Replacing Breast Implants - Back Under or Go Over?

Last year I had 375 cc submuscular, then explant w/o replacement. I am 46.T oo large for my 5"3" 115 lb frame. I am thinking about getting implants again, but going smaller. My PS suggests over the muscle this time because I had pain and I would not have to worry about the double bubble. Under or over?

Doctor Answers 9

Remove and Replace: Size and position

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The double bubble issue depends on the breast tissue, the crease and the position of the nipple. You may require a lift as well. Under the muscle is likely to provide you with the most amount of tissue coverage and permit better quality mammograms. IF you go over, you may want to consider silicone to minimize rippling. Discuss these concerns with your surgeon.

Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

A smaller implant placed above the muscle may be the right approach

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If I have interpreted your situation correctly you have had your original implants removed for two reasons. First they were too large for your taste and second there was a double bubble deformity. You are now considering replacing them. The second time around it will be easiest to correct the issue of size. Have your surgeon give you sizer implants to try on that are smaller then your original 375cc implants. This will give you a good idea of how much smaller you might want to go.

Compare your choice side by side with your original size to visualize the size difference. This routine will help prevent an second error in implant size.  The double bubble issue is more complicated. Yes, a solution would be to place the new implants in a different plane above the muscle. The double bubble does not occur over the muscle. However, if your inherent breast size ls less then a B cup you may lack adequate tissue to cover your implant exposing you to a risk of visible wrinkling and rippling. You would then be trading in one problem for another.

If you are normally a B cup or greater then going above the muscle is  an excellent approach. If you are not, then replacing the implant beneath the muscle may be necessary but you will have to contend with the possible recurrence of the double bubble. Your surgeon will have to take measures to prevent this from happening again with some form of internal reinforcement of the breast fold. You will have to discuss all this very carefully with your surgeon prior to replacing your implants.

David A. Ross, MD (retired)
Chicago Plastic Surgeon

"Buyer's Remorse" in Breast Augmentation surgery

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All experienced Plastic surgeons see patients weekly who have chosen their breast implants poorly. Your choice of implants should NOT be based on what you read in women's magazines (starlet X got so many cc's, starlet Y just switched to so many cc's) nor on misleading and retouched Internet photos or compensated or phony testimonials, nor on phony "sales" or promotions by desperate doctors (often not even plastic surgeons), or on pressure from girlfriends and others.

The BEST way to pick an implant should be based on YOUR breasts dimensions and its abilities to both accommodate and cover a specific breast implant as well as on your chest dimension (to keep the implants in front rather than constantly sliding off and bumping into your forward moving arms - unless, of course, you prefer to play solo - "volleyball" for a very long time...)

It is NOT clear WHY your implant were removed and not replaced immediately: ? infection ? choice. But, unless there is a pressing reason I prefer to go back under the muscle and get as much cover as possible on the implants. The dissection would NOT be as painful this time but your choice of implant needs to be very careful. This is not a shoe store where you can try out various implants because every operation complicates the next ones and buyer's remorse should not be a part of Cosmetic Surgery.

Peter A. Aldea, MD
Memphis Plastic Surgeon

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Replacing breast implants - back under or go over

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Are you saying you had implantation last year than explantation within the same year, so two surgeries within a year? If yes, than I have a concern of your realistic expectations! You may be a risky patient and need a very detailed inform consent. As for replacement, I would recommend under the muscle again.


Implant position depends on your anatomy and reason for revision

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Whether or not the implant is placed under or over the muscle depends on how thick your tissues are.  If you are very thin, with visible ribs, etc. it is best to place the implant under the muscle.  In these situations, the muscle will add thickness to the tissue coverage over the implant, and reduce the risk of visible implant edge.  Other considerations do not apply to you.  For example, if a patient is having removing and replacement for capsular contracture, I place the implant under the muscle.  Other factors that influence patients in their decision include the fact that more breast tissue can be visualized with the implant under the muscle and under the muscle implants can have dynamic distortion.    Hope this helps.

Tracy M. Pfeifer, MD, MS

Tracy Pfeifer, MD
Manhattan Plastic Surgeon
4.8 out of 5 stars 29 reviews

Redo breast implants

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An implant exchange can be performed if you want smaller breasts, but a thorough exam is critical to see what pocket, implant, etc., would be best for you.

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

Replacing with smaller implants generally in the same space

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If you didn't have a double bubble with the larger implants, you won't with the new ones in the same pocket under the muscle. The pocket itself may have to be adjusted, but that isn't usually very complicated to do. So if no problems other than size, keep it simple.

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

Redoing augmentation requires retrospective analysis

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The most important thing to consider in redoing your augmentation is why you had the implants removed in the first place.  If size is the only concern then this is easy to fix but the issue of pain also needs to be considered as to why.  Make sure to have a complete discussion with your surgeon about all of your prior symptoms and issues.

As thin as you are I would avoid putting implants above the muscle.

Best Wishes.

Marcus L. Peterson, MD
Saint George Plastic Surgeon

Re-augmentation after implant removal

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It is difficult to give you good advice without a photo or examining you. If you had a double bubble deformity with your first surgery it is possible you would benefit from a breast lift with or without augmentation. You also didn't say why you had your implants removed. I would return to your plastic surgeon and go over the details of why he/she recommended going over the muscle.

I wish you well.

Dr Edwards

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.