Does moving implants from over to under muscle require 3-4months explant?

There is no need to explant, and the entire procedure is done in one surgery. The space is closed at the time of surgery and a resorbable mesh is used to control the implant in its new partial subpectoral space. BTW, if you already had a capsulectomy for capsular contracture, you immediately became subglandular and not subfascial, because any fascia there was above the implant would have been removed. The concept of subfacial implant placement is a noble one, eliminating the need to violate the pectoralis muscle, but unfortunately it has higher rates of cc and implant palpability.

There is no standard protocol. There is some logic to leaving the implants out for a few months prior to placing them under the muscle. However once you get a capsule the chances of recurrence are high regardless of what is done. If you get the implants removed make sure the capsule is also removed

If you capsulated fairly quickly after getting implants, I would suggest going with the second surgeon to remove the implants and let your tissue settle down. Always take antibiotics prior to any dental or OB/gyn exam to also help prevent capsules.

One of the benefits of some pectoral placement of breast implants is that it lowers the incidence of capsular contractions.
Different plastic surgeons well, I have different opinions. The choice of doing this as a stage procedure can be influenced by a variety of factors.
When patients have multiple recurrent capsular contractions, the likelihood that there is a staph epidermidis contamination becomes more real. This is a very slow, growing bacteria that cannot be treated without antibiotics. It is difficult to make an accurate diagnosis if the capsule or implant is contaminated with the bacteria.
Staphylococcus epidermidis contamination is probably the most likely explanation for patients who continue having capsular contracture’s again and again.
The bacteria cannot be completely eliminated, but attempts should be made to eliminate the contamination as much as possible, and this would be better done with a complete capsulectomy and implant removal and delayed augmentation in the subpectoral plane.
When converting from some glandular to some pectoral, there’s also a risk that the implant can move back into the old position.
Simply speaking it, surgeon will have their own way of doing this and there are a lot of variables to take into consideration, justifying different approaches. There is no one single gold standard.
For someone who has had multiple capsular contractions and wants to maintain augmentation long-term I would take the most conservative approach. This would be undergoing implant removal with complete capsulectomy, followed by delayed augmentation in a different plane, preferably sun-pectorally.
In my opinion, there is no fascial plan over the pectoralis muscle. I don’t know what somebody mean when they say sub fascial placement of the implants since the pectoralis muscle has no fascia to speak of other than at the insertion.
That said, there are also some good advantages for doing immediate repositioning from sun glandular to sub pectoral. I would probably do this as a single procedure if you didn’t have the history of multiple capsular contraction.
Your situation is complicated and having had multiple counselor contractures put you at risk for having this complication happen again especially if there is bacterial contamination.
Slime Coates from staph epidermidis contamination is not clearly understood by everyone. It is a complex topic and the treatment is not done with antibiotics or how most infections are treated. The bacteria does not cause clinical infections. It is very slow growing, but causes biofilms with pseudoaneurysm’s Along vascular graft and capsular contraction’s around breast implants.
On top of this is very difficult to diagnose the presence of staph epidermidis in the breast implant capsule.
The micro organisms cannot be grown in the laboratory. It to be identified by trying to separate the bacteria, using ultrasound, and then visualizing them for confirmation of the diagnosis.
For most patients and providers it is a diagnosis of exclusion that is usually not confirmed by Testing.
It is the most common reason for patients to have ultimate implant failure due to repeated capsular contractions?
Make sure you’re working with plastic surgeons who have a lot of breast augmentation experience over many years.
Best,
Mats Hagstrom, MD