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

Question

400cc Allergan TSF over the muscle implants placed 9 years ago. Following 2 pregnancies and breastfeeding, I have waterfall deformity, palpable implants / rippling + sagging. I know I will need a lift & if I do not replace the implants I would be left with an A possibly B cup. I am currently a 30FF - mostly implant and saggy post partum skin! I have had a few consultations, 1 said under muscle due to lack of tissue, 2 said over (she doesn't place sub muscular!). What should I do?

Thomas A. Mustoe, MD, FACS · Answer

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

Daniel Barrett, MD · Answer

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

Gary M. Horndeski, MD · Answer

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.

Connie Hiers, MD, FACS · Answer

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.

Tyler Frew, MD · Answer

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

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

Answers (6)

Answer: Implants

Answer: Implants

Answer: For you- under the muscle

Answer: For you- under the muscle

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Everything you need to know about Breast Implant Revision

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

Answers (6)

Answer: Implants

Answer: Implants

Answer: For you- under the muscle

Answer: For you- under the muscle

Browse related questions

Recommended reading

Everything you need to know about Breast Implant Revision

Our mission is to create a world where every investment in modern beauty is Worth It.