Should I Have My Breast Implant Replacements Placed Above Or Below The Muscle?
Q: Dr. Eppley, I havge silicone implants that were originally placed way back in 1986. They have served me well and have felt fairly natural until recently. They now have sgtarted to leak and the right side has become contracted nad harder. I have had two plastic surgery consultation with conflicting opinions on how to replace then not remove them. One recommendation was to use a Sientra silicone implant staying on top of the muscle with a lift. The other surgeon would use a Mentor silicone gel implant, placing it under the chest wall muscle, along with a lift. These two opinions have me confused, what do I do?
A: Your original breast implants have served you well, getting over 25 years of service out of them. That has been a good value but their failure was an eventuality and now you must decide how they are going to be replaced, hopefully lasting another 25 years. If you look closely at those two recommendations, they only substantially differ in whether the new implants are placed above or below the muscle. There is no clear cut answer and plastic surgeons will differ in their opinions on this issue.
When it is a primary breast augmentation, the decision for above or below the muscle is more optional and good results in most patients can be obtained either way…albeit with some minor differences when it comes to silicone implants. But when it comes to replacement surgery in someone with established ruptures which will require total capsulectomies, you are going to be better off going under the muscle. (actually partially under the muscle) This is better for prevention of recurrent capsular contracture and infection of which you are now at higher risk.
Dr. Barry Eppley