Are over the Muscle Breast Implants Really As Risky As I've Been Reading About? (photo)

I posted not long ago regarding the disappointment with my size following my recent breast aug & the possibility of having 'Double Bubble'.After a follow-up with my PS it turns out that I do have 'DB' & have booked my revision for the 12th Dec.I currently have 400cc,silicone,dual-plane & am exchanging them for 525cc,silicone,overs.Now,after much research,I'm having serious doubts about overs mainly due to capsular contraction.Are overs really so risky?I'm 5"6,128lbs,Dr says I have enough tissue.

Doctor Answers 12

Are over the Muscle Breast Implants Really As Risky As I've Been Reading About? (photo)

Only can say it should be no issue, but even with photos nopt 100% sure. Best to obtain a few in person second opinions. 

Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Breast Implants Over the Muscle?

Thank you for the question and pictures.

Frankly, I think you are asking for trouble if you have your implants replaced above the muscle. You're much more likely to end up with rippling/ palpability  of implants,  higher risk for encapsulation  and interference with mammography.

Of course, there are different ways to approach revision breast surgery.  In your case, I would opt for keeping your implants in the same plane by fixing the pockets by performing capsulorrhaphy ( permanent suture repair).

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,498 reviews

Capsular Contracture in any breast pocket

There are major differeces between over and under the muscle.   The contracture rate is slighly higher, more streching of the skin over time, and less of a natural look unless you have a good amount of breast tissue.

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 76 reviews

Repairing a "double bubble" after breast augmenation

The solution to your problem should be in the analysis of the current situation. The implant has fallen below the tighter, normal anatomic region known as the inframammary fold (breast crease).  This leads to a visible crease where this fold was, and at the bottom of the existing implant, creating a double bubble. Switching location of the implant to above the muscle doesn't address the issue of the double fold. However, restoring the fold to its appropriate anatomic position will fix the crease component of your issue. Often, if the crease is higher than normal, a smaller, not larger, implant can be helpful.

Best of luck,

Vincent Marin, MD
San Diego Plastic Surgeon

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 47 reviews

Over the muscle breast implant exchange not needed

Exchanging your implants for a larger size and placing the implants in a subglandular plane will probably make your results worse. I would recommend a repair of your inframammary fold or a procket revision to allow your implants to fall on a normal plane, thus alleviating the double bubble.

Donna Rich, MD
Webster Plastic Surgeon
4.5 out of 5 stars 33 reviews

Should I have my breast implant above or below the muscle?

I personally do not place breast implants above the muscle for three reasons.

Reason one, and the most important one, is the potential interference with mammography more than below the muscle placement.  Since one out of every seven female in this country will develop breast cancer, why make the screening process more difficult?

If the implant is placed above the muscle, the risk of capsular contracture increases.  A textured (rough surface) implant will decrease the risk, but will significantly increase the chance of rippling.

Unless you have a great amount of breast tissue, placing the implant above the muscle will also increase the chance of palpability and visibility.

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

Bigger implants will cause more problems

You already have problem with the implants and to adding more volume will make the surgery for the revision more complicated. Your surgeon need to to repair the pocket and add more volume will stress the repair. Please do not make the situation more complicated. The solution is not above the muscle and bigger implant will cause even more problems down the road.The cause of the DB is disruption of the infra-mammary fold attachments and it should be repaired.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 124 reviews

Over vs. under the muscle for breast implants

Without an examination and evaluation of your preoperative photographs I cannot give you a definitive answer, but I will share a few thoughts based on your photographs and proposed plan.  You do indeed have some degree of "double bubble."  There may be a number of reasons for this, but my primary concerns are inferior migration of the implants and your preoperative breast diameter.  I cannot tell without seeing your preoperative photographs, but I imagine that your breasts were somewhat 'constricted' or narrow prior to surgery.  Narrow or constricted breasts increase the risk for a double bubble because of a mismatch in the diameter of your breasts to the diameter of the implants.  In addition, your incision appears a little low which might make it difficult to 'reef' or tighten up the lower poles of your breast with a capsulorrhaphy without having the scar end up beneath the new inframmary fold.

Moving the implant to a sub glandular position is unlikely to help the situation.  Increasing the size of the implant, in my opinion, is likely to worsen the problem.  I would strongly recommend that you go back in for another consultation with your plastic surgeon to discuss all your possible options.  Good luck.

Eric T. Emerson, MD, FACS
Charlotte Plastic Surgeon
4.7 out of 5 stars 28 reviews

Another opinion on over muscle implants

There are a number of things to consider with going from under to over the muscle with implants. First, the reason that it corrects double bubble is because the pectoral muscle is pulling on the capsule where you see the groove across the lower part of the breast, so it isn't typically the original fold as is usually stated.(You can tell if you see it pulling up there when you flex.) The real issue in my view is not coverage but lack of support long term for large implants. Capsular contracture is more likely with subglandular vs submuscular but it should still be uncommon. Check out 2 other options just so you have a more complete understanding: subfascial and split muscle. A third option is a Strattice internal bra which would add support and correct the double bubble but that is expensive.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 53 reviews

Risks of above muscle breast augments

Your new implants will be sufficiently larger than the current ones so as to create the possibility of sagging postoperatively if they are placed over the muscle. I would not categorize implantation above the muscle as "risky" in that it is a more easily tolerated procedure than the sub muscular approach. I would, however, not recommend it for patients who have already undergone submuscular implantation.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 42 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.