Advised to Change from Submuscular to Subglandular 6 Months Post Op-Some Advice Please? (photo)

I had 330cc subpectoral silicone implants placed 6 months ago, they never dropped despite vigorous massage & wearing a strap. My surgeon suggested a revision to increase the pocket size & allow the implant to drop down, but on examination, he wants to change the position to over the muscle as my muscles are too tight & this will fill out the bottom of the breast & give a better result. I am very nervous due to risks of CC, visibility of implant & difficult mammography. I am thin with mild droop.

Doctor Answers 10

Changing implant positions after 6 months

Based on your picture, I think your doctor may be giving up on the submuscular pocket too soon.  In my mind, this is the best position for an implant for all of the reasons that you cited.  Also, you already have a pocket in the submuscular position.  While this pocket may need to be tweaked just a bit to give you a better appearance, I don't think it needs to be abandoned altogether.  Of course, my opinion is based solely on your picture.  Also, I don't know if it is just the position of your arms in the picture but it appears that your right nipple/areola sits slightly lower than your left.  This might also be an illusion based on the position of your implants, however, it it is indeed true that your right nipple/areola is lower than your left then there are some things that could be done to correct that as well, if you are interested, such as a peri-areola (aka, Benelli or "donut") breast lift on your right side.

Atlanta Plastic Surgeon
4.6 out of 5 stars 25 reviews

Advised to Change from Submuscular to Subglandular 6 Months Post Op-Some Advice Please?

Appears to me you may need a donut lift on the right breast. But can not comment on capsule since you would need in person examination. Seek in person second opinions. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Six Months Post-Op...Submuscular to Subglandular Move for Breast Implants to Improve Result?

Dear Rosedub77,  Unfortunately sometimes after breast augmentation surgery, the tissues do not stretch and open as the surgeon desires and a revision procedure is required to obtain the desired result.  Given that you are six months from the time of your surgery, it is doubtful that the implants are going to move lower without another procedure since the pockets around the implants are matured and stable at this time.  While your Plastic Surgeon recommended moving the implants from below the muscle to above, there are many reasons not to do so.  You have very thin tissues and an implant in a subglandular position is at high risk for being visible with rippling and puckering.  Instead, you may want to consider releasing the lower pole of the the pockets, and allowing the implants to drop lower into the breasts.

While I rarely recommend a second opinion for most patients once they have had surgery, you may want to obtain a second opinion before proceeding.  

Best of luck.

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.7 out of 5 stars 84 reviews

Should my implants be moved to in front of the muscle?

I would heartily recommend against having your implants placed in front of the muscle for the reasons mentioned (poor coverage, less natural look, higher risk of upper breast rippling and wrinkling, etc). Contrary to other answers to your post I am a firm believer in post surgical massage. I do believe it should be modified for each patient, especially the revision patient but virtually every one of my patients is instructed do and guided by me. There most certainly is a time when it will not make any significant changes and after 6 months I believe you are in that category. I would recommend you seek consultation with another board-certified plastic surgeon in your area who can examine you and give you an opinion of your options.

I hope this helps

Dr Edwards

Michael C. Edwards, MD, FACS
Las Vegas Plastic Surgeon
5.0 out of 5 stars 35 reviews

Subpectoral to Subglandular


Straps and massage don't do anything.  Why surgeons still recommend it is perplexing.  Changing from under muscle to over is usually a bad idea for most individuals, except maybe professional body builders, in whom it is actually a worse idea, but they have very special needs. I think it would be in your interest to see another surgeon.  Your breasts are actually not that bad; I think you could have an optimal result though. 

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 90 reviews

Changing of implant from sub muscular to sub glandular

In my opinion 330 cc imp,ant in a thin person will increase the risk if placed in sub glandular position. One option is to split the muscle so the implant is half covered by the muscle and half under the breast. Secondly the nipple to sub mammary Distance need to be increased to accommodate the implant in the lower pole.

Sanjay Parashar, MD
Dubai Plastic Surgeon
4.6 out of 5 stars 22 reviews

Going from submuscular to subglandular

Without seeing your "before" pictures it is not easy to render much of an opinion. Going from submuscular to subglandular will put you at risk for a rock in a sock look. It looks like your pocket just needs to be opened inferiorly for the implants to settle. A second opinion may be in order. Good luck!

Marcel Daniels, MD
Long Beach Plastic Surgeon
4.8 out of 5 stars 23 reviews

Revisionary Breast Surgery Options?

I would share your concerns about the downsides associated with re augmenting your breast implants into the sub glandular position.  As you mentioned, there are many potential downsides associated with this positioning.

I think a relatively simple operation involving release of the breast implant pocket inferiorly may help improve your results significantly.  If in doubt, you may benefit from additional consultations with well experienced breast surgeons in your area.  You may also find the attached link helpful to you as you learn more about revisionary breast surgery.

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

Moving Implants from Submuscular to Subglandular position

Yes your implants are a touch high in relation to the nipples.  Re-positioning the implants in the pocket is an option.  I would be interested in knowing your height as well as the measurements from the suprasternal notch to nipple on each side.  One option is to excise a crescent of skin above the areola to center them in better relation to the implant.  This is easy to do in the office under local.  The scar is acceptable and is along the areolar margin.  I frequently do this routinely if one nipple is higher than the other to achieve symmetry at the time of augmentation.  Your right nipple looks slightly lower than the left.  I only try to move the nipple/areolar complex 2cm at the most with this. In your case I might try lifting the right side 2cm and the left 1 cm and see how it looks.

Randy Proffitt, MD
Mobile Plastic Surgeon
4.6 out of 5 stars 23 reviews

Changing implant position

Based solely on your photo it appears to me that your implants are in good position and that the problem is drooping breast tissue on right. If this is so the solution would be some sort of breast, or nipple, lift--not implant adjustment. Seek a second opinion. Good luck!

Andrew Stewart, MD
Charleston Plastic Surgeon
3.8 out of 5 stars 8 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.