Can Under the Muscle Implants Be Moved to Over?

Yes you can move breast implants from under the muscle to over the muscle or vice versa. You have two options to correct the deformity you describe:

1. You can change the position of the implants from under the muscle to over the muscle. This would correct the animation deformity you have with muscle contraction. The downside is that the entire weight of the implant would be placed on the breast gland and skin, which can cause thinning of your breast tissue and accelerate the effect of gravity. In addition, you would increase the risk of implant visibility and rippling.

2. The second option to to use regenerative medicine to reinsert the moving muscle. An acellular dermal matrix like Strattice would allow you to keep the breast implants under the muscle and reduce or correct the animation deformity you see with muscle contraction.

I would say that there is a good chance that the muscle was inadequately released at the first surgery, and that remove replace with cutting of the capsule and releasing the muscle will improve your outcome.  switching the implant position is not the answer.

The simple answer is yes the
implants can be moved over the muscle. The most common reason to move the
implants above the muscle is in active patients that develop an “animation”
deformity. An animation deformity is
when the implant and breast are moved when the pectorals muscle is flexed. Typically it will cause a crease across the
breast as the muscle is flexed.


Like anything in life there are pro and cons to
moving the implant over the muscle. Typically the implants are placed under the
muscle to keep the breasts soft and natural. If you move the implant over the
muscle you have to do several things to keep the breast looking natural and
soft. Any time you place the implant over the muscle you will feel more of the implant,
as the muscle is no longer present to cover the implant. You also typically
need to use a textured implant when the implant is placed above the muscle to
prevent excessive scar tissue from forming around the implants. Silicone implants have made placement of the
implant above the muscle more reasonable as they are much softer and natural
appearing than saline implants were previously.
In the past a saline implant placed above the muscle would be very firm,
this is not necessarily true for the new silicone breast implants.



Patients with the correct
operation can achieve a very attractive breast and avoid the animation
deformity with an implant placed above the muscle.

This surgery is possible and occasionally needs
to be done in very active woman. I would just make sure that you discuss the
surgery with a board certified plastic surgeon that can discuss the risks and
benefits of the surgery with you.

Hi there,
It appears that you do have a significant degree of breast animation deformity with a dynamic double breast contour at the breast lower pole upon contraction of your pectoralis muscle. This often relates to inadequate release of the muscle at the infra-mammary folds during your original surgery, thus causing a "regurgitation" of your implants in an "up and out" direction towards the axilla while causing a dynamic "double bubble' deformity at the the breast lower pole.
As you correctly observed, this problem will not improve unless the cause of the problem is fixed with the correct surgical solution which either involve a complete release of muscular attachment at the breast folds or switching the pocket to the pre-muscular plane (i.e. from under to over the muscle) where the implant acts as an interface between the breast tissue and the underlying muscle. Suitability of the appropriate surgical remedy in your situation will be determined by both the quantity and quality of your tissue coverage. It'll be best to consult your original plastic surgeon for further advice.
Hope that helps.
Best wishes
Ellis Choy

As can be seen, you have a very good results at rest and when you move the animation can be seen. If it remains painful, you can consider moving the implants to above the muscle. Based on the amount of breast tissue you have you van discuss with your surgeon if you will benefit from any mesh. Generally secondary operations do have their own risks and complications

Thank you for sharing your question and photos.   Your issue, dynamic breast implants, is not uncommon.   The simplest and most reliable solution is to do just what you are asking about - moving the implant to a subglandular plane.     Based on your photographs, it looks like this would be a reasonable solution for you, but of course, you need to be examined by a plastic surgeon to discuss the risks and benefits.    

YES!! You sound like a perfect candidate for a subfascial conversion assuming you have sufficient soft tissue coverage to camouflage the implants. Generally speaking, if you have at least 2cm of "pinch" in the upper pole of the breast, you would potentially be a great candidate for such conversion. You have hyperanimation which is a fairly common event following submuscular implant placement. Even with the addition of ADM in the lower pole, if you keep your implants in the dual-plane position, they are subject to the animation forces of the pec muscle and you will still have that classic unsightly contracture which can also be uncomfortable. This is a fairly routine procedure whereby in addition to the subfascial conversion, a piece of mesh is utilized to stabilize the implant, minimize rippling, and provide a long lasting result. Some patients who are thin may require secondary fat grafting if there is any associated rippling. Talk to your board-cerftified plastic surgeon about this. 

Hello, thank you for submitting your pictures and providing such a good description. You have what’s called an “animation deformity”. 
Animation deformities can definitely be improved with revision surgery. While moving the implants from under the muscle to over the muscle is certainly possible, it is definitely not recommended as the results will be short-lived and ultimately you will have more breast stretching and sagging.  This is particularly the case with your active lifestyle. 
I recommend that you see a plastic surgeon with experience in breast revision surgeries using acellular dermal matrix. That being said, just finding out a little more information about how your surgery was done and what types of implants you have may provide a different solution. This is why going to see your original surgeon is always the best first stop to see if they are experienced enough with breast revision to correct it for you. 

Thank you for your question.  Yes, is it very possible in revision breast surgery to do a "site change" and change the breast implants from the subpectoral pocket (under the muscle) to the subglandular pocket (above the muscle); however, it is not without some trade-offs. All patients that have breast implants under the muscle will have some degree of "animation deformity" which means that there can be movement and indentation lines seen usually in the lower part of the breast area when the pectoralis muscle (chest muscle) is flexed.  Sometimes it can be very subtle and other times it can be more of a nuisance or concern. Each patient is different and each patient's muscles are different.  This variation can also have to do with "where" and "how much" of the inferior slips (lower portion) of the pectoralis msucle was "released" at the time of surgery.  One option in my opinion to help with this would be to consider a revision of the breast pocket to evaluate the muscle and capsule.  Sometimes, it can be found that there was an under-release of muscle that can be released a little more, and a simple "dual-plane" release of the muscular attachments to the skin can be done which can improve the animation significantly.  Other times, I might consider a neosubpectoral pocket change and dual-plane release to release some of the overlying skin attachments to the muscle.   I think these options can improve the animation deformity, but it still may not go completely away.  If you absolutely want no movement of the implant at all with flexion of the pectoralis muscle, then I would recommend a site change to the subglandular pocket as you query above.  This does involve some trade-offs such as an increased risk of capsular contraction and more possible visible rippling and wrinkling of the implants;however, many patients do quite well with subglandular breast implants.   If you choose to go subglandular, then I think it would be important to consider using a more cohesive silicone gel breast implant with a higher gel-to-shell ratio to have the least chance of implant rippling. This is something to ask your plastic surgeon about.I dedicate a large portion of my practice to aesthetic breast surgery revision, and I think it is important to discuss your concerns and options with one or several board certified plastic surgeons that specialize in aesthetic breast surgery revision.  I hope this is helpful.  Good luck!

Thank you for the question and photos. What you are experiencing is flexion distortion or animation deformity of the implants with contraction or flexion of the pectoralis muscles. This is very common with under the muscle placement. This could also get worse with time and result in bottoming out as the muscle continues to push the implant. The only way to prevent it completely is placing your implants on top of the muscle. Naturally the breasts are anatomically on top of the muscle so if you have enough breast tissue to cover the implants I don’t see why you can’t have them placed over the muscle. To lower your risk of capsular contracture and rippling I would choose the textured implants instead of smooth and place them over the muscle. Many of my patients have had the same complaint and after switching their implants to over the muscle their breasts look natural with minimal rippling and no contraction deformity. Best of luck with your decision. Dr. Khuthaila 

Hi, a new pocket over the muscle can be created and implants placed there but a few things:The implant will be more visible and more easily feltThe risk of capsular contracture (capsule around the implant getting hard) is higherYou will also see the implant more, so it will be more round with less of a natural slope at the topHowever, you can discuss your current issues with your surgeon as there are several possible solutions for what you're describing. Best wishes,Dr. BlaggAustin, TX