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Topic: Implants Over or Under Muscle?

Forum: Breast Reconstruction —

Talk with others facing decisions about whether or not to have breast reconstruction, and if so, what type and when.

Posted on: Oct 27, 2021 02:53PM

lab44 wrote:

Based on your experience, looking for pros & cons of placing implants over vs under chest muscles. I currently have them under but 1 breast gets distorted when my muscle flexes, which has always bothered me. I have been thinking about placing the new implants on top of the muscle but I am concerned about the possible rippling of the implant showing thru with the over the muscle placement. Looking for input. TIA

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Oct 28, 2021 01:48AM LaughingGull wrote:

My implants are under, and the ripples are visible on both sides. This is just to say that having the implants under is not a guarantee that you can avoid ripples. I am still happy with my implants. I look good when dressed and in a swimsuit (I am a swimmer), the recovery time after surgery was short, I could go back to exercise pretty soon after surgery. My plastic surgeon warned of higher chances of complications if placing the implants over the muscle, and he wouldn't do it, so it wasn't an option for me. But I really didn't look at the evidence for that assertion. I am sure others will chime in that will give you more data points and personal experience.

Best of luck with your decision!


ACx4, THPx4, HP (1y); Nerlynx (1y); Arimidex (expected 10y); Surgery: BMX + ALND, Oophorectomy, Reconstruction. Radiation. Dx 10/26/2017, IDC, Right, 3cm, Stage IIB, Grade 3, 2/6 nodes, ER+/PR+, HER2+ (IHC)
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Oct 28, 2021 02:07AM DaughterOfBarb wrote:

Not exactly the same, but I had under the muscle silicone implants from an augmentation for over 20 years before my BC diagnosis. They distorted when I flexed my pecs, which I found slightly annoying but it wasn’t noticeable under clothes. For my reconstruction, I’m going over the muscle (exchange surgery is in a few weeks). My understanding is after mastectomy the distortion can be significantly more bothersome since there is no breast tissue to help disguise it, so going over the muscle is the new recommendation for reconstruction (in my area at least). Fat transfer can be done to soften the edges and disguise ripples, etc. if needed. My PS waits three months after reconstruction before doing fat transfer to see how things settle. My understanding is the more extra weight on you, the less likely you are to have significant rippling issues. Good luck with your decision!

Kaycee (a/k/a DaughterOfBarb) - Dx at 46, Oncotype Score 7 Dx 5/24/2021, ILC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- Surgery 7/15/2021 Mastectomy: Right; Prophylactic mastectomy: Left Surgery 11/16/2021 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Oct 28, 2021 04:19AM lab44 wrote:

Thank you both for your input.

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Oct 30, 2021 09:41AM micdpowers wrote:

Mine were placed over the muscle almost a year ago, with fat grafting done at same time. The fat was very quickly absorbed by my body and ripples appeared within months. It bothers me a little. Doesn't show under clothes that I've noticed (with a bra on). I'm still deciding whether it bothers me enough to have more fat grafting done. My PS said I should, to at least fill in the "chest dents" above implants. But he said the rippling is also due to the shape of the implants.

I do have to wear a bra for lift and support whereas my sister-in-law who had hers placed under-muscle does not wear a bra at all (and we're both in the C-D range). She had the tear-drop shaped ones before they were recalled and she has no ripples. The muscle distortion when working out bothers her a bit. I could lift my arms right after the mastectomy surgery, whereas she needed lots of help for two weeks. I don't know though.... if it meant no rippling and no bra... I might have chosen the more difficult surgery - longer recovery time but better long-term results?

Diagnosed at 45. ​Mother of three: 9, 11, 13. PALB2 Mutant. Dx 2/14/2020, IDC, Right, 2cm, Grade 3, 0/1 nodes, ER-/PR-, HER2+ (IHC) Chemotherapy 2/24/2020 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 2/25/2020 Perjeta (pertuzumab) Targeted Therapy 2/25/2020 Herceptin (trastuzumab) Surgery 8/18/2020 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 11/12/2020 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant

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