Can Under the Muscle Implants Be Moved to Over?

I am 5'8" in height and weighing 138 lbs. I'm in good shape--I jog, do push ups, and light weights. I've nursed 3 children for the last 5 years. I have 425 cc implants placed partially submuscular a year ago. The slightest flex of chest muscle makes my breasts appear unnatural. It makes the implants move upward while the bottom part ripples out. It's becoming more obvious over time. Overall, my breasts look natural and pleasant the muscle is relaxed. But to keep this from worsening, can one go from under the muscle implants to over?

Doctor Answers 51

Moving Breast Implants Under Muscle to Over is Risky

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Thank you for your question. It is technically possible to move under the muscle breast implants to over the muscle. But it is a difficult procedure because the breast tissue and skin over the muscle have been stretched and are thinner. Dissecting the overlying breast tissue can be difficult and if any breast tissue is damaged it can cause a visible deformity.

Personally I would not recommend moving your implants because

  • Risk of contour deformity or rippling in overlying breast tissue
  • The opening in your muscle cannot be closed-thus you will still see movement with muscle contraction
  • Adhesions between the old muscle incision can attach to the skin and create a worse deformity with muscle contraction
  • Risk of capsular contraction caused by secondary surgery
  • You have a good cosmetic result risk of losing it with secondary surgery is substantial

A true dilemma

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Jodie,

This is very unfortunate because you look so fantastic in the relaxed state. It appears that the muscle has scarred to the skin over your breasts causing, not the implants, but the breast tissue itself to be pulled up resulting in what we know as the "double bubble" effect. Correction would involve releasing the muscle from the skin and possibly inserting a layer of material to prevent a recurrence or perhaps moving the implants to a position over the muscle. The kicker is that you would need another surgery to correct this and the more you do, the more you open yourself up to complications and the surgery is not always simple. Also, large implants placed above the muscle tend to age poorly due to the thinner tissue coverage. See your surgeon for suggestions. Good luck!

Elevation of subpectoral breast implants

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Absolutely!  There have been many situations in which a very active subpectoral implant placement can lead to a distortion in the appearance of the implant, with significant elevation with each contracture of the muscle.  This can be seen in very muscular individuals or very physically active patients.  In cases such as these  the implants could be positioned in  a submammary or subfascial position.  Your Plastic Surgeon should be able to appropriately give you advice about this.

 

Good luck

Breast Implants and Muscle Distortion

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Thank you for the question.

Yes it is possible to move the  implants from the sub muscular to the sub glandular position. However, there are many potential downsides to having implants in the subglandular position.  These include potential for rippling/palpability of the implants,  increased rates of encapsulation, and increased  interference with mammography. 

The better option may be to attempt to release the muscle attachments inferiorly.  This operation is often only  partly  successful; nevertheless, it may be better to accept some muscle distortion as opposed to the downsides associated with the sub glandular breast implant positioning. 

Please make sure you seek consultation with well experienced board-certified plastic surgeons.

I hope this helps. 

Move breast implants from under muscle to over?

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Yes, you can have your implants from under the mucle to over the muscle. This is the only way to totally rid the breast of distortion with muscle contractions.  The drawback is that, if your breast tissue is thin in the upper portion of your breasts, you may see a more prominent upper edge of the implant, and if thin enough, may even see some breast implant wrinkling in some positions.  Saline implants require more tissue thickness to hide edges and wrinkles, silicone gel implants require less thickness of tissue to camouflage these characteristics.  A surgeon examining you would be able to give you an idea as to whether your tissue is thick enough to properly camouflage a gel implant if placed above the muscle.

Animation Deformity and moving implants from under muscle to over muscle

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Yes you can move the implants from under the muscle to over the muscle, and yes, this could help your problem, but it's not usually that simple. You have what is called "animation deformity". It is not really a deformity but results from the contraction of your Pectoralis Major muscle which elevates the muscle and breast tissue on top of the implant when you contract the muscle. This might be more noticeable for you as you sound like you are athletic.

Placing the implant on top of the muscle could make this problem go away, but cause another. Likely your tissues would thin over time and you could end up with visible rippling. Also the rate of capsular contracture is higher on top of the muscle.

Using a biplanar technique to place the implant at the original surgery and doing less of a release of your Pec Major muscle could have minimized this problem. Fixing this now would require adding a reinforcing tissue such as STRATTICE to the inferior border of the muscle to limit the upward movement, and also separating the breast tissue from the muscle and repositioning lower. Complicated and expensive.

Repositioning to Breast Implants to above the muscle

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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.

Ankit Desai, MD
Jacksonville Plastic Surgeon

Repositioning Breast Implants

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Implants can easily be moved from a submuscular position to a subglandular one, usually through the same incision. If capsular contracture has occurred, removal of the scarred capsule can be performed at the same time. This would alleviate the breast distortion that you are experiencing.

Yes, the implants can be repositioned

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Yes, it is possible to reposition the implants over the muscle. In your relaxed state, the implants look great. In the contracted state, it appears that the muscle is pulling the skin and making an unaesthetic fold. You really have two options. First, your surgeon can try to disrupt the muscle attachments that are pulling the skin. Second, your surgeon can move the implants to the subglandular (above the muscle) position. Good luck.

As with everything, there is a trade off.

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The simple answer to your question is yes. It is relatively easy to change the position of your implants to subglandular. This should diminish or stop the distortion you are experiencing with muscle contraction.

The more involved answer is not so simple. There may have been a good reason why your surgeon placed the implants under the muscle. Maybe he/ she thought that your soft tissue layer was too thin and by placing the implants on top you may have been more prone to seeing wrinkling or a pronounced demarcation of the implant on the upper part of your breast.

If you have a good amount of coverage between the muscle and your skin surface this should not be a problem.

Leslie H. Stevens, MD
Beverly Hills Plastic Surgeon

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.