Replacing saline implants placed above muscle 12 years ago. Need to decide whether to stay above muscle or go under? 5'4,127 lb

34 yrs old, Breastfed 2. Per surgeon, I have 3 issues: little/no breast tissue, rippling in one/contraction in other, & improper placement. Do I do 3 surgeries: removal, lift, then go under muscle or use gummy implant w a lift (reverse mastopexy). He recommends 2nd bc the texture of the gummy and the scar tissue from the lift will hold implant in proper place. If needed would add silk/fat graft to prevent rippling at later date. Concerned skin will just sag again if I go above v. Going under

Doctor Answers 8

Replacing saline implants

Without seeing you its hard to make a plan. I can only tell you what I end up doing most times in these cases and why. I would remove the saline implant and capsule. Close off the old pocket and make a new one under the muscle. If the amount of muscle release necessary for the size implant we want is alot then the risk of the implant pushing back into the old pocket becomes and issue. In that case, a piece of Strattice is usefull to place at the bottom of the muscle all the way to the bottom of the pocket.The newer higher fill lbreast implants from allergan and sientra (Inspira and 107) will wrinkle less than the old style of gel.  Sometimes a mastopexy or breast lift can be done at the same time. If a lot of skin needs to be removed it may be safer to do the lift at a second stage some 3 months later to acheive the best result. Seek the counsel of a board certified plastic surgeon with experience with revision augmentation. Best of Luck.

Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews

Changing From Submammary to Submuscular

It is not uncommon to change positions if you are deemed a candidate to do so per the condition of your current implants and pocket. There are some studies that report a lesser incidence of firm capsules with placement behind the pectoralis muscle. If you developed firm capsules and your implants were submammary (behind the breast tissue) then conversion to a #submuscular position should be considered. This #placement is particularly better for the very thin patient who has little breast or fat in the upper part of their chest. In most circumstances, those patients with #ptosis (#sagging) require placement above the muscle in a #submammary position or under the muscle combined with a mastopexy (breast lift) for #contour purposes. It's best to consult with a board certified plastic surgeon in person to better learn your options. 

Deciding on additional #elective cosmetic #surgery is a personal #choice. Your procedures should always be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery. You will then greatly improve your chances of getting the result you desire, and, without the need for a revision surgery. It is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

Implant exchange after breast augmentation


Thanks for posting your question. I am happy to try and help you. It is important to remember that a board certified plastic surgeon will be your best resource when it comes to an accurate assessment of your situation, and concerns.

Having said that, you should go see some plastic surgeons and pay for their recommendations. Online consultants are not the appropriate source of information for you; your plastic surgeon should be your resource when it comes to these types of complex situations. Your anatomy, previous breast history, surgeries, genetics, examination and wishes all play MAJOR roles in how to manage this type of revision surgery.

Asking surgeons who do not have access to all of the above information is not fair to us. We would be providing you a disservice by guessing. Having several surgeons 'guessing' will only lead to you being even more confused because they may be influencing you incorrectly because they only have parts of the equation. If they were given all of the equation their answers may dramatically change.

These are your breasts and should not be managed by guesses, educated guesses or not, they are still guesses. Please take the time to invest in your breasts and go see several plastic surgeons, give them the entire story and then, you will get terrific advice.

Best wishes,

Dr. Michael J. Brown
Northern Virginia Plastic Surgeon

Michael J. Brown, MD
Ashburn Plastic Surgeon
4.8 out of 5 stars 33 reviews

Breast revision

Under the muscle is better for rippling and switching from saline to silicone would help with rippling as well. Without seeing your breasts though it's hard to say what type of lift would be appropriate. 

David E. Kim, MD
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 97 reviews

Replacing saline implants placed above muscle.

With thin breast cover we would suggest placing the implant in a new submuscular pocket which will reduce any ripple or show through, and will reduce the risk of capsular contracture as well.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Replacing saline implants placed above muscle 12 years ago. Need to decide whether to stay above muscle or go under? 5'4,127 lb

Thank you for the question.  Although it is very difficult to give you precise advice without a person evaluation some general thoughts may be helpful to you. Generally, I would recommend re augmentation in the sub muscular position if at all possible. This is especially true for patients who have problems with breast implant rippling, palpability and/or encapsulation.

My best suggestion: see consultation with board-certified plastic surgeons who can demonstrate significant experience helping patients with these types of revisionary breast operations. Then, communicate your goals carefully. Working together, you will come up with the best plan to achieve an outcome that you will be pleased with.  You may find the attached link, dedicated to revisionary breast surgery concerns, helpful to you as you consider options.  Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Best plan for revision of above the muscle implants

There is no replacement for an in-person exam with a board-certified plastic surgeon to come up with the plan to help you safely achieve your goal. A site change procedure ( moving the implants to partly under the muscle) will provide better upper inner breast coverage and decrease the risk of recurrence of capsular contracture. A gel implant will also help whether a form stabile (gummy bear type) or cohesive gel can also decrease the rippling and feel ability of the implant in the lower outer breast. Whether other procedures will help such as fat grafting or breast lift will be determined by your plastic surgeon. 

I wish you well.

Dr. Edwards

Michael C. Edwards, MD, FACS
Las Vegas Plastic Surgeon
5.0 out of 5 stars 35 reviews

Under vs. over for revision

Hi.  While it's difficult to give you an exact answer without the benefit of an in-person examination, I'd recommend placing them behind the muscle to give you the benefit of extra padding in the cleavage area (reduced rippling) and also a lower chance of recurrent capsular contracture.  Gummy bear implants are also useful in these cases.

All the best,

Thomas Fiala, MD
Orlando Plastic Surgeon
4.9 out of 5 stars 79 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.