Why Cant I Get New Implants and a Lift Under the Muscle This Time?

I have had saline, over the muscle. breast implants for 15 years .. two kids later need a lift and replacements . Want uner the muscle with cilicone and a lift... Doc i saw said NO to uner the muscle.... I dont understand why..?. Is this a problem or high risk...?. I want them a little bigger and want them to look as natural as possible and I dont want them to sag 15 min. after surgery!!!!

Doctor Answers 10

Pocket Switching in Secondary Breast Augmentation

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You have asked multiple questions and obviously the full answer cannot be given without an in person physical exam.
As far as pocket switching from over to under the muscle, that in itself is pretty simple - do an anterior capsulectomy (remove a portion of the scar above the muscle), then obliterate that space with stitches and a drain, elevate the pectoralis muscle off the 5th rib, and place a new implant below the muscle.  This part of your question is simple and it can be done.
The question of whether you can do a lift at the same time is a little bit more complex.  Of course, you can do a lift, no sweat, if you are willing to accept your nipple being removed and placed back on your breast as a free nipple graft.  That being said, most people won't accept that, therefore an in person physical exam would be necessary to decide what other type lifts are possible.

Pocket exchange for implants

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Without an exam it is hard for me to say, but in most cases a change of pocket is ok and going under the muscle in thin patients is reasonable.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

New Implants and a Lift Under the Muscle

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Without an in person consultation and exam, there is no way of definitively answering your question. Generally, patients can make this switch. To further explore your options, consult with 3 - 4 experienced and expert board certified plastic surgeons.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 56 reviews

Don't see a reason why not

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It is hard to say with out pictures and a physical exam, but there are very few reasons why you should not be able to do that!  Seek another opinion from a board certifies plastic surgeon!


Good luck!

Changing breast implants from above to below the muscle

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As a plastic surgeon that is old enough to have dealt with a large number of breast augmentations with implants placed above the muscle before subpectoral position became the clear standard, I can say that it is rather straightforward to create a new pocket in the usual subpectoral plane with a dual plane release of the pectoralis muscle. The dual plane refers to the coronal and horizontal planes for the lower edge of the muscle and some of the new implant in the lower pole of the breast is not covered by muscle and may even be in part of the old capsule pocket. Of course a plastic surgeon needs experience on how to do this reliably. 

Several caveats should be mentioned. The sizing of the implant should be as for a first time augmentation in order to fit behind the breast and under the muscle properly. A certain volume of implant above the muscle will look bigger (or have a bigger effect) than the same volume below the muscle. (This is one reason using external sizers is misleading for determining implant size). These days that can be offset by using a higher forward profile (which wasn't available in the past). I would also question the need for a lift, something that can only be determined by exam, and is problematic to do at the same time as a redo augmentation. The other apparent misconception is that putting implants below the pectoralis muscle somehow keeps the breast up or avoids sagging in the future. I don't see this happening over the years and I also don't think the size or type of implant makes any difference in future sagging as long as it is sized and positioned properly. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Y Cant I Get New Implants and a Lift Under the Muscle This Time?Answr:

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I actually prefer to put implants under the muscle in women with previous above muscle implants because I think it gives a longer lasting result and more upper breast fullness, something that is missing in so many patients with droop. I prefer to do this all in one operation as well, although some doctors prefer to break it up into 2 or so.

John J. Corey, MD
Phoenix Plastic Surgeon
4.7 out of 5 stars 48 reviews

Options for revision breast surgery

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There is no replacement for an in-person physical examination before giving your advice about a more complex breast revision surgery. There are some plastic surgeons who are not comfortable with the concept of lifting up the muscle for a partial sub-muscular placement followed by a breast lift with larger implants. I would suggest you seek consultation with another board-certified plastic surgeon who perhaps does more breast revision in their practice. You may be told the same thing but at least try to get an answer as to why it is not advisable. I wish you well.

Dr Edwards

The patient should have the final say in whether the implants are inserted above or below the muscle.

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Implant placement above or below the muscle never has an absolute contraindication.  There are situations where one or the other might be preferable, but not contraindicated.  If you want your implants under the muscle at the same time as your breast lift, it should be your choice.

Why Cant I Get New Implants and a Lift Under the Muscle This Time?

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This is a very simple answer...find a different doctor. Putting new and larger implants under the muscle when your original ones were on top of the muscle is not at all complicated as long as the doctor has experience in doing that. And Dr. Peters is right that they will be in a dual plane.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Revising Above Muscle Implants to Below Muscle

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I prefer the look and feel of implants placed under the muscle, also known as  dual plane.  I prefer the look and feel of silicone implants over saline. Both have advantages and disadvantages. Sometimes  changing an above muscle implant to a below muscle  can be difficult because the muscle may be too thin or the capsule of the original implant pre vents expansion with a new implant below.  If I were your surgeon, I might ask that you allow me to place the implants below the muscle unless I discovered at surgery that it was not technically possible.  You should make sure you have had a careful discussion with your surgeon about the possible limitations of a revision of a prior breat augmentation, but your goal sounds appropriate.

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 117 reviews

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.