Breast Implant Placement..

[mybody]

10. Is the rate of capsular contracture (CC) higher with overs than with unders?

Some surgeons believe that Capsular Contracture (CC) can be avoided somewhat if the implants are placed under the muscle. This belief is thought to be from the act numerous contractions of the implant by the pectoralis major muscles - all throughout the day and might. Sort of like a 24 hour massage. However, CC happens in either placements with either implant fillers and either surface options (smooth or textured).

CC can happen to anyone at any time but amazingly does not happen to everyone under the same circumstances. CC has happened after bacterial infections, breast trauma, pregnancy, breastfeeding, and for simply no reason at all and placement had no bearing in these cases.

[styleguru]

11. Can I change from unders to overs and vice versa if I am not happy with my placement?

Yes, you are able to change at any time. However, if you are switching from overs to unders, you will experience more discomfort than you previous surgery.

If you are switching from unders to overs, you will also have discomfort although not possibly as much as with an over-to-under switch. However! If you have had textured implants for some time, removal of some muscle tissue may be possible and it is also possible that your muscles may not adhere back to the chest wall and pectoralis minor. If this happens you will notice an odd movement of the muscles post-operatively as though it was bunching up unnaturally. Revision may include scoring of the posterior portion of the pectoralis major and anterior scoring of the pectoralis minor for re-adhesion.

[styleguru]

12. My doctor only does unders (or overs), what should I do?

Ask your surgeon why he only offers one placement, get other opinions to determine if it is your specific needs that may need either placement or simply because your surgeon only does it one way. Both placements have pros and cons to thoroughly research your options and your own determinates to make a better choice regarding surgeons.

Some really great surgeons may only offer full sub-muscular or sub-pectoral and even only subglandular. Every surgeon will have their own preferences and reasons for them. Inquire as to why, compare and make your choice regarding all the other factors which determine who is right for you.

[styleguru]

13. I was told Symmastia and displacement can be common in active people with unders?

Some surgeons do believe that Symmastia is experienced more often in patients with subpectoral placement. However, symmastia can happen due to several reasons, implants too large, excessive sternum dissection, connective tissue failure and muscle dissection. Just know that it is possible in any placement, not just one in particular. Ask your surgeon for more information on this subject.

Displacement can happen with unders. This can happen if you are active or sedentary as your pectoralis major is used very often through out your daily activities. This happens more with smooth implants although this doesn't necessarily mean that textured implants are the better option. The most widely used implant is a smooth, round implant. However, contoured (teardrop) implants are textured and are so to decrease the chances of implant "flipping" and general displacement.

[styleguru]

14. Does subpectoral placement cause muscle atrophy?

Some surgeons do believe that this is possible. However, there are so many women with sub-pectoral placement with no loss of muscle tone or function so this very well may be exaggerated. This may be considered a very controversial issue as different surgeons have different opinions so please ask him or her for their opinion on such.

[styleguru]

15. How long does it take for implants to drop with unders?

It takes time to heal and depending upon your implant surface, size and muscle tone - this can vary significantly. You may be asked to forcefully massage your implants, push them down, wear a strap, wear no bra (or the opposite) to help them drop (or keep them from such). This can happen between 1 to 6 months on average so please do not worry if they are still high and hard by 6 months. This can happen.

If you still haven't dropped by over 6 months (or have textured implants) a re-operation or firm massage may be needed. Please ask your surgeon regarding your specific case as everyone is different. However, smooth unders usually drop by the 4th or month.

[styleguru]

16. Do implants placed over the muscle drop faster than those placed under?

Usually, yes. Unders only have the breast envelope to hold themselves high and tight and as the skin stretches the implants will settle more. This also depends upon a few factors such as pre-operative size, implant size/post-operative size chosen, implant texture and post-operative instructions. If your surgeon advises for you not to wear an underwire bra you may drop faster than without, however some surgeons ask you to wear an underwire bras for a reason, so you don't drop too MUCH.

There is no tense, traumatized muscle holding the implant to the chest so the dropping or fluffing is a skin issue not a muscle one.

[styleguru]

17. I know I need a lift, but do not want the scars - I would like to get unders, is this okay without a lift?

If you do not get the lift and get the unders, you may have a result which is very unpleasing called double bubble. Double bubble is when your implants are under the muscle and produce one breast mound and the tissue which sags lower on the chest creates yet another breast mound. The results are 4 breasts and not two. OR it can be described as having breasts higher up on the chest (created by the implants under the muscle) but nipple complexes and the natural breast being lower on the chest with NO augmentation (mound).

[styleguru]

18. Should I get smooth or textured implants if I get overs/unders?

This option is also entirely up to you. If you are getting contoured, textured is recommended so that the implant does not flip or rotate. There are smooth and textured surfaces available on both Mentor and McGhan round implants. Some surgeons prefer textured unders when placing silicone-filled implants under the muscle and smooths for silicone overs. Some prefer smooth salines in any placement, and of course, vice versa for all options. It is a surgeon-preference and many times a surgeon usually sticks to one option that he feels he gets the best results with. Ask your surgeon for more information on his preferences.

[styleguru]

19. Do I have to massage if I get unders?

Massage is another issue which is surgeon-preference. Many surgeons believe that massage definitely helps ward off CC and keeps the pocket open and just as many do not. Please ask your surgeon regarding his belief on most quadrant exercises and implant compression/massage.

To stay neutral I will explain the reasoning both for and against massage. Some surgeons believe that massage will help keep the roomy pocket open so that the implant movies around comfortably, naturally and so that the implant pocket does not begin to squeeze the implant (not CC).

Some surgeons believe that compression exercise (manual squeezing of the implant) will help keep the fibrous capsule that forms around the implant, roomy and from contracting (CC).

Some surgeons believe that only massage is necessary with overs as the pectoral muscle massages the implant all through the day and night with your natural muscle contractions.

However! CC happens with both unders and overs, you make the call. Me? I personally do both types of exercises, my surgeon believes in it and instructs that his patients do so no matter the implant placement.