Can You Have a Breast Preservation Procedure When Switching Implants to Over the Muscle? – Restoration Preservation Procedures

Short answer: yes, in most cases. If your implants currently sit under the muscle (fully submuscular or in a dual plane, or partially under the muscle (also known as half under the muscle), we can move them above the muscle and still use a modified breast preservation technique. It is one of the more common breast revisions I do, and it solves problems, such as animation deformity, that a lot of patients live with for years without realizing there is a fix.  In the past, patients with animation deformity were told they had to live with the motion or remove their implants; they often were not given many other options.  

By Dr. Johnny Franco at Austin Plastic Surgeon

Why patients most commonly want their implants moved over the muscle

A few concerns come up again and again in my office:

• The implant drifts to the side. Instead of filling out the cleavage, it sits too far laterally, toward the armpit. A little sexy side boob looks amazing. An implant placed completely in the armpit is often not the desired look for our patients.  
• The cleavage never looked the way you hoped. No bra, no clothing, no positioning ever gave you the result you were picturing. In the past, we as plastic surgeons were limited by the anatomical boundaries of your pectoralis muscle. Where that muscle inserts into your sternum dictated how close together we could place your breast implants. When we put them above the muscle, we are not limited by that anatomical boundary.  
• Animation deformity. This is the big one, and it is the most common reason patients come in for a change from below the muscle to above the muscle. When your pectoralis, your chest muscle, flexes, it pushes the implant and distorts it, causing unnatural breast movements that can often be seen in a sports bra or bikini.  You are not trying to flex. You reach for something, push up out of a chair, work out, and you can see the breast shift or ripple in a way that looks unnatural. That distortion comes from the muscle sitting on top of the implant, not from anything you are doing on purpose. As the muscle flexes, it shortens, compressing and shifting the breast implant.  

When those are the main concerns, moving the implant out from under the muscle to above typically resolves these issues and helps our patients achieve their aesthetic goals.  

What the preservation procedure actually involves when you have an implant under the muscle already. 

The goal is to take the implant out of its old home and give it a fresh, well-controlled new one above the muscle. This lets us completely reset the framework and get a fresh start to your breast augmentation procedure.  

First, I remove the existing implant. Then I free the pectoralis muscle (just enough to have an edge to restore it into its natural position) and reset it back into its natural anatomical position, securing it with sutures so it heals where it belongs instead of continuing to pull on the implant. Once the muscle is back in place, I build a new pocket above it as we have now reset your anatomy. This is our restoration procedure. We are restoring your natural anatomy.   

In the traditional approach to switching the breast implant from half under the muscle to above, that would be done by changing it to a subfascial pocket, above the muscle. It gives you a genuine fresh start: a new pocket where I have a lot of control over shape and position, and one that pairs well with an internal bra for added support.

The Restoration Preservation Breast approach

Breast restoration is the modernization of this approach.  We restore the pectoralis muscle back into its natural position.  Reset the footprint of the breast. Instead of opening the breast pocket, I limit the dissection to just the edge of the muscle. I take the old implant out, reset the pectoralis muscle back into its natural position, and then use a breast preservation technique to protect the ligaments that are still intact above the muscle while I create the new pocket.  The amount of ligaments and tissue that is still in place is dependent on the previous surgery; however, anything that we can preserve will be to our benefit.  

The benefit is that you keep whatever support structures are still in place. Typically those are your medial and lateral ligaments, the ones toward the midline and the ones that help keep the implant from sliding toward the armpit. That preserved support is exactly what fights the two problems most revision patients are worried about.

The amount of ligaments and soft tissue support remaining from the previous surgery is variable, as some of the inferior, or bottom, ligaments were most likely released during your original breast augmentation. In a revision, we cannot rebuild natural architecture that was already cut or mobilized in a previous surgery. But there is still a lot to be gained by preserving what remains, and in the right patient that makes a real difference.

Who gets the most out of this

This modified preservation approach tends to shine for a few specific patients:

• Symmastia. If your implants have drifted toward each other in the middle, preserving the medial ligaments gives us more control at the midline, which makes this my primary option. Symmastia can be extremely challenging, and restoring the breast, creating a new start, and utilizing these ligaments has been extremely successful in treating this challenging issue.  
• Fullness without going bigger. If you want more fullness but not an overly large implant, preserving your ligaments lets us get more out of the implant you have.
• Stability and functional fullness. If your main goal is an implant that stays put, one that does not fall toward the armpit and holds a better position, this gives you what I call functional fullness, or fullness on top of the breast, without reaching for a much larger implant to get there.

Summary about Restoration Preservation Procedures

I truly believe that patients are going to see more of these preservation modifications in secondary and revision breast procedures. We can harness most of the benefits of the technique, as long as we go in with clear expectations that we are not starting with a blank slate. Your first surgery altered some of the tissue, and we work with what is there.

If you have been dealing with animation deformity, lateral fullness, or an implant that just will not stay where you want it, this is worth a conversation. Revision breast surgeries can be challenging; however, patients have more options than ever before.  Restoration preservation procedures have given patients choices that they have never had previously.  

Frequently asked questions

Does moving implants over the muscle fix animation deformity? Yes. Animation deformity happens because the muscle sits on top of the implant and distorts it when you flex. Moving the implant above the muscle removes that mechanism, which is why it is one of the most common reasons patients ask to change their implants from half under the muscle to over the muscle.  

Is breast restoration preservation procedure the same in a revision as in a first-time augmentation? No, and I will always tell you that up front. Some ligaments, usually the inferior ones, were likely released during your original augmentation. We preserve what is still intact, typically the medial and lateral support, rather than recreating everything.

Can this be combined with an internal bra? Yes. Preservation procedures in primary or secondary breast procedures can be combined with an internal bra.  There are a variety of reasons that patients may benefit from an internal bra.  

Will I need a bigger implant to get more fullness on top? Not necessarily. Preserving your remaining ligaments and stabilizing the pocket lets us create functional fullness, fullness on the upper part of the breast, without defaulting to a much larger implant.  However, we do need to choose an implant that matches your ultimate goals.