Submuscular to over the Muscle ?

I currently have 450cc gel shaped implants, I had 300 cc round sailine before. it gave me nipples that look like they are projecting outwards. i tried to fix it and have higher nipples also but again it looks the same. It's been about a month I know it's early, but I find they look like my old breast implants. I'm really not happy, I am wondering if maybe over the muscle is a better option for me.

Doctor Answers 9

Nipple position after breast implants

The nipple position is a set point on your body.  The position of the implant will not change your nipple position.  The large implants will naturally settle down and outward based on gravity.Also, on top of the muscle will tend to streach out the skin even faster.

San Francisco Plastic Surgeon
4.8 out of 5 stars 76 reviews

Submuscular or Subglandular Position for Breast Augmentation?

I agree, it is difficult to answer your question regarding your result without comparing before and after photos 3-6 months after surgery.  At one month, there is significant amount of swelling.  From what I can see, the result is certainly not unusual at your stage of recovery.

I prefer sub-muscular placement of breast implants for several reasons.  First, with 1 out of 7 women developing breast cancer, the sub-muscular placement provides better imaging during mammography.  Second, if an implant is placed above the muscle, a textured implant should be used to minimize risk of capsular contracture.  A textured implant, however, has a higher risk of rippling.

Most plastic surgeons prefer smooth, round implants placed under the muscle.

Michael A. Jazayeri, MD
Santa Ana Plastic Surgeon
4.7 out of 5 stars 13 reviews

Over vs under

This is always a debate.with silicone you have more options.perhaps over the muscle and a slightly smaller implant would be in order.I always look at the breast as a balloon the more air ie the bigger the implant the firmer and more unnatural the breast feels.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 64 reviews

Implant position

I would keep the implants under the muscle. As  to your final result it is very hard to comment without having side by side photos to compare from before your surgeyr.  Remember no two breasts are exactly the same.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Silicone Gel Breast Implants and Nipple Position

Dear MayB,

Very few results are truly perfect, as much as one might want that.  In general, your final result depends on what you look like before, the surgery that is done, and the way you heal.

First of all, I think you have a very nice result.  I understand your concerns and how you feel, but from an objective standpoint, I think you can be comfortable with that result overall.

Secondly, nipple position is almost impossible to change without some sort of a lift or surgical repositioning, both of which will result in more scars around the areola.  Niether is justified for you (you don't have problems that can be fixed with those procedures) and the risks of additional and notiiceable scarring are too high.

In my experience, most of the time that patients have nipples that are somewhat outward facing after implants - they had that anatomy, more or less, before the surgery.  The only way around that would be to place the implants farther apart - and then there are other problems.  For the implant size you have, on the frame you have, I think you have a good surgical outcome.  And switching the implant to above the muscle will not only fail to address the nipple issue, but will cause other problems, including being more likely to see and feel the edges of the implants at the edges of the breasts.  I would advise you not to do that.

In sum, and even with the undertstanding that this is not what you want to hear, I think you have a very good result, and I would urge you just to try to be happy with what you have, and not to have more surgery that risks, in my opinion, undoing a lot of good work.

I hope that this helps, and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 125 reviews

Breast implant revision surgery

Changing the location (pocket) of your breast implants will not have a significant effect on the overall appearance of your breasts in your case.  Based on your photos, your nipples appear to located slightly more laterally (toward the side). This is most likely due to your natural anatomy, and implants can not change this very much.

Please consult with a board certified plastic surgeon prior to considering any further revision surgery.

Best wishes,

Dr. Bruno

William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 376 reviews

Revision augmentation

I agree that the nipple position is lateral but I am not sure that changing the position of the implants will reliably improve this.

Jeff Scott, MD
Everett Plastic Surgeon
5.0 out of 5 stars 10 reviews

Going from submuscular to subglandular

Changing your implant location is unlikely to improve the appearance and may accelerate sagging. While your result may not be exactly what you want, revisional breast surgery comes with it's own set of risks....

Marcel Daniels, MD
Long Beach Plastic Surgeon
4.8 out of 5 stars 23 reviews

Nipple position......

I would not recommend changing from under the muscle to over. This will not move your nipples more medially. You currently have a beautiful result! Give it time. Hopefully you will agree as time goes by and you get used to them. Revision may only cause problems.

Daniel P. Markmann, MD
Baltimore Plastic Surgeon
4.9 out of 5 stars 114 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.