In the consultation process for a revision - considering switching from under to over. Thoughts? (Photos)

Question

36 F here, no kids, 5'7 and 140 lbs. My implants are eight years old, 650 cc, smooth round silicone under the muscle. I developed a double-bubble deformity in the left breast and am now seeking a revision. I am strongly considering changing the plane to over, as I am athletic, and the animation deformity is annoying (although not a dealbreaker.) I also have plenty of my own breast tissue to hopefully achieve a natural looking/feeling result and I would be upping the size to 700-750. I am worried about rippling, however. I really don't know what to do. Surgeons have conflicting opinions. Any input would be highly appreciated. I should also point out that a lift and sizing down is not an option for me. I would rather just "buy more time" with my new set. Thank you! :)

Daniel Barrett, MD · Answer

Dear Charming209937,

I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Richard Baxter, MD · Answer

Double bubble is often related to animation deformity because the detached portion of the muscle typically pulls on the capsule right where you see the double bubble crease. Correction of this requires that the muscle gets re-attached behind the implant. This can be done either with subfascial (better than subglandular) or by converting to the split muscle plane.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. I have been in practice over 30 years and revisionary breast surgery is a large portion of my practice.  Placing implants on top of the muscle is never a good idea-never.  Especially in your case, in which you are tissues of stretched out and have a lot of inferior pole breast tissue. I have a whole gallery on my website dedicated long-term changes associated with implants on top of the muscle.  There are many patients who look good in the first year after subglandular breast augmentation, however ultimately the skin envelope will just stretch.  The good news, is that in your case, you can have an excellent result if you keep your implants under the muscle, perform a internal bra-capsulorrhaphy, and a lift. Additionally, you will need excision of the lower Pole breast tissue.  The surgery is termed  "Reductive augmentation ". I wrote the first paper on this topic in 2017. You are an excellent candidate for this.  Best wishes to you.

Connie Hiers, MD, FACS · Answer

Please do not go larger, especially if you want them placed in front of the muscles. They will just sag down with the weight. I do recommend going smaller and keeping them behind the muscle. what you have now is too large and heavy for your frame and tissue. Long term, it would be best to go smaller.

Darryl J. Blinski, MD · Answer

Based on your questions in one post a photo recommend in person or virtual consultation exchanging the 750 cc motor for power plus or high profile implants is an option in the dual plane location expect fees to range from $8000-$12,000 again best of virtual consultant with

In the consultation process for a revision - considering switching from under to over. Thoughts? (Photos)

Answers (5)