Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks  are greater with a 1 stage  procedure and the patient does have a higher  likelihood of needing revisionary surgery.

Prior to proceeding with revisionary surgery it will be very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.

I hope this helps.

I Have Implants over the Muscle and Need an Uplift, Shuld I Hve Them Moved Submuscular? Answer:

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YES!!! In cases like yours I keep the new implant completely under the muscle to give it long term support and then do the lift on top of that, in one operation. But remember, your surgeon can only fit a sm-med sized implant totally under your muscle so if you desire to have a bigger size, I use Strattice to give added support to the bottom of the muscle, which has to be released to make room for a bigger implant. It has been my experience that without Strattice, the implant falls again.

John J. Corey, MD
Phoenix Plastic Surgeon
4.7 out of 5 stars 48 reviews

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Should I change the plane of my implants with uplift?

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Dear smarsh,

I would leave your implants in the subglandular pocket and I think you will have a great result with an uplift.  It is the uplift that will bring the volume of the breasts back up your chest, not your implants.  If you rely on the implant to give upper pole fullness, you run the risk of the breast falling off and creating a double bubble deformity.

You can see that there is not a consensus of opinion, and like so many things in medicine, there is no right or wrong answer.  Find a surgeon that you can trust and make sure that he or she is a trained plastic surgeon with FRCS(Plast) qualification (you can find a list on the BAAPS and BAPRAS websites) and ideally choose someone who speciaises in breasts.

Have a look at some before and after photographs and try to develop a rapport.  I think these things are more important than worrying too much about the technical aspects of how the procedure is done.  Good luck.  Jonathan Staiano

How to ensure longevity in implants...

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Smarsh: Like any woman who chose to have breast enhancement before pregnancy, you have sustained some changes.  Your photo appears to show that the subglandular (on top of the muscle) implants have sagged and stretched the areolar complexes as well.  Your intuition that changing implant plane to the dual plane (under the chest muscle) will improve the superior pole fullness (i.e. distance between the collar bones and nipples) as well as mitigate against recurrent slippage.  This is associated with more discomfort than the subglandular plane, but it is a small price to pay for implant "stabilization" as well as facilitation of mammography. 

A standard "anchor mastopexy" would do much to reshape your breasts.  One word of caution, do make sure that you are no longer lactating, as the combination of submuscular implant and breast lift can occasionally reactivate the milk let down reflex and cause a variety of post-op complications.  good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 59 reviews

Beautiful breasts without implants

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I would strongly suggest that you remove the implants altogether. I've done countless of breast augmentations in my career and have come to one conclusion. Breast implants are disfiguring regardless of where they are placed. It's only a matter of time before gravity stretches everything out. Women who have come to me with your problem and chose implants with a lift come back later to have another lift. If this is not an issue then...

Sounds like you had enough breast tissue before your implants. What I would do in your case is perform an Ultimate Breast Lift with no implants. This technique takes your existing breast tissue and reshapes it to resemble that of an implant. Breasts are firm and perky. An added benefit is that there is NO VERTICAL SCAR. I hope this helps. Best wishes, Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Implant exchange with lift

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Implant exchange in this situation is not a clear cut decision.  From your history, they are large implants leading to sagging, especially subglandular.

Submuscular implants tend not to sag as much, due to the muscular support.  They tend to have less complications as well, but are more painful.  In this situation, changing to submuscular may or may not increase risks.

I don't think it would be unreasonable to do an exchange, but it might also be a wise idea to remove them, do the lift, and if needed, do an aug in 6 months.  You seem to have quite a bit of tissue, and may just be happy.

Should implants be repositioned at time of breast lift??

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No need to even expose implants at time of lift if they're OK.  No advantage to going submuscular, in my opinion, unless there is a firm per-prosthetic capsule (in which case, capsulectomy and repositioning implants may be indicated).  If implants are soft and intact, I would leave them alone.  Can consider MRI or high resolution ultrasound pre-operatively to evaluate for rupture.  The one advantage of implant manipulation in this setting is that if your inframammary crease needs to be elevated, entering the capsule and opening it superiorly will allow your surgeon to move the implants up, and thus raise the inframammary crease along with the remaining breast and nipple areola complex.



Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 50 reviews

I Have Implants over the Muscle and Need an Uplift, Should I Have Them Moved Submuscular?.

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Yes place the implants sub muscularly and have the lift, anchor type. Ask you chosen surgeon to discuss with you in detail. 

Up lift years after breast implants

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We would suggest keeping the subglandular pocket rather than the submuscular switch when you have a breast lift. The submuscular implant may stay high though the breast may not. With your current implant, or a new one, there will be a better marriage between the implant and the breast proper with the implant in its present location. The key to improvement is in the lift and results will stay if well done.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

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