Replacing implants 280 CC anatomical from over the muscle to under the muscle. Will I need a lift if I have slight sagging?

I am going to replace my implants that are 280 CC tear drop over the muscle My current implants are quite visible under my skin so I am leaning towards going under the muscle but I am worried about the things I have read and what one of the surgeons has said that I will have droopy skin at the bottom of my implant. If I go from over to under without doing a lift but increase the volume will that take care of the droopy/saggy skin? How mush is considered droopy?

Doctor Answers 6

Going from Over to Under - Lift Needed?

It is difficult to give you a definitive answer without at least a photo. In general, implants on top of the muscle will tend to fill out the skin envelope better, but a major downside can be an easily palpable or visible implant. So if you now switch to under the muscle the implant often will not fill out your skin envelope as well, so if you use the same size implant you might need a lift. On the other hand, switching to a larger implant will better fill out your skin and then you may not need a lift.
Another thing to keep in mind is that it is important that your tear drop or anatomic implant adheres to your tissues so you don't experience rotation of your implant. You don't want to use your original implant because many of the microscopic crevices on the implant surface will have gotten filled in with your tissue and this can't be completely removed. So if you use the same implant you might not develop good adherence and you will be at increased risk for rotation. If you are upsizing then you will obviously be getting a new implant.

Over to Under the Muscle

Thanks for your question! Really without seeing photos of you, it's impossible to give a good educated opinion. However, in my experience of doing hundreds of sub muscular conversion implant exchanges, I really love this surgery: going from "lemons" to "lemonade"! I would convert u to a dual plane implant with a high profile gel implant. Ask your surgeon for sure if they have a lot of experience with this surgery: it's difficult & your results can vary widely if you don't go to a board certified plastic surgeon with "10,000 hours" of aesthetic breast surgery experience. Best of luck to you!

Robert P. Schmid, MD
Lubbock Plastic Surgeon
4.9 out of 5 stars 31 reviews

Changing visible subglandular to partial subpectoral implant position.

It's impossible to give you a precise answer without a face to face exam, however in general I would be thinking of transition to a subpectoral pocket using a somewhat larger cohesive smooth round silicone gel implant.  The texturing of the anatomic implant may be making it more visible and in a subpectoral position most of us choose smooth implants.  With a somewhat larger implant the skin laxity may be sufficiently taken up to avoid an uplift HOWEVER, if you appear ptotic now then I would consider performing at least a periareolar lift or a full mastopexy.  You need to discuss this with your ABPS Bd Certified surgeon to achieve the best plan.  Keep in mind that in both subglandular and subpectoral augmentations, approximately the lower 50% of your implant is not covered by the pectoral muscle so this should not change IMO.

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

Replacing implants

Many patients with "slight sagging" do very well with implants alone. As to you specifically, it would take photos or an exam to answer your question. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Replacing implants 280 CC anatomical from over the muscle to under the muscle. Will I need a lift if I have slight sagging?

Thank you for the question. You are correct in that sometimes, depending on the degree of "sagging" (breast ptosis),  breast lifting may be necessary when breast implants are converted from the sub glandular to sub muscular position.  Without photographs or in-person evaluation, online consultants will not be of much help to you when it comes to specific advice.
 Some general thoughts regarding this operation may be helpful to you however: The procedure itself involves removal of the current breast implants, careful dissection of the sub muscular ( dual plane) space, and usually closing off the previously dissected space above the pectoralis major muscle. Closing off the existing breast implant pocket will help prevent the new implants from slipping from the sub muscular ( dual plane) pocket into the previous pockets.
Depending on the patient's anatomy and goals, sometimes additional work may be necessary to improve the outcome of the procedure. For example, additional manipulation the breast implant pockets (such as capsulorrhaphy) or of the overlying skin envelope ( such as breast lifting) may be necessary. If the pocket conversion is being done because of breast implant rippling, the use of acellular dermal matrix may be helpful.  You may find the attached case demonstrating breast implant conversion (link) helpful to you. Best wishes.

Implant replacement

Without seeing photos or examining you, it is difficult to give you any good recommendations.  However, for women in your position, the addition of fat around the implant (fat grafting) is a powerful tool that can camouflage the edges of the implant and avoid having another set of implants.  It can also provide a slight lift in the process.

Jason J. Hall, MD, FACS
Knoxville Plastic Surgeon
5.0 out of 5 stars 10 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.