Going from under the muscle to over the muscle?

I currently have 650cc's under the muscle. One breast is higher do to the muscle on my right side. I'm considering removing them from under the muscle. And going over the muscle... I'm wondering if I should go a 100cc's less to I won't look bigger.

Doctor Answers 10

Under the Muscle to Over the Muscle?

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Suggesting that one breast is higher due to the muscle doesn't really make sense. It would not be an issue directly related to the muscle. You potentially could have another problems such as capsular contracture or implant malposition. In either case the treatment would not be to switch to over the muscle. Placing a large implant on top of the muscle will subject you to other problems such as thinning of the tissues, visible or palpable implant, visible rippling, and an increased risk of capsular contracture. Also large implants on top of the muscle do not hold up well over time and tend to quickly migrate south under the effect of gravity. The end result is a large sagging breast, probably not what you had in mind. 

Breast are different after Breast Augmentation due to muscle, is this true or NOT?

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Hi Rmclark90,

Thanks for your question. Some photos would certainly help in your assessment. It is unlikely that the muscle is what is keeping the implants "OFF." Usually the pocket was not made properly or scar tissue formed that created irregularities. I would not place them over the muscle even if going slightly smaller as they settle faster and do not hold up over time. I would get several consultations to make sure that you are treating the right condition and changing pockets of the implants for positioning alone is not the best idea. Good Luck!


All the best,

Carlos Mata MD, MBA, FACS

#breastrevision   #breastasymmetry        

Board Certified Plastic Surgeon

Carlos Mata, MD, MBA, FACS
Scottsdale Plastic Surgeon
5.0 out of 5 stars 38 reviews

Under to over muscle: what to know

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First, with implants in the size range that you have, downsizing makes sense because they will otherwise have an unnatural contour without the muscle coverage. Second, the muscle should be re-attached or there can be animation problems even with the muscle behind the implant. Third, be sure that the reason for making the change makes sense. Implants are not usually higher on one side because of the muscle unless there are other issues such as animation.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Revision Breast Augmentation

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Unfortunately, recommendations cannot be made based on your situation. A thorough history and examination would is necessary to give you advice and information. If your surgeon isn't an ABPS certified/ASAPS member surgeon who specializes in revision breast surgery, then you should see a few in consultation.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Breast asymmetry due to muscle

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thank you so very much for your question. I do not believe, unless I'm able to examine you in a clinical office setting, that your muscle is the cause of your asymmetry.  One breast can be higher due to the fact that you're right anatomical breast footprint is naturally higher compared to the other side, or you have a breast implant capsular contracture. This excessive scarring process around the implant draws up your implant compared to the other side.   Until you're able to be thoroughly examined by a plastic surgeon who is experienced in breast complication surgeries, I would wait to determine whether smaller implants are your solution. Best of luck for speedy resolution!

Sean T. Lille, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 32 reviews

Breast Revision

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First of all, 650 mL looks like 650 mL whether it is on top of the muscle or under. Secondly, the implants aren't asymmetric because of the muscle, if there asymmetry it may be because the muscle was inadequately released on one side relative to the other. It does not require changing the location of the pocket to gain symmetry, it requires making both pockets the same. You can be just as asymmetrical with implants over the muscle if the pockets are not properly created.

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

Going from under the muscle to over the muscle?

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Thank you for the question.

Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, and computer imaging) will be critical.

Generally speaking, the best online advice I can give to ladies who are considering breast augmentation revision surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 

In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "too big” etc means different things to different people and therefore prove unhelpful.

Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.

3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.

I hope this (and the attached link, dedicated to breast augmentation revision surgery concerns) helps. Best wishes.

Moving implants from below to above muscle

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Hi and thank you for the question. I rarely recommend patients move implants above the muscle. The only reason I usually do it is for patients who get an animation deformity where the implants get very distorted when you flex. In your case I would guess that one implant is higher than the other either because you have capsular contracture or the doctor didn't divide the pec muscle enough on one side so that implant didn't drop enough.  If you still decide to move the implants I don't think it's necessary to change size. Before you do any further surgery consider getting a second opinion from a surgeon who does a lot of breast surgery.  Good luck. 

Dr West

Justin West, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 30 reviews

Moving implants from under the muscle to on top of the muscle.

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Thank you or your question. I would first return to your plastic surgeon to determine why you have asymmetry.  It may be a capsular contracture that needs to be taken care of first which would be "easy" to fix and keep the implants in the same plane. 650cc implants are large implants moving them on top of the muscle certainly will increase your complication rate. If you choose something smaller, you may require a lift. You should go back to your plastic surgeon to determine what options will work best for you.

Switching planes

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I would first investigate options of correcting your asymmetry while staying under the muscle before deciding to make a switch with such large implants. It may be more of a muscle release problem or chest wall asymmetry.  You are correct in downsizing the implants a little (I estimate 25-50 cc difference) to maintain the same size appearance. Large subglandular implants may not be a good long term solution unless you have a lot of tissue. The contracture rate will be higher and the implant more palpable. Get a couple of opinions before deciding.

Stacey Folk, MD
Denver Plastic Surgeon
4.8 out of 5 stars 25 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.