Implant replacement - over or under muscle? 400cc Allergan TSF over the muscle implants placed 9 years ago.

I would not consider and over the muscle placement: you are thin, and there Woukd not be optimal tissue coverage. You woukd need a breast lift and precise pocket dissection. Without a lift you will inevitably get a recurrence of the waterfall deformity

Dear blondie2021,
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

At this time, I recommend explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Hi there,
I would recommend moving the implants under your muscle. This will add a layer of tissue above the implant and essentially remove all rippling and make the breast feel and look more natural.
I would not consider above the muscle in your case as it will likely continue to ripple over time, if the MD said they never do under the muscle I would question their training more and be sure they are an actual board certified plastic surgeon.
All the best

With small amount of natural breast tissue, I suggest placing the implants behind the muscle for better coverage of the implant, better upper breast fullness, and better support of the implant with less implant sagging in the future. The lift will reposition your breast tissue and remove excess skin. Do not go larger but consider going smaller because your tissue has been stretched with pregnancy and will not support heavy implants well.

Are you planning on having a breast lift?
At this point, you don’t have sufficient soft tissue envelope to cover the implant.
This is in due part to previous decisions of placing the implant above the muscle.
If you’re talking to surgeons that can’t offer sub, pectoral augmentation, then you’re probably talking to the wrong surgeons.
You’re going to have to find the most experienced breast surgeon in your community, and this may take having a few more consultations.
A sub pectoral conversion with a breast lift is most likely your best option.
This is not an easy procedure.
Best,
Mats Hagstrom, MD