Would be a total capsulectomy be more damaging if I have the implants placed above the muscle or below the muscle?

Question

Dear Community, I would like to know before having my breast augmentation procedure, just in case I would be among those people who develops BII and needs to remove the implants with a Total capsulectomy, this would be more damaging (like removing more breast tissue, or damaging more the breast tissue) if I have the implants placed above the muscle or below the muscle? I am thinking of placing the implants above the muscle to avoid cutting the muscle. Thank you!

Gary M. Horndeski, MD · Answer

A total capsulectomy is more difficult to perform and more damaging when implants are placed behind the muscle.  When placed in front of the muscle it is much more simple to remove them.

Best Wishes,

Gary Horndeski, M.D.

Alan Gonzalez, MD, FACS · Answer

Hello @Mihaella2290 thank you for your question. It does not make a difference because what is explanted is the implant and the whole capsule, not the breast tissue. When talking about placing the prosthesis under the muscle, behind the gland or in the mammary in the fascia of the muscle are techniques of approach to introduce the prosthesis. This affect the way the breasts looks especially in the long term. The best course of action is to consult one or several board certified plastic surgeon for more information and options tailored specifically to your needs. I share a video to shed more light! Best wishes! Alan Gonzalez MD FACS

Irena Karanetz, MD · Answer

Hello, 
And thank you for the question.
Breast implants can be safely placed above or below the muscle depending on patient's soft tissue characteristics and preference. Currently, there is no evidence that the placement of implants (above or below the muscle) affects the risk of development of BII.
Even if breast implants need to be removed at a later point for any reasons, as long as the breast capsules are soft without any issues or evidence of capsular contracture, it is safe to just remove the implants without performing capsulectomy. 
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast surgeries to further discuss your options, specific techniques, concerns and expectations. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results. 
I hope this helps.
Best, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Daniel Barrett, MD · Answer

Dear Mihaella2290,
there is no significant difference. In case of capsular contracture, only the capsule and implant are removed. Breast tissue is left inside. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

Removing the entire capsule, especially a very thin capsule, with implants placed behind the muscle cannot always be done to avoid injuring the lungs.  A recent study confirmed heavy medals, especially arsenic, in women with BII. This is often seen with tattoos and heavy hair dye use.  Avoid getting tattoos and using too much hair dye, especially dark dyes.

Would be a total capsulectomy be more damaging if I have the implants placed above the muscle or below the muscle?

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