Should I go for a dual plane or submuscular revision? (Photo)

Question

Female 31 years old. Had a BA for sagging due to weight loss and stretch marks.Wanted a tiny implant that would fill/ lift my breasts. Dr convinced me 225c subgland high profile and gave me a Bellini lift that scarred horribly, was left with huge stretched out aerolas. turns out my fragile stretched out skin could not carry the implants. I now want to go smaller to 180 cc moderate profile and have him give me aerola reduction. Should I go dual plane or submuscular for the most natural lifted result? Thank you

Steven Sigalove, MD FACS · Answer

As long as you are not an active bodybuilder, or a routine weight lifter particularly with your chest, assuming you are otherwise happy with your implants in the subglandular position physiologically, then I would keep your new implants prepectoral, use Galaflex to support the pocket, downsize your implants, and do a full mastopexy leaving you with an anchor scar. This would accomplish skin tightening, areola reduction, as well as improved implant positioning with a better cleavage and closer midline. The important thing to note is that downsizing is absolutely possible, but you would have to undergo a full mastopexy. I don’t think it’s a mistake to change the pocket to a dual plane position, but I actually see no need for a more invasive procedure particularly since you have otherwise been happy with prepectoral implants.

Daniel Barrett, MD · Answer

Dear kamilast91,
I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

You have little tissue, so I would suggest placing the implants behind the muscle for better upper breast fullness and coverage. I do agree with going smaller. The vertical lift might do well for you and is less likely to stretch your areolae.

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