surfer SAID:

I am 51 years old and had under the muscle saline implants (which essentially brought me just back to pre breastfeeding size), 13.5 years ago. Would like to have them replaced with silicone…smaller. The saline implants never really dropped and my areola is basically “dropping” off my breast and I feel they are too “round” or full on top. One surgeon recommended under the muscle again and to cut my pocket lower so the breast would settle lower. The second surgeon was adamant about putting them over the muscle…period. Any suggestions?

3 Answers

  1. DrJamesWethe wrote on :

    With replacement of breast implants you can use either position…under the muscle or above the muscle. Both will work but under the muscle has some advantages such as better mammograms but also negatives like what you are currently experiencing with the implant remaining higher and the breast dropping a bit with time and gravity. Neither answer is “best”. There just happen to be two correct answers. Most important, find a surgeon you trust and have them explain the pros and cons for both approaches. The physician should have good reasons for picking one over the other but realize that there is not one correct answer. Mostly, find a surgeon who will explain it in clear English so that you know your options and be sure you have faith in that doctor.
    J. Wethe, M.D.

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  2. DrScottSattler wrote on :

    It sounds to me like you have developed sagging breast tissue relative to the position of the implant, which probably has not changed very much. I refer to this phenomenon as a ‘waterfall deformity’ as your breast tissue is cascading over the surface of the implant. My typical solution is implant replacement below the muscle and a simultaneous breast lift. Give our office a call for a free consultation with me 425-776-0880 – we are in the Seattle area.

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  3. DrKourosAzar wrote on :

    It sounds like you are experiencing a common problem where the the implant stays high and the breast droops over it a bit. When it is severe, it is called a snoopy deformity because the breast hangs over the implant like snoopy. From what I can tell of your description I think it is much wiser to keep them under the muscle and do a breast lift at the same time as replacing your implants. This will keep your risk of capsular contracture lower and improve the shape. I agree with the surgeon who told you to release the pocket a little and do a lift. The problem with moving them to on top of the muscle is that over time you will have a 15% higher risk of capsular contracture and as you age, the breast tissue and fat will thin out making the implant more visible. Therefore, better to keep them under the muscle from my point of view.

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