Wrong breast implant placement: one under muscle and one above. Is this normal?

Thank you for your question. I have seen a few patients over the years who have had implants placed in different planes.  They had all had their implants placed through the belly button.  In my opinion this is a horrible procedure.  One of the reasons is that it is done blindly so the surgeon has no idea if the implants are above or below the muscle.  I wish I could say that these procedures were all done by non plastic surgeons but some were, in fact done by a board certified plastic surgeon.  I have seen a case where one implant was over the muscle and the other was partially over and under, the surgeon having torn through the muscle about halfway down going through the armpit.  Again, the procedure was done blindly with no visualization of the pocket as could have been done with an endoscope.  So it is possible that your surgeon placed one above and one below or, as Dr Canales has said perhaps they were both below but over time the one breast has dropped so low that it no longer has muscle over it.  If you had your surgery done by a competent surgeon certified by The American Board of Plastic Surgery and he is still in practice then you should follow up with him/her to figure out what is going on.  If that is not the case then you should see an ABPS certified plastic surgeon who is also a member of the American Society for Aesthetic Plastic Surgery and the California Society of Plastic Surgeons. 

and I suspect yours were both placed under the muscle and one found a way to work itself above the muscle.  The easiest way to determine if your implants are under the muscle is to contract your chest muscles (hands on hips and push down on hands) and see if both breasts distort or just one.  If its above the muscle, it should not distort.

I am sorry to hear about the problem you are experiencing. Given your description of breast asymmetry, it sounds like it is time for a return visit with your plastic surgeon. Physical examination will be necessary to make a good diagnosis and provide you with treatment recommendations. You may find the attached link, dedicated to revisionary breast surgery concerns, helpful to you as you learn more.  Best wishes.

It would be best to talk to your PS about the issues you are having.  I have had patients who after having their mammogram found out their implants were above the muscle when they were told otherwise by their operating PS.  If only one is affected then it could possibly be that over time the implant has dropped out of the pocket.

The muscle only partially covers a breast implant. In addition a smooth implant slides downward with your breasts over time.  Over the past 8 years it is possible that your breasts have drooped enough that the implant now has little or no muscle coverage, leading to its "above the muscle" appearance on mammogram. The same thing could happen on the other side. Visit with your original plastic surgeon to review your concerns. 

Thank you for your question.  It is unlikely that one implant was put on top of the muscle and one was put underneath it.  It is possible for an implant to work its way out from under the muscle over time, especially in a patient with a long chest, short muscle and some ptosis.  You could get a copy of the operative report and find out where they were originally placed.