Once over the Muscle. Can I Now Go Under Muscle?

As you may know, the submuscular approach is generally the preferred placement of implants.  When compared to a subglandular pocket, these submuscular implants are associated with a more natural appearance, a lower incidence of capsular contracture, and less palpability (you can feel the implants less).  There are a few options in this scenario.  One is to remove the implants and allow the breasts to heal back down to the muscle.  After 4-6 months, the implants can be replaced in a submuscular plane.  Most patients understandably prefer to avoid a staged procedure.  In order to remover the implants, an incision in the periareolar region or inframammary fold is required.  Silicone implants can then be placed in the submuscular plane.  However, this creates two breast pockets.  To maintain the implant in the submuscular plane, a dermal matrix implant such as AlloDerm or surgimend may be required.  This is sutured on the lower aspect of the muscle and over the implant to maintain the implant in the submuscular plane.  This can be accomplished with a good aesthetic outcome and no overlying skin issues.  Hope this helps.

Thank you for the question.

In the event of capsular  contracture or severe breast implant rippling replacing implants in the sub muscle position is the best way to go in my opinion.  This may or may not be possible depending on your specific situation.

Generally, it is possible to replace implants under the pectoralis muscle (dual plane).  However, the major issue of concern is the overlying breast tissue and skin and whether further surgery will be necessary to achieve the aesthetic  results desired.  For example, some patients who have implants replaced into the sub pectoral space may benefit from breast lifting to achieve the desired goals.

This type of surgery does require some level of experience. It would behoove you to seek consultation with well experienced board-certified plastic surgeons well-versed in revisionary breast surgery.

I hope this helps.

Going from over the muscle to under the muscle is a feasible option but this may require sutureing the muscle to the tissue to prevent the implant from "popping" back into the previous pocket. It also would require a scar on the breast.