Switching Breast Implants from Submuscular to Subglandular

Question

I got submuscular saline implants 5 years ago. Every time i tense up my breasts move/flex. I do not like it at all, i would also like them to be softer. When i got my saline implants i went from an A-cup to a D-cup. I now want to switch to Silicone implants. I am also condidering switching to Subglandular silicone, so they won't flex and to get a more natural feel. Can i switch from submuscular too subglandular, if not how can the flex problem be fixed???

Larry S. Nichter, MD, MS, FACS · Answer

Saline and Silicone, Safety and PerformanceWomen have so far had essentially just two breast implant fill choices: saline or silicone.Silicone implants have distinct advantages over saline implants in terms of performance: they wrinkle less and conform to a more natural breast shape, and also have a softer feel that is more breast-like. However, silicone implants have gained a reputation—possibly undeserved—for being less safe than saline implants. Despite the fact that there is no known toxicity of silicone gel breast implants, the possibility of a “silent rupture,” undetectable except by MRI, has been enough to make many women opt for saline implants or wait for a better product to come along. The time will be here most likely within a year or so with the advent of the Ideal Implant, the name given to a new design saline hybrid implant. It has the natural feel of silicone and safety of saline.The Ideal Implant has bothThe Ideal Implant is one of the major technological advances to come along in the past few decades in implant manufacture. Using a novel design with internal baffles, the saline implant is manufactured to achieve a similar feel and performance comparable to a silicone implant. Approximately 95% of both patients and their surgeons expressed satisfaction at the current two-year data point by the FDA. The Ideal Breast Implant is now FDA approved and soon to be released in the US market, hopefully with in the year.

Matthew Schulman, MD · Answer

Placing breast implants below the chest muscles help to camouflage the implants, giving a more natural appearance. It also helps to reduce in the risk of infection and capsular contracture. Somethimes, though, contraction of the pectoralis muscle can make the implant move. This is called an "animation deformity". Changing the implant to a subglandular (above the muscle) position will eliminate this. However, this will also make the implant more visible so using a silicone implant is a good idea because it tends to show less rippling than its saline counterpart.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Generally, it is possible to remove implants from the sub muscular position and replace them in the subglandular  position  depending on the specific patient's anatomy/situation.  You will need to be evaluated in person by a well experienced plastic surgeon to see if this would work for you.

	Having said that,  you should be aware that there are many potential downsides of breast implants placed in the sub glandular position. These downsides should be weighed against the current issues you are experiencing.

	Although breast implants in the sub muscular ( or dual plane)  position may experience &ldquo;distortion&rdquo; with muscle movement (workout) I still think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the &ldquo;dual plane&rdquo; sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).

	The submuscular positioning  also tends to interfere with mammography less so than in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.

	I hope this helps.

Shahin Javaheri, MD · Answer

This is possibly a complicated situation. It will necessary to examine you, or at least photos, before giving any reasonable advice. There could be consequences with switching from a sub-pectoral position to a subglandular one. There are lots of issues that need to be covered.

Darryl J. Blinski, MD · Answer

Sure you can ask for relocation of the new silicones from your surgeon of choice. I have done this many times with very satisfactory results.

Robin T.W. Yuan, MD · Answer

Breast augmentation with implants is an imperfect operation. Your surgeon should review all the pros and cons of each type of technique and category of implant. He should review what the ideal implant might be for each situation. Thus may not coincide with the result you want so compromises or potential complication and side effects must be accepted by you. Robin T. W. Yuan, M.D.

Peter E. Johnson, MD · Answer

Implants placed under the muscle do have advantages, such as lower capsular contracture rates, and less thinning and show of the upper edge which can be quite important for a saline breast implant. The trade off is movement of the implant with muscle motion, which can be quite a bother to some. You can change to a subglandular silicone gel implant without difficulty. We suggest a lower profile implant to minimize the upper edge and prevent an over rounded look.

	Best of luck,

	peterejohnsonmd

Kamran Khoobehi, MD · Answer

The implant position change is a complex procedure and should be limited to the special conditions. The main reason in your case is the implant movement with pectorals contraction. Switching the pocket will help, but you may get more sagging, more rippling and more palpable implants. Please get more than one consultation and also your problem may be fixed by pocket revision. Pictures with relaxed and contracted muscle can help us to give you better answer.

Robert M. Grenley, MD (retired) · Answer

There is no perfect position for breast implants. Subpectoral implants have better camouflage with thicker tissue (because of the muscle) covering the upper edge to make it less visible and to reduce the risk of visible wrinkling in a patient with thinner tissue. They may also have a lower risk of capsular contracture. Unfortunately, contractions of the muscle cause some distortion of the implant, and the severity of this varies from patient to patient. Placing the implants above the muscle (subglandular) avoids this muscle distortion, but in a patient with thinner tissue the upper edge and wrinkling can be an issue. This is more of a problem with saline implants, but can also be an issue for silicone gel implants if the patient's tissues are thin enough. There is currently no great solution for leaving the implants under the muscle and minimizing the muscle contraction effect, although perhaps placing $3000-6000 pieces of Strattice between the muscle and overlying breast tissue may be an expensive option to try, although there is no guarantee that this would work.

Switching Breast Implants from Submuscular to Subglandular

Answers (9)

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