Need to Switch Placement During Breast Implant Replacement?

I had silicone implants removed after 13 years and one had ruptured but the silicone was held in by the capsule formation. I replaced them with saline ones over the muscle and after 10 years one has ruptured. Is it time to go under the muscle? I am small with very little tissue but have feared cutting muscle and changing it for life. I am awaiting an appt with a plastic surgeon.

Doctor Answers 12

Need to switch implants

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This is a difficult question to answer without seeing you, but you describe yourself as having very little tissue. I am surprised that you didn't have a great deal of rippling or wrinkling with saline over the muscle.

I think you can do them either way with silicone. A ruptured saline implant should have no affect on the pocket although you may need a capsulotomy.

If you were my patient unless you had a specific reason to go under the muscle, I would try to put them submuscular (subpectoral) and if there was too much scarring then place them subglandular. The implant - saline or silicone - is of course your choice.

Switching Implants

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If you have a ruptured implants, then it is advised to have the implant removed and/or switched for new implants. In tertiary cases, it is also advisable to place the implants under the muscle to ensure that there is adequate tissue coverage of the implants. I hope this is helpful. Good luck with your procedure.

Over or under the muscle augmentation

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The rupture issue has little to do with the placement of the implants. It is a risk intrinsic to the implants themselves. Whether you have the implants over or under the muscle is a very individual question that has many variable that you should review with your surgeon. There is no right answer.

What you will need to do is prioritize the characteristics, side effects, and future risks of your surgery and breast augmentation and determine whether putting them over or under the muscle satisfies most of these priorities since these techniques make for quite different results.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Need to Switch Placement During Breast Implant Replacement?

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I generally prefer implants placed under the muscle especially in thin patients. I elieve this creates the most natrural looking breast.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Implants under the chest muscle

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Hi there-

It sounds like the only problems you have experienced in the past with your implants have been related to implant rupture- an inevitability that all women with implants should expect sooner or later...

If you were otherwise pleased with the implants, there is no compelling reason to relocate them to a new pocket under your chest muscle-

However... There can be no question that there are benefits to the patient of having the implants placed under the muscle. How great and relevant these benefits would be in your particular situation would be impossible to understand without a consultation and examination.

Your Board Certified Plastic Surgeon will be better able to answer these questions for you after your visit.

Good luck!

Split muscle technique avoids cutting muscle with implants under

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Although every case is different, in general I would recommend that the new implants go under the muscle. However, the traditional technique does require cutting the muscle off of it's attachment on the reibs which can cause things like animation deformities. Another option is the split muscle technique, which preserves all of the muscle attachments and function, but still allows the upper portion to go under where it is most helpful. It's one of the techniques used for athletic women who need some coverage but want to avoind problems with the muscle.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Over or Under the Muscle the Third Time Around

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The KEY to natural appearing augmented breasts is to get as much tissue as possible on top of the implants. Failure to do so ALWAYS results in the visibility and palpability of the implant shell and its folds.

As a result, the Under the muscle position is better for most women but is absolutely ESSENTIAL in smaller women and women with little breast tissue. In your case, unless absolutely impossible, I would try and place your implants UNDER the muscle before looking anywhere else.

Peter A. Aldea, MD
Memphis Plastic Surgeon

Switching pockets when switching implants

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While I always go under the muscle for first time patients, if your implants were above the muscle and if there was no problem with capsular contracture, it is reasonable to stay above the muscle especially if your tissue coverage of the implant is adequate. Otherwise, it is best to convert to below the muscle.

No need to switch position of breast implants if they looked good.

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If your saline breast implants over the muscle looked good for years, there is no reason to create new implant pockets under the muscle. Much more surgery.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Implant exchange and placement switch

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If you are having problems with your implants that are above the muscle, such as from rippling or significant palpability, then you might conside going under the muscle.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.