Going from subglandular to submuscular -- is it possible? (Photo)

Question

36, 140lbs, 480cc in 2017, Going from subglandular to submuscular - is it possible? I got a silicone subglandular breast aug (480cc) in 2017 and have noticed a lot of rippling lately. Could be weightloss but also age. I’m now 36, 140#. What are my options for getting this resolved, as I know my skin tissue will continue to thin with time? Is it possible to go submuscular with a revision or is my skin too loose now? Curious for anyone’s recommendation.

Joel Patrick Maier, MD · Answer

Submuscular conversion will LESSEN the rippling on the inner aspect of the breast, but not totally get rid of it. However, the outer-lower aspect will not be covered by muscle so you will still see rippling without change. Unfortunately, rippling is a limitation of the devices we have available today. To completely avoid rippling, fat grafting is the best option. Thank you.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.A large portion my practice is dedicated to revisionary breast surgery.  I have been in practice for almost 30 years. Generally, the only way to get rid of wrinkling in the center is to reposition the implants in the subpectoral location.  I wrote one of the only papers on how to do this.  You would also need to have a lift at the same time.  You are an excellent candidate for this.  Best wishes to you.

Daniel Butz, MD · Answer

Thanks for your question. 
You certainly could go to a sub muscular or dual plane pocket. However I might recommend switching to a more cohesive implant that will have less rippling and or adding a small amount of fat grafting to help camouflage the implants. 
Pros and cons to both. Seek out a couple in person consultation to get the best options for you.

Sean Fisher, MD · Answer

The photo quality makes it difficult to say definitively what would be needed surgically. Generally speaking, yes it is entirely possible to go from a subglandular to submuscular plane. Often times when I perform a pocket switch I will use an absorbable mesh (internal bra) to help support the implant laterally and control the newly created pocket. Any decision about adding a lift with the breast augmentation would depend on a more detailed assessment of your anatomy and whether your goal is to keep similarly sized implants.
Sean Fisher Aesthetic Plastic Surgeon

Connie Hiers, MD, FACS · Answer

A full frontal view with you standing would have been very helpful. However, you can get good improvement placing the implants behind the muscle for better coverage. I do not recommend going larger.

Kenneth R. Francis, MD, FACS · Answer

Dear pacificnorthwesterngal,
Rippling of breast implants continues to plague the breast augmentation world.  There are newer generation "overfilled" silicone gel breast implants designed to minimize the problem, but long term effectiveness is yet to be seen.  If you choose those, you may be able to stay with your above muscle position.  Another option is to place the implants under the muscle for an extra layer of tissue cover.  Good luck!

Mats Hagstrom, MD (license on probation) · Answer

A sub muscular conversion can be done. 
There are a lot of variables to take into consideration.
The size of the implant and the shape of the breast can have some impact.
The overall size of the prior pocket needs to be taken into consideration.
 I generally recommend sub muscular conversions as the preferred primary procedure 
Conversion is definitely a bit tricky and potentially unpredictable.
Best,
Mats Hagstrom MD

Going from subglandular to submuscular -- is it possible? (Photo)

Answers (7)

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