Implants under the skin or under the chest muscle
Hi Everyone!
I had a breast cancer a while back and a double mastectomy with the silicone implants reconstruction. The implants were put in behind the muscle, following the tissue expander. It's been 10 yrs and I plan to have the implants replaced. The reconstruction surgeon I saw suggested a prepectoral procedure using alloderm, where the implants will be inserted underneath the skin, not the chest muscle. 10 years ago I was told the only option was to insert the implants under the muscle, for the breast cancer patients.
Does anyone have the silicone implants placed underneath the skin? If so, are you happy with the decision? Any pros, cons, recommendations? I would really appreciate the info!
Thank you so much!
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If you do a search of this site you will see that many if not most people now have the implants pre-pec. Lots of discussions about wrinkling if I remember correctly. I also had silicone implants 10 years ago, but i don't plan to replace mine at this time.
If you go to "my profile' and enter your diagnosis & treatment to date, it helps everyone follow along with your questions.
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Thank you, MinusTwo! I wish I could wait with the replacement surgery but my breasts are totally deformed at this point. My left one is saggy and huge and almost under my armpit. My right one is small and tight. Sounds like the prepectoral option comes with its own set ofissues …
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innakap - I have implants over the pec, unfortunately the aloderm stretched and my implants feel very heavy and I have ironbra (I must mention that my "breasts" came out bigger than they were supposed to). I see the PS next month to find out what the next steps and what my options are. I have met many women who have had implants prepec and are very happy. Good luck with whatever you decide!
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i just had my implants placed under my skin but not under my muscle. My chest anatomy prevented me from going under the muscle. It’s early but I’m very pleased with my results. My plastic surgeon told me I could only go so big though. I am satisfied with my size. Before cancer I was between a C cup and a D cup. And Id say I’m close to that no
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I had sub-pectoral when I had my first MX, with a sub-pec reconstruction implant on the MX side and a sub-pec very small enhancement implant on the contralateral side.
When I was diagnosed again 13 years later, with BC on the contralateral side, pre-pectoral reconstruction had taken over as the norm. I was offered that, but since I'd had no problems with the sub-pectoral, I opted to go sub-pectoral again, with a new reconstruction implants put in on both sides. To me, one of the benefits of sub-pectoral is that with the implant under the muscle, any skin or chest muscle recurrence will be immediately noticeable as a tiny lump under the skin - no imaging required. With pre-pectoral, I would imagine that a chest wall recurrence might be more difficult to find if it is behind the implant. Imaging would spot it, but imaging isn't always done regularly after a BMX.
I am very happy with my new sub-pectoral implants. And as a side note, my 13 year old implants, when removed, were found to be in pristine condition ("pristine" being the word the BS used in her surgery notes).
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Thank you ALL for sharing your stories with me!! The information you have provided is very helpful as I’m deciding what route to take …
My PS says, if I go with pre-pec, I will have 2 drains on each side for 2 weeks after the surgery and can only take a sponge bath! Not a happy thought … but trying to tell myself “it is ONLY” 2 weeks.
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I had been wondering this issue too, found this publication:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC68826...
One of the surgeons I will visit soon only does it subpectoral, I would like to ask him why.
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As Beesie mentioned - subpec used to be the standard of care. On top of the muscle is a relative new procedure. I would go back with subpec. It will be interesting to see what your surgeons say Sarah.
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I had immediate reconstruction in October with pre-pec 535cc silicone implants. I discussed the placement with my surgeon, and he only goes pre-pec now - he believes the healing time is easier (no muscles cut), and in my case (being my first surgery) he felt the pre-pec left more adjustment options if I needed radiation. Spoiler: despite a BMX, I still need radiation. Bummer for me.
I will say that I was religious about wearing a sports bra 24/7 for the first three months, no exercise or stress at all. My surgeon also did a nerve reconnection-type procedure, so I have sensation in most of my breast region. He also made me "nipples" during surgery by twisting the tops of my incisions - I'll just have areolas tattooed at the end, and should have a pretty natural-looking result. But I digress.
I just had my three-month post op, and overall things have healed nicely. The tops are really, really wrinkly - I carry no natural fat in that area, and will need fat grafts once I'm done with chemo and radiation to smooth things out. But even with that, those few people I've showed my new breasts to (husband, BFF, adult stepdaughter) are shocked at how good they look without being under the muscle.
In your position, having already had sub-pec, I'd be inclined to go with the "ain't broke, don't fix it" and go sub-pec again unless the surgeon has a distinct reason for going pre-pec now. Just make sure you understand the pros and cons of each.
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Replying to NNS121317: “I will say that I was religious about wearing a sports bra 24/7 for the first three months, no exercise or stress at all.”
Interesting. My PS never used an ace bandage or recommended a bra of any type. I’m 2 months post-surgery (UMX+TE implant) and wondering if the lack of support is why my sub-pectoral TE has shifted towards my armpit. Guess I’ll start wearing a bra again.
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