What Are the Complications I Could Have Moving my Existing Implants from the Subglandular to Submuscular?

The biggest complication is having a full lift.  This technique frequently results in ugly vertical scars, which cannot be hidden, nipple numbness and the inability to breast feed.  For that reason, there is a new technique that has been developed called the Ultimate Breast Lift.  This technique avoids the ugly vertical scars, reshapes your breast tissue creating upper pole fullness, elevates them higher on the chest wall and more medial to increase your cleavage.  This technique maintains nipple sensation, the ability to breast feed and is stable long term by transferring the weight of the breast to the underlying muscle.  At the same time, your implants can be removed or replaced with submuscular implants if desired.  Unfortunately, you have not told us your bra size or provided any photographs.  However, you may be a candidate for this new technique.



Best Wishes,

 

Gary Horndeski, M.D.

I don't see the problem moving implants from sub glandular to sub pectoral. There should however be a good reason to do it. The surgeon who proposes that switch should give you good reasons why sub muscular position is better for you than sub glandular.

Changing from subglandular to submuscular is commonly done, and the subglandular pocket is closed off to prevent the implants from going back above the muscle.  If the lift is done without getting into breast tissue, then the vascularity of the skin and nipple should be OK, but this is the major risk, since the thinned out skin and breast tissue can lose vascularity with incisions into the breast tissue.

If the subglandular pocket is completely closed off, there should not be a problem of the implant flipping or looking odd.

     The pockets are sealed and the flipping will not occur.  Going submuscular will create a more durable result with greater implant camouflage.  I think that you can have silicone implants placed under the muscle with a lift.  I perform breast augmentation and breast lift at the same time, and I do this several times a week.  For the lift,  I typically start with the smallest incision and custom tailor each breast lift to the shortest scar possible. Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast lifts each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD Los Angeles, CA

Switching the implants from above to below the muscle is possible but not always necessary.  It's really a matter of opinion from the individual surgeon.  I would concentrate more on the skill and experience of the individual surgeon.  For this type of surgery, selection of the right surgeon is the number one consideration.  If you have capsular contracture, however, I would favor placing the new implants under the muscle.

Risks for problems certainly are there and as mentioned, the breast tissue will have to be anchored to the muscle to eliminate that pocket so the new implant under the muscle will not try to migrate into the old pocket.  But anchoring the breast tissue doesn't always produce the desired result and sometimes staying above the muscle is necessary.  As for the lift, your original incision may limit the options but if your incision was at the nipple, the lower pole tissue could be 'skinned' and buried in the old pocket to provide more fullness on top.  And if you're really worried about what to do with the drooping tissue, you could also remove it and increase your implant volume to make up for the excised tissue, understanding when you eventually have them taken out, that your native volume will be less.

A general premise in breast augmentation is that if there is a problem with one pocket, changing to a different pocket is the safest way to avoid recurrence of the problem. In other words, that surgery is common.

There is one setting where changing from the subglandular to the submuscular pocket is ill-advised. That is when the implant originally placed was put in the subglandular space to avoid having to do a lift.  If a lift is planned, switching pockets to the submuscular plane is absolutely reasonable.  Some surgeons suggest replacing the implants and then waiting 3-6 months before doing a lift.  That is very rarely necessary. Most comfortably do both procedures at the same time.

Finally, make sure you find a good, board certified plastic surgeon with whom you feel comfortable. 

Best of Luck

Dr. Jeremy Pyle

It is a relatively routine procedure converting from a subglandular to the submuscular position. The problems are that the subglandular pocket has to be closed down to prevent the implant from flipping back into the subglandular space.  This can be done with suturing and a drain.  The bigger problem is with the breast lift.  If the breast skin has been stretched and thinned then great care must be taken to avoid devascularization of the skin flaps and nipple areas.  In some cases it is recommended that the implant be removed first and then 3 - 6 months later a re-augmentation and breast lift can be performed.  

Placing the implant under the muscle is fine especially if the original is visible in the subglandular plane.

Thank you for the question.  Generally speaking, all of the potential complications associated with revisionary breast surgery are relevant in your case.  However, there also some specific issues that you should be aware of.

 In my practice, when patients undergo a conversion of a sub glandular breast  implant position to the sub muscular position, the space where your current breast implants sit would be closed off preventing the breast implants from slipping into  the previous pocket.  If this maneuver is not carried out then the breast implants can “slip/turn”.

 Once the breast implants have been placed in the sub muscular ( usually dual plane) position, then careful 'redraping"  of the overlying tissues is important. Often, tailor attacking techniques are helpful during this portion of the procedure ( breast lifting).

 These types of operations are not the  most simple breast operations performed; it will be important for you to select your plastic surgeon carefully. Ask to see lots of examples of his/her work helping patients in your situation.

  I hope this, and the attached link, helps.