Breast Augmentation Revision for Animation Deformity

Q: Dr. Eppley, Hello,  I am interested in breast augmentations revision.I have an old pair of submuscular saline implants (15 years old) and have had and nursed two babies since. The entire time I’ve had them the right side has felt much tighter and actually uncomfortable. I almost feel like the muscle is permanently flexed. I am very muscular naturally so I get pretty severe deformation even with a little flex and am mostly insecure about that aspect. if i bend over to pick my kid up my implant does not fall forward with me so i am left with wrinkly breast tissue just hanging there. So I am exploring sub glandular. My ideal breast would have almost all the volume in the lower pole. I am under the impression that the sub muscular implants tend to sit higher and then whatever breast tissue I have just hangs off the end of it. I have also read that they can migrate upward over time? I would consider sub muscular if I was convinced I could keep them low and they would not migrate upward through time and as my natural breast age and continue to sag. I am actually pretty satisfied with my left implant placement besides how they move when I flex. I’m looking to minimize the deformation when I pick anything up that is more than 10 pounds. I understand the risks with sub glandular most notably the palpability as I am thin.

Do you do revisions where your patient changes from sub muscular to sub glandular? Is there a method with the sub muscular placement where the pocket can be lower? I am also interested in something called the Dual Plane technique but I don’t totally understand it.

A: Thank you for your inquiry and detailing all of your breast implant history, concerns and objectives to which I can make the following commentary about your possible breast augmentation revision:

1) It sounds like you have 100% submuscular implants, a breast augmentation technique that has not really been in vogue for decades. With 100% submuscular position you would have most if not all of the symptoms you have described.

2) The decision in your case is whether your implant pockets, with new silicone implants, should be adjusted to a partial submuscular (aka dual plane pocket) or switched out to a completely subglandular position. Dual plane implant positioning avoids most of the symptoms that you have described and is how I have done ‘under the muscle’ breast augmentation. for 25 years. It is a combination of submuscular and subglandular pockets. Each implant pocket location as its own advantages and disadvantages….there is not perfect breast implant pocket location.

3) I have changed implants from subglandular to dual plane and vice versa. Implant malposition (implant falling after surgery back into the old pocket) is less likely going from submuscular to subglandular than the other way.

4) I would need to see pictures of your breasts, static as well as with the animation deformity to provide further insight.

Dr. Barry Eppley

Indianapolis, Indiana