Is it worth switching from over the muscle to under? Was 34DD before my surgery but lost upper fullness due to weight loss.

Hi, I have 560cc over the muscle gel implants 3 years old. We opted for overs because I had breast tissue on the bottom. I'm scheduled to have them redone to go under the muscle to help them stay in place and to not have rippling. My concern is they will look smaller. I love the size they are but don't know how they'll look going under.Ugh I'm driving myself crazy! Has anyone dealt with this? I should add that I'm 5'8 and 150lbs, and I'm in the gym training 5 days a week.

Doctor Answers 4

Switching from sublandular to subpectoral.

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Thanks for your question however it's impossible to answer with accuracy without examining you in person.  I assume that you're troubled by dropout and rippling due to the size of the implants and thinness of your tissues.  Personally, I nearly always place implants in a partial subpectoral position to enhance coverage of the upper pole for a more natural result and better mammograms, but others disagree (especially when someone is a weight lifter).  I would expect that you may need an increase in size (if you're not in need of a skin reduction) to match your present subglandular implant size so do discuss this with your surgeon.  If your implants are saline (which tend to ripple more commonly) you may need to consider a change to a cohesive silicone gel implant (my preference is smooth round implants).    I do not feel that the muscle helps to avoid large implants dropping down since the lower half of your breast isn't covered by the muscle and there is no lifting effect when you're not contracting your pec muscle. When you do contract your pec muscle expect to see some degree of deformity of your breast but this shouldn't be visible at rest.Discuss all options carefully with your surgeon and good luck with your surgery.  Best.... Jon A Perlman MD FACS  Certified, American Board of Plastic Surgery  Extreme Makeover Surgeon ABC TV Best of Los Angeles Award 2015, 2016  Beverly Hills, Ca 

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 32 reviews

Breast Implant Revision/Breast Augmentation/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision Surgery

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I appreciate your question. The best way to determine implant size is based on chest wall measurements that fit your body.  Once we determine that we can choose the profile based on what you want or need to achieve.   Implants under the muscle, there is less risk of capsular contracture.  Anatomic implants tend to give a more natural shape with more nipple projection. The best way to assess and give true advice would be an in-person exam.  Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery. Best of luck! Dr. Schwartz Board Certified Plastic Surgeon Director-Beverly Hills Breast and Body Institute #RealSelf100Surgeon

Is it worth switching from over the muscle to under?

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Thank you for the question. Whether or not to convert from the sub glandular to sub muscular positioning, will require much more information; nothing will replace in-person evaluation and careful consideration of pros/cons associated with each option. Some general thoughts regarding the conversion may be helpful to you however:

Sometimes, patients undergoing conversion of breast implant positioning from the sub glandular to the sub muscular space benefit from additional maneuvers such as breast lifting (depending on the position of the breast skin envelope in relation to the position of the sub muscular breast implants) and/or the use of acellular dermal matrix for lower pole support. Closing off the existing breast implant pocket is a technique utilized to help prevent the breast implant from moving back into its previous space.
I hope this, and the attached link demonstrating many examples of revisionary breast surgery cases, helps. Best wishes.

Subglandular or Subpectoral (under breast or under muscle)?

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As mentioned by my colleagues, the answer to your question has many influencing factors. Typically in the United States, Board-certified Plastic Surgeons will opt for under the muscle placement or half/half (dual plane) technique for a number of reasons:1. Reduce the risk of capsular contracture - when the breast becomes very hard and unnatural because of scar formation around the implant2. Reduce rippling or being able to feel the implant3. Placement more secure than just under breast tissueIf you go to Europe or South America, you'll find that they generally prefer under the fascia or under the breast tissue. If you are very active at the gym, particularly if you do a lot of chest exercises, you may not love the result from under the muscle augmentation! Your chest muscles would cause the implants to move, something called animation deformity. Ask the surgeon you have about this! Usually they will have patients who are similar to you and would be happy to talk to you about their experience.As for fullness up top, that has much to do with the size of your breast and chest and the implant chosen. Gravity is no one's friend. You implants will eventually go south regardless of where they are placed, and if you continue to lose weight you may need a breast lift down the road. I hope this has been helpful! -Dr. Mills

Dan Mills, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 35 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.