4th revision - can one implant be placed in front of the muscle and leave the other behind?

Implants may look equally good when placed either above or below the muscle, but typically they do look different. If you will be putting one implant above the muscle, you will likely have better symmetry by putting the other above as well.

While it is technically possible to place breast implants in different positions (one in front of the muscle and the other behind), it is not a common or recommended practice. Breast augmentation is typically performed with both implants placed in a consistent position to achieve symmetry, balance, and optimal aesthetic results.

Placing implants in different positions can lead to noticeable asymmetry in the appearance, feel, and movement of the breasts. It may also increase the risk of complications, including an uneven implant pocket, differences in how the implants settle over time, and potential distortion of breast shape.

In most breast augmentation surgeries, the choice of implant placement—either submuscular (behind the chest muscle) or subglandular (in front of the chest muscle)—is made based on various factors, including the patient's anatomy, breast tissue characteristics, and the surgeon's preferences.

If you have concerns about breast asymmetry or are considering breast augmentation, it's crucial to discuss your goals and expectations with a board-certified plastic surgeon. They will assess your unique anatomy, discuss the most appropriate implant placement for your situation, and provide recommendations to achieve the desired outcome. Consistent implant placement is a key element in achieving natural-looking and symmetrical results in breast augmentation

In my opinion, it is always best to have both implants in the same position. Placing an implant in a sub glandular pocket won't prevent it from dropping.

Thank you for your question. A large portion of my practice is dedicated to breast revision surgery. Without seeing your picture, it is very difficult to understand what is going on. In over 28 years in practice, I have never had to relocate an implant on top of the muscle wall leaving the other one under the muscle. There are very few breasts that I have not been able to fix. Best wishes to you.

Placing one implant in front of the muscle and keeping the opposite behind the muscle will most likely result in an asymmetrical appearance. You are better off having both implants behind the muscle.

Best Wishes,

Gary Horndeski, M.D.

Although we surgeons hate to move implants that look great, you will be more symmetrical with both in front of the muscle. However, please discuss this with your surgeon for she has seen what you look like, and I have not.

I would get another opinion from another plastic surgeon who does a lot of secondary breast surgery. At least post some photos

I think it’s time to get a proper second opinion.
The type of revision surgery you are referring to is pump, legs and difficult. If your provider doesn’t have the skill and experience to do this kind of work, then you should have been referred to someone who has more skill and experience.
If your doctor doesn’t realize she is over her head then you will have to take responsibility for the situation yourself.
Finding the right provider is not always easy or straightforward. It usually requires scheduling multiple consultations.
For a second opinion consultation, I’m prepared, bringing with you a complete set of before, and after pictures and operative report for each of your previous operations.
Look for plastic surgeons who have extensive breast augmentation experience in your community.
I don’t know the plastic surgery community in Vancouver, but in Southern California providers like Tom Pousti MD serve as the gold standard for breast augmentation surgery, including complex revision surgery.
I suggest getting some second opinion consultations before you get to the point of completely failing breast augmentation.
The following are some general guidelines for finding the right provider.
To find the best provider, I suggest patient schedule multiple in person consultations with experienced plastic surgeons in their community. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who have similar body or facial characteristics to your own. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. An experienced provider should in fact have hundreds or preferably thousands of before and after pictures to choose from for commonly performed procedures.
Being shown a handful of preselected images, representing the best results of a provider’s career is insufficient to get a clear understanding of what average results will look like in the hands of each provider.
There is no correct number of consultations needed to find the best provider. The more consultations you scheduled the more likely you are to find the best provider for your needs.
Take careful notes during each consultation, especially regarding the quantity and quality of before and after pictures. It’s not a bad idea to bring pictures of your own body/face to use as reference when reviewing before and after pictures.
The biggest mistake patients make is scheduling only one consultation without properly vetting or comparing providers before scheduling surgery.
Best,
Mats Hagstrom, MD