Why Go Under when Current Saline Implants Are Over? (photo)

5'6" 160lbs current 300 cc considering smaller and silicone and lift

Doctor Answers 11

Under better than over

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The best implants are silicone gel placed retro-pectoral since they look and feel more natural and are less likely to ripple.  If you are dissatisfied with your current 300 cc implants then smaller implants are necessary.  However, you do have asymmetry with your right breast appearing larger than the left.  You are an excellent candidate for a new technique called Implant Exchange with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to remove the old implants, place the new implants, reshape your breast creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage.  Aligning the areola, breast tissue and implant over the bony prominence of the chest wall will give maximum anterior projection with a minimal size implant.

Best Wishes,

Gary Horndeski, M.D.

Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews


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i agree, especially since the newer gummy bear implants are readily available and there is significantly less rippling with these

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon

Why Go Under when Current Saline Implants Are Over?

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     At the very least, going under the muscle creates more camouflage for the implant and decreases the chance of rippling.  However, maintaining the pocket would certainly be easier for the surgeon.  Kenneth Hughes, MD Los Angeles, CA

Changing Breast Implant Pockets during Revisionary Breast Surgery?

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Thank you for the question and picture. Generally speaking, if  a patient is pleased with the appearance, feel, position etc. of the existing breast implant, there is likely no need to increase the complexity  and risks associated with revisionary breast surgery by changing the breast implant pockets I. 

 I hope this helps.

Placing implants above or below the muscle is multi-factorial.

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In your situation if you had no difficulties with your implants above the muscle I don't know why they could not return there. If your surgeon disagrees with this ask him why.

Changing from Over to Under

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The decision about breast implants and pocket position (over or under the muscle ) is quite complex. It is even more complex in a revision situation like yours. There is no way to have an appropriate conversation about this without a full evaluation by a board certified plastic surgeon. He or she should be able to answer all your questions.

Why go under?

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The procedure can be performed either way.  Given the degree of asymmetry and unilateral ptosis, your plastic surgeon may believe that he can achieve better symmetry by going under the muscle, particularly if the ptotic breast has loose skin.  This could only be determined by a physical exam.  I don't think we should rush to judgment about the proposal for implantation under the muscle with the limited information provided.

Implant site change

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In your particular case there does not seem to be any real reason for a site change.  If there are specific questions you have you should ask your plastic surgeon to explain his rational in changing the site.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Why go under if present implant is over

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If there is no problem with the present pocket, and the change is for a smaller size, there may be little reaon to change to an under the muscle pocket. Submuscular implants are so because of thin breast cover, and capsules. If you have no problems then the same pocket should be fine.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

No reason

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Some people like to make their job harder. I usually use the same pockets if there were no issues with the prior placement. Time for you to get a consultation.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 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.