Is Breast Lift Always Required when Implant Changed from Subglandular to Submuscular? (photo)

Long story short...Saline implants subglandular placement 2.5 years ago. Developed a bleed in L. Breast, post-op, fluid drained, no infection. Developed capsular contracture in it, implant has ruptured. New surgeon recommends switching to submuscular saying a lift is req. due to pocket above sagging? Wondering won't pocket on top close on its on with time? Or is lift necessary? I really, really don't want one, but I also don't want my breasts to look strange.

Doctor Answers 13

When is a breast lift needed with implant change?

Every case is different, and there is no reason why every patient who has implants change from above the muscle to below needs a lift. However, implants above the muscle may be more prone to stretching the skin and tissues resulting in sagging. The lift is for sagging, not the plane change specifically.

Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Breast lift and implant exchange

Based solely on your photos, it looks like you could benefit from a lift.  Implants above or below muscle will not eliminate the need for a lift if you are a candidate for one.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Is Breast Lift Always Required when Implant Changed from Subglandular to Submuscular? (photo)

You have large areolae and ptosis (sagging)

I believe these can both be corrected with a subareolar mastopexy

and subfascial placement of the implants

Internal mesh support may be necessary

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Breast Augmentation

When changing from subglandular to submuscular there is a pocket change for the implant.  If the breast itself is not drooping (noted when the gland and nipple fall below the crease beneath your breast) then a lift would most likely not be necessary.  As the implant provides volume and projection, if the nipple is well above the lower crease then it should project nicely forward and not require the lift.  I hope this information is helpful

Ronald H. Stefani Jr, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 2 reviews

Exchanging Breast Implants from Sub glandular to Sub muscular Position?

Although I cannot provide you with advice specific to your situation, based on the information provided, some general thoughts may be helpful to you.

When exchanging breast implants from the sub glandular to the sub muscular position, breast lifting may or may not be necessary depending on the degree of breast ptosis ( “sagging”) and the position of the nipple/areola complexes in relation to the planned position of the breast implants.

 When I do this operation, I do surgically close off the  sub glandular space,  in an effort to prevent the breast implants from shifting back into the previously dissected sub gandular space.

 In regards to breast lifting scars, mostpatients (If properly selected and who are doing the operations and the right time of their lives  psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry. This acceptance of the scars is the essential “trade-off” associated with many of the procedures we do in the field of plastic surgery.

   I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,485 reviews

A breast lift is not necessary when moving the position of the implant.

Ptosis is a condition that exists independently of the size and position of the breast implant.  A large implant can camouflage modest ptosis but does not correct it.  The breasts pictured look satisfactory with implants only.  Nevertheless, this needs to be discussed in detail with the surgeon.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Capsular Contracture

 A breast lift is indicated for breast ptosis or a sagging breast. The amount of sagging is usually determined by the nipple position in relation to a patients inframammary fold (IMF). Based upon you photograph it is obvious your nipple position is at or below the IMF. So, a perhaps better question would be “Does a breast augmentation in the sub glandular or sub muscular position improve breast ptosis.” The answer is neither position improves breast ptosis. A Mastopexy or Breast Lift is the most common surgical procedure to correct breast sagging or ptosis.
 The issue your surgeon has brought forward about moving your breast implant from the  sub muscular to the sub glandular position most likely is related to your developement of capsular contracture. Some surgeons have shown that if the tissue envelope is adequate moving the breast implant to a new pocket  ( sub muscular to sub glandular ) can possibly decrease the incidence of capsular contracture or the hard post augmented breast.
May I suggest your write down your concerns & return to your surgeon to have them addressed. Consider requesting seeing some of their patients who have had breast augmentation with mastopexy’s. Best,


Gary R Culbertson, MD, FACS

Gary R. Culbertson, MD
Columbia Plastic Surgeon
4.9 out of 5 stars 9 reviews

Is Breast Lift Always Required when Implant Changed from Subglandular to Submuscular?

I might just exchange only or even do donut lift to see if the result is acceptable to you. I might go larger implants a;so Good luck. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Breast lift with implant exchange

You raised a question that's commonly encountered with capsular contracture and implant exchange. Are you planning on different implant size or using same implant? Do you like current nipple/breast shape/location or would you like them higher? Often time with capsulectomy, the breast will appear more sagging after the surgery if breast lift is not performed. Your decision is based on choosing between getting improved breast shape vs. no additional scar.

Best Wishes,

Stewart Wang, MD FACS, Wang Plastic Surgery 

Stewart Wang, MD, FACS
Los Angeles Plastic Surgeon
4.6 out of 5 stars 28 reviews

A lift would improve your results, but not absolutely necessary.

I think a lift would help to improve the areola size discrepancy, as well as the nipple/areola complex position, but you could get better symmetry than you have now with pocket change and capsulectomy.

W. Tracy Hankins, MD
Las Vegas Plastic Surgeon
4.9 out of 5 stars 292 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.