Can I change from dual plane to fully under the muscle?

Question

Currently I like the way the upper pole feels, but hate the way lower pole feels (so much so that I want them taken out). Would changing to unders fix this? Silicone 286cc

Jeffrey A. Sweat, MD · Answer

When plastic surgeons refer to "over" vs "under" the muscle, they are almost always referring to a dual plane technique when describing under the muscle.  Very few plastic surgeons perform a completely "under the muscle" technique, such as what you are asking.  While it can be done, it is relatively painful and adds very little to your ultimate outcome.  It is very normal, especially in a thin patient, to feel the implants out to the side and under the breast since the implant in the area that is not covered with muscle.  No one can tell you whether removing the implants might be the best option for you if you hate the feel of the implants, but I would suggest that conversion to completely under the muscle is unlikely to yield the benefit you desire.  My best advice to you is to return to your previous surgeon or seek the advice of several others and express your concerns, then discuss what realistically could or could not be done to address these concerns.  Best of luck!

Gerald Minniti, MD, FACS · Answer

Hello,It looks like one breast has more upper pole fulness than the other. You are currently dual plane if you think you are subpectoral. Have a discussion with your surgeon or visit a revision breast expert. Best of luck!

Eugene Kim, MD · Answer

When implants are placed in a dual plane, the muscle is cut at the bottom of the breast.  Unfortunately when the muscle is cut, it cannot be repaired to place the implants in a true subpectoral position.  The problem you're experiencing may not be due to the position of the implants though.  I recommend following up with your plastic surgeon or getting a second opinion.

Urmen Desai, MD, MPH, FACS · Answer

When plastic surgeons say "Under the muscle" is essentially means dual plane.   I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Steve Laverson, MD, FACS · Answer

No, changing implant position to complete sub-muscular is not likely to successfully solve your issue, and may introduce problems you don’t now have.  Recruitment of serratus anterior muscle to completely cover implants was long ago abandoned for good reason.Consider addition of substance over your implants such as fat (grafting), acellular dermal matrix (Alloderm, Strattice, Belladerm), poly-L-lactic acid (Sculptra), Galatea absorbable mesh, and/or a more cohesive gel device for more suitable consistency.

Curtis Wong, MD · Answer

If you have palpability issues with your implants, consider getting more cohesive gel implants.  Going totally under the muscle is challenging to achieve level folds, more painful, causes more animation deformities, and add very little benefit to you except for emptying your pocketbook.

Tim Sayed, MD, MBA, FACS · Answer

First off, your result looks good overall. As you are thin, it is not surprising you may feel the lower edge of the implants. The "dual plane" is somewhat of a new marketing term that plastic surgeons use to describe what most of us have been doing (and recognizing as a normal part of implant positioning) for a lot of time. Namely, the reality is that the pectoralis major muscle does NOT reach all the way around the lower curve of the breast either in its natural position or after being lifted up to accomodate covering the upper part of an implant. Only the upper 2/3 (max) of most implants will be truly covered by muscle, as the muscle lifts up like the hood of a car when you raise it off the chest wall. Trying to lift up other muscle tissue like the rectus abdominis or serratus anterior muscles to "supplement" the coverage by muscle and have the implant totally submuscular would likely cause pain and distort the natural shaping of the breast. If you want more "camouflage" of the implants, you might consider fat grafting or dermal matrix sheet placement but I am not certain these would actually improve your result and they do have risks.

Nicholas A. Flugstad, MD · Answer

Not sure how far post op you are, but you may benefit from more time. From what can be appreciated in the photos, you seem to have a very good result. In thin people, dual plane is most often the way to go. One issue you may be having is you can feel the implant more close to the surface on the lower part of your breast. There is no practical way to change that at the time of surgery, and it is the best way to get a very natural implant position for someone like you. If you like the feel of the upper pole, you may also like feel of a higher fill or more cohesive silicone gel implant. In the long run, if it bothers you, some fat transfer to that area may improve coverage of the implant and help your concerns. Congrats on your surgery.

Marc J. Salzman, MD, FACS (retired) · Answer

The word under the muscle is somewhat of a misnomer as no one today puts the implant both under the pectoralis and serratus muscles. This will not allow for the bottom of the implant to expand and will not make a very pretty breast. The dual plane means that the upper part of the implant is under the muscle while the bottom portion is usually under the lining or fascia of other muscles. Should you want to change the feel of the lower portion of the breasts, then either the addition of fat grafting and/or a support like Strattice or Galaflex for may be helpful. Best of luck.

Jon A. Perlman, MD (retired) · Answer

It sounds like you made a wise choice in selecting conservatively sized implants to give you the best chance for a natural look and feel.  Placing implants in a partial subpectoral position (or dual plane position) provides extra coverage of the upper breast area thanks to the thickness of the muscle but this does not benefit the lower pole of the breast since the muscle is too short to provide adequate coverage without terrible flattening and tightening of the breast contour.  Your results appear to be very good although early in the healing course and your preoperative photographs make you appear to be a very good candidate with adequate breast tissue to provide good coverage of the implant.Best advice would be to discuss your results with your plastic surgeon to see if he or she has any recommendations.  Best wishes,Jon A Perlman M.D., FACSDiplomate, American Board of Plastic SurgeryMember, American Society for Aesthetic Plastic Surgery (ASAPS)ABC-TV Extreme Makeover SurgeonBeverly Hills, CaliforniaIG: jonperlmanmd

Can I change from dual plane to fully under the muscle?

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