I have over the muscle implants. Should I replace and keep implants over? (photos)

I had C breast with slight sag before. I have had over the muscle implants for 13yrs. I've had 2 kids since then and massive weight gain. They sag, are heavy and one is bigger then the other. I am having a lift with silicone implant and a tummy tuck. I've been to numerous consultations and the doctor I liked the most is recommending to keep them over. Due to flipping, shading and less complications. He said if I place under the muscle they won't stay. I'm confused??

Doctor Answers 8

Explant with Ultimate Breast Lift™ and Abdominoplasty with Mesh Reinforcement

If you were a C, had sagging and have massive weight gain, it is most likely you would benefit from removal of the implants and a lift.The advantage of explant is you will not have implant complications such as capsular contracture, leakage or descent.I recommend a new technique called Explant with Ultimate Breast Lift™.The breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.Aligning the areola and breast tissue over the bony prominence of the chest wall maximizes anterior projection without the use of implants.The abdominoplasty will give you a more hourglass figure making your breasts look larger.For the abdomen, I recommend Abdominoplasty with Mesh Reinforcement, which will increase the mechanical strength of the abdominal wall resulting in early satiety, weight loss and maintains the reduced weight.


Best Wishes,

Gary Horndeski, M.D.


Texas Plastic Surgeon
4.7 out of 5 stars 209 reviews

Same plane or not?

Hi.  If, for example, you had capsular contracture, or rippling - then I would certainly switch them to being behind the muscle.  Otherwise, I think it's reasonable to leave the implants in the current subglandular position.

Implants In Front vs Behind the Muscle

I agree with your doctor's advice.  You have tolerated the subglandular position for 13 years.  There is little to gain from repositioning your implants.  And, because of the laxity of your pocket, the implants are likely to slip out from under the muscles.  Best of luck

Gilbert Lee, MD
San Diego Plastic Surgeon
4.8 out of 5 stars 22 reviews

I have over the muscle implants. Should I replace and keep implants over?

   The plan seems reasonable based upon your anatomy, description, and pictures.

Kenneth Hughes, MD

Los Angeles, CA

I have over the muscle implants. Should I replace and keep implants over?

If you have tolerated the subglandular implants for 13 years with no problem, I see no reason for changing to the submuscular position.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Under or over muscle with implant exchange and lift

In general, implants under the muscle are less likely to develop capsular contracture, and treatment of CC often means plane change (i.e., over to under.) However, if you don't have contractures now, and there seems to be adequate coverage without visible ripples, it makes sense to keep them over especially when combined with a lift.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 47 reviews

I'm having a breast lift; should I continue to have the new implants on top of the muscle?

You have a pretty smart doctor. On the one hand, I always like to put implants under the muscle when I do lifts. On the other hand, given your 13 year history of implants being on top of the muscle (which thins out the pectoralis muscle), the fact that you have rather large implants (which probably wont stay under an a thin pectoralis muscle), some degree of capsule contracture (Baker 3, which mandates some degree of capsulectomy), and a larger right breast which will require a modest reduction, I would say that your best bet is going to be to have your new implants (hopefully textured) on top of your pectoralis muscle.
  
  Best wishes.

Stephen W. Gordon, MD
Las Vegas Plastic Surgeon
4.3 out of 5 stars 11 reviews

Reasons to stay over or go under with implants

If you have implants on top of the muscle (overs) and are not experiencing:
  • capsule contracture
  • rippling
  • implant visibility
There is no real reason to have the implants placed under the muscle.

All the best,

Dr. Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 154 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.