American Society of Plastic Surgeons
For Medical Professionals
2 years ago

Post Bil mastectomy ruptured implant

I had bil mastectomy for breast cancer in 2018 with expanders and implants under the muscle . My recent MRI showed right intracapsular implant rupture. Noticeable changes in right breast shape. I always felt tightness with the implants felt uncomfortable. Since I now need to have the implants removed what are your thoughts on having the implants placed above the muscle? Any complications?

Procedure: Breast Implant Revision
Location: Des Plaines, IL

Replies 4

Ellis Tavin
ASPS Surgeon
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It is certainly an option to change from sub pectoral to the pre-pectoral plane. You should discuss the surgery with a plastic surgeon in your area who does breast reconstruction.

Rahul Vemula
ASPS Surgeon
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Thanks for your question.

The switching of the implant can absolutely be done from the sub muscular position to the pre pectoral ( above the muscle)

Please meet with a board certified plastic surgeon in who is well versed in this technique.

Another option to also consider is a natural tissue reconstruction issuing your own tissue such as a DIEP flap

Alfred Antonetti
ASPS Surgeon

If you have a rupture it is advised to remove the implant and possibly replace. It may not be advisable to just replace above muscle. Remember you had a mastectomy and the skin over that would be very thin. You need to discuss all t his in person with a board certified plastic surgeon to learn all your options in detail.

Daniel Allan

I believe that the implants belong under the muscle. This is true for augmentation patients, and more so for post-mastectomy reconstruction, where the soft tissue coverage is very thin. That said, not everyone will agree with me. Some surgeons will propose AlloDerm or some other proprietary tissue cover, but these can have their own problems. If you had a feeling of tightness it may be that you were not expanded sufficiently or the expanders were not left in place long enough to prevent contraction when they were removed and replaced with the permanent implants. It is my belief that the expanded volume should be at least 50% larger than the anticipated subsequent implant, and the fully expanded expanders should be left in place for 6 months before removal.


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