Replacing 17 year old implants. Opinion on switching old breast implant placement to dual plane - is it possible?

Thank you for your question. I have been in practice over 30 years and revision breast surgery is a large portion of my practice. I do see a lot of women who have implants on top of the muscle. The likelihood of capsular contracture is twice as common as under the muscle. Additionally, many people who have implants on top of the muscle have "slide down" in which the breast travels down there chest to a low position. I have written the only technical paper on replacing implants from on top to below the muscle. Oftentimes, you will also need a lift. Even though you do not have much breast tissue, you should be able to have an excellent result. Best wishes to you.

It is typically possible and safe to move implants from above the muscle to a dual plane position. There may be mitigating factors that preclude this. If you have a desire to move the position it would be reasonable to discuss further with your surgeon why this is not possible.

Dear Fantastic971591,

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

Without seeing photos or doing an exam, it is difficult to say definitively what the best course for you would be. However, when I evaluate patients who have capsular contracture with subglandular implants, generally my recommendation is to perform a capsulectomy with pocket switch to dual plane and combining this with either internal mesh bra or an ADM to control implant position. Depending on patient anatomy and size goals, this may be combined with a breast lift. If you have capsular contracture, especially if it is causing significant distortion or pain, to consider revision surgery.
Sean M. Fisher MD Aesthetic Plastic Surgeon Seattle, WA

There’s no right or wrong way to approach this.
Converting to a sub muscular position has certain advantages and disadvantages.
It would potentially lower the chance of rede developing a capsule contraction.
Having context to when and why the capsule contraction formed could be important information.
The definition of dual plan is somewhat subjective and arbitrary.
All sub muscular augmentations are in fact, dual plane since the muscle can never cover the lower part of the implant.
It’s simply a matter at what level the pectoralis muscle is transected or taken off the rib cage.
Personally, I like to leave as much muscle covering the implant as possible, and only release enough muscle for the implant to sit in the correct position.
Working with smaller implants is usually safer and easier.
If you convert to a sub muscular augmentation, then you may need several months for the tissues to readjust.
Some surgeons may have a little experience with converting from sub glandular to sub muscular.
If this is important to you then Find a plastic surgeon who has a lot of experience doing the procedure.
Depending on what the ideology is for the capsular contraction. You are at risk for this happening again, especially if you use the same anatomic position above the muscle.
Provider selection is usually the most important variable.
Finding the right plastic surgeon is not easy or straightforward.
It does usually involve having multiple in person consultations and the ability to vet plastic surgeons.
Good luck,
Mats Hagstrom MD