Breast Augmentation Revision/Implant Exchange, Considering going from Subfascial to Dual Plane, Very Conflicted

Dr. Michelle Roughton


Hi, Dr.  Roughton, I had a breast augmentation this past February and I have tuberous breasts.  I also have very little breast tissue and thin skin.  My dr recommended textured shaped implants and over the muscle.  I later learn it is subfascial, not sure if that even makes a difference.  He also said that my areolas didn't need to be corrected as they aren't that bad.  So, I went with what he suggested.  Fast forward to now and I am very unhappy.  I think it just exaggerated my tuberous breasts.  I call them my potato triangles.   


So, on August 14, I am to have everything revised with smooth, round implants, areola correction and constriction release underneath but he wants to keep them in the subfascial plane.  I am really torn.  He did graft fat to hide the edges, which, imo, doesn't help much.  I can still see the implant.  And it is very palpable.  When I read up on dual plane, it doesn't say how much of the implant is covered.  Is it more than half? Three quarters?  How much of the implant shows in the bottom portion of the breast?  How bad is the animation deformity?  I am active, but as an average person, not a bodybuilder or fitness competitor.  I also rarely ever work my chest.  I am more of a leg day person. 


He also said that there is no additional support in a dual plane position, that it is just for coverage and that it won't prevent laxity of breast tissue.  That there could be more complications as the muscle pushes down and out.  Capsular contracture is unclear and bottoming out is possibly worse with dual plane.  He never answered my questions as to whether the skin thins faster or if the pressure on the areola prevents blood flow in the subfascial position.  I asked him the latter as I still have no feeling in my areolas 7 months later.  


Some other risks he mentioned with going dual plane are a tight upper pole which can lead to a contour deformity.  And then by changing implant pockets, there is the chance of malposition of the implant.  He said I may have to go more laterally if dual plane, which means malposition both laterally and inferiorly.  I don't know if he meant in general or in my specific case.  


I am truly hoping you can give me some more insight.  He seems to favour over the muscle and I am not even sure if he does unders at all.  I am really hoping that I can come up with something with this dr as he is revising everything free of charge.  It has been a very emotional recovery, to say the least.  I'd be asking him more questions as well, but he is currently on holiday.  And I am even debating as to whether I need to cancel my surgery just so I can talk to him further.  But I know his answers won't change, which is why I am hoping another Dr can give another point of view.  Thank-you for your time :)

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  • Whew!!  That's a lot.  Let me see if I can get a few of these answered.  #1 please talk to your surgeon, you should see someone who takes the time to answer your question and with whom you feel comfortable--before surgery.  Do not assume he knows what you want. ๐Ÿ™‚

    Subfascial (pectorlis major muscle fascia up over implant) is an alternative to subglandular which in some studies has a lower capsular contracture rate than truly subglandular (with fascia down below implant).  One of my partners believes in it and the other doesn't and that's a pretty fair cross-section of plastic surgeons.  

    Yes, in general animation happen with implants below the muscle (either submuscular or dual plane) rather than over the muscle but most women (myself included) aren't bothered too much by it.  You are right, the women who are the most active in their chests are the ones who notice it the most. 

    Textured, shaped implants are the most firm and therefore the most palpable. I suspect a smooth round device that's more mobile will be less noticeable for you and you'll like it better. 

    As far as the under vs over, in short it's a capsular contracture related decision combined with activity level and how thin the patient is (prone to rippling).  Would you mind sending a photo?  I think it may be helpful if you need/want any more specific advice.  Good luck!!


    I would be honored to see you at my office in Raleigh, NC!
    (Bustmob members get a $500 travel voucher ๐Ÿ™‚)

    Reply Like 1
  • I have been unable to talk to him as he has been on holiday for almost a month as is his assistant.  Hence why I am on here :)  He is very against going under the muscle.  I suppose my main concern in comparing unders vs overs, is how much does the muscle cover the implant in dual plane and if you were to grab your breast, is it palpable?  I find with mine being subfascial, it is very noticeable.  If I were a mannequin, I wouldn't be worried about my decision, but I am not lol  


    Is there animation with every movement?  I know my Dr gave the examples of just pushing a shopping cart and opening a door?  I wouldn't mind the movement, I just don't want my breasts to look disfigured every time the muscle moves.  And I don't understand why he said the upper pole would be tighter?  I don't understand that.


    I suppose I could just cross my fingers and hope the smooth isn't as noticeable.  As sad as this sounds, I've barely looked at my breasts since February.  They are too small for my frame, too narrow, I am very upset that he never corrected the tuberous areolas.  So, now they will be bigger, wider and he will correct the constrictions.  I am just really torn on placement.  And I am concerned that the numbness of my areolas is bc they are overs. 


    Thank-you for taking the time to help alleviate my concerns :)  

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  • One more thing, is it harder to change pockets?  From over to under?  Is the surgery longer and more complicated?

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  • Yes for sure it's harder to change the location of the implants but if you do a lot of breast work, it's not bad.  

    Muscle will cover the implant to the level of the top of the areola, level of nipple, or to the level of the bottom of the areola depending on the degree of dual plane, 1, 2 vs 3.  

    Animation isn't bad at all and I think there are a lot of women on here with sub muscular implants who could weigh in on that.  

    As to your numbness, if your areolas are numb now and haven't gotten better in 7 months, I'm sorry to say it is unlikely that feeling will return.  At best little nerves grow at 1 mm a day but they should have come back if they were going to.  A change in pocket won't change that.

    I hope this helps you at least a bit.  I would also strongly encourage you to get a second opinion while you wait.



    I would be honored to see you at my office in Raleigh, NC!
    (Bustmob members get a $500 travel voucher ๐Ÿ™‚)

    Reply Like 1
  • Thank-you for taking the time for answering all my questions :)  That is very upsetting about my areolas though :(  

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