Changing Breast Implant Placement from Under the Muscle to Subfascial

Implants placed under the muscle suit many women, but some later ask whether they can be moved. This guide covers moving breast implants from under the muscle to a subfascial (over the muscle) position, one of the operations within breast implant replacement and revision. It is written for people who already have submuscular implants, sometimes called sub muscle implants, and are weighing up a change.

If you are still choosing where a first implant should sit, start with our comparison of breast implants over the muscle versus under the muscle. For a definition of the plane itself, read what is subfascial breast augmentation. This page deals with the revision: why women switch, how the operation works, what the research does and does not show, and when leaving things alone is the wiser choice.

Can You Change Breast Implants From Under the Muscle to Over the Muscle?

Yes, in selected patients. Implants can be moved from one pocket to another during revision surgery, and this is one of the standard techniques used for implants that cause problems because of where they sit. Our breast implant replacement and revision page describes pocket change as part of the revision toolkit: implants under the muscle that cause animation deformity may do better above it, often with fat transfer.

Over the muscle covers two planes. Subglandular implants sit directly behind the breast tissue. Subfascial implants sit a layer deeper, beneath the pectoral fascia but still in front of the muscle. Surgeons often prefer subfascial for a conversion because the fascia adds a thin extra layer of cover, although the evidence for that is limited and the choice is individual.

This is a revision, so which plane is used is not a decision to make from a web page. Placement and technique are agreed at consultation, once your surgeon has examined your breast tissue, skin, chest wall and the position of your existing implants.

Why Do Women Move Breast Implants From Under the Muscle?

Implants go under the muscle for good reasons, chiefly more tissue cover at the top. The trade-off is that the implant now shares its space with a muscle that moves. These are the problems that most often lead women to ask about a change.

Animation deformity: why do my breasts move when I flex my chest?

Animation deformity is the visible shifting, flattening or distortion of an implant when the pectoral muscle contracts. The implant is pushed up and outwards, the breast shape changes, and the skin can dimple or ripple. It is most noticeable during exercise, lifting, pressing a hand against a wall or reaching overhead.

How common is it? A 2019 systematic review in Archives of Plastic Surgery ↗ pooled the few studies that had measured it and found that a median of 58% of patients had some degree of animation after submuscular placement. The degree appeared to rise with the amount of muscle involved: it was highest after the Regnault and standard dual plane techniques (73% to 78%) and lowest with muscle-splitting dual plane and triple plane approaches (30% to 33%)^[1]. The authors noted that evidence was scarce and that the problem is probably under-reported. Many of those patients are not troubled by it, and mild movement is not a reason for surgery on its own.

A randomised trial in breast reconstruction from 2022 ↗ compared implants placed in front of and behind the muscle. At 12 months animation deformity was present in 23.8% of the in-front-of-muscle group against 100% of the behind-muscle group, and the behind-muscle group had more pain in the first three days. Mild distortion still appeared in the group with the implants in front of the muscle^[4]. The trial involved reconstruction, not cosmetic augmentation, so it shows the direction of the effect rather than a figure to expect.

Does moving the implant in front of the muscle fix animation deformity?

In the studies available, it usually does. A 2020 retrospective review of 80 breast conversions in Plastic and Reconstructive Surgery ↗ moved subpectoral reconstructions to a prepectoral plane. Every patient had resolution of animation deformity at an average of 15 months. Two reconstructions (2.5%) needed an unplanned return to theatre and 11 (13.8%) were treated for infection, and adding acellular dermal matrix or fat grafting beforehand was linked with less asymmetry and capsular contracture^[2].

Two cautions apply. These were reconstruction patients, who have different tissue and a higher baseline risk of infection than cosmetic patients, and the report was retrospective with no comparison group. It is encouraging evidence that the operation works, not a guarantee.

Capsular contracture: will changing the plane stop my implants hardening?

Capsular contracture is the tightening of the scar capsule around an implant, which can make the breast firm, round, high or painful. It is one of the most frequent reasons for revision surgery. A 2023 systematic review of 34 observational studies in Plastic and Reconstructive Surgery ↗ concluded that capsulectomy, implant exchange and plane change all appear useful for reducing recurrence, but that high-level evidence is limited^[3].

In practice, a plane change is one option among several, and it is usually combined with managing the capsule itself. Our guides to capsular contracture and en bloc capsulectomy explain when some or all of the capsule is removed.

Implants that have moved: why is my breast implant too high, too wide or too low?

Under-the-muscle implants can drift upwards and outwards when the muscle repeatedly contracts, and they can also settle too low or too far to the sides when the pocket stretches. Both are forms of malposition. In a single-practice series of 106 revision patients, 51.9% had capsular contracture, 38.7% had implant malposition and 8.5% had ptosis (sagging), and around 40% had already had at least one earlier attempt at correction^[5].

Whether a plane change helps depends on how the implant moved. A high implant pushed up by the muscle may sit better in front of it, whereas a pocket that has stretched too far sideways usually needs the pocket tightened with internal stitches as well. Our guides to how to tell if a breast implant has moved, bottoming out and symmastia (uniboob) explain how each is recognised and corrected.

Subfascial vs Submuscular: What Is the Difference After the Change?

The practical differences are summarised in the diagram below. After the change the muscle lies flat against the ribs again, and the implant sits in front of it under the fascia.

What are the pros and cons of subfascial implants?

In front of the muscle, there is no animation, the early recovery is usually gentler, and the fascia adds a thin layer of cover. The downsides are thinner coverage than the muscle provides, so rippling and a visible or palpable implant edge are more likely, and less support, which means the pocket must be sized and the implant chosen carefully to limit drifting.

The evidence on subfascial placement is encouraging but incomplete. A 2020 systematic review of 22 studies and 3,743 patients ↗ found capsular contracture in about 1% and infection in about 0.1% after subfascial augmentation, with animation deformity not reported^[6]. A 2024 meta-analysis found lower rates of haematoma, rippling and capsular contracture than subglandular placement, although every included study was at high risk of bias^[7]. Those figures describe primary augmentation, not conversions, and scar tissue from a previous operation can change the picture. Our guide to breast implant rippling explains the risk factors.

Is Moving From Submuscular to Subfascial Worth It?

It is worth it when the problem is clear and the change targets it. It is not worth it when your implants are doing their job. A change replaces one set of trade-offs with another, and it comes with a second operation, a recovery period and a risk of needing a third.

When might a plane change be a good idea?

A conversion tends to be considered when:

• distortion on flexing bothers you or interferes with exercise, as it can for people who lift, climb or swim (see our guide to breast implants for athletes);
• your implants have been pushed too high or too far apart by the muscle;
• you have enough breast tissue and skin to cover the implant in front of the muscle;
• you are already facing an exchange for another reason, such as capsular contracture, a ruptured implant or implants that are many years old, so that the pocket can be changed at the same operation;
• you are in good general health, at a stable weight, and a non-smoker or able to stop.

If you are already considering an exchange, our guides on how long breast implants last and breast implant rupture help you judge the timing. A routine breast implant check is a low-commitment way to find out what is going on.

When is it better to leave things as they are?

Leaving the implants where they are makes sense if:

• they are comfortable, look natural and are not changing;
• you have very little natural breast tissue or fat, so that the implant edge would show through, or you already have rippling;
• the breast has dropped over the implant and a breast lift is the real problem to solve;
• your symptoms are mainly from a contracted capsule, in which case treating the capsule matters more than the plane.

When tissue cover is thin but movement still troubles you, fat transfer can add a soft layer over the implant. A small 2021 case series of 42 patients ↗ used a subfascial pocket combined with fat grafting in primary and revision augmentation where overlying tissue was insufficient, and reported no rippling or malposition at an average of 18 months^[8]. It was small and from a single team, so it suggests an approach rather than proving it. Options such as hybrid breast augmentation and fat transfer to the breasts are discussed at consultation where relevant, and some women decide they would rather have breast implant removal. Our comparison of breast implant removal vs replacement helps frame that choice.

How Does Surgery to Change Implants From Under the Muscle to Subfascial Work?

The exact plan depends on your anatomy and on what is found at surgery, but the operation follows a recognisable sequence.

What happens during the operation?

1. Incision. The surgeon usually reopens the original scar. If your first implants went in through the armpit or around the nipple, the fold under the breast may be used for better access.
2. Removing the implant and managing the capsule. The old implant is taken out. The capsule is left, released or partly or fully removed, depending on its condition.
3. Repairing the muscle and old pocket. The muscle is returned to its natural position against the chest wall, and the old pocket behind it is closed with internal stitches.
4. Creating the new pocket. A new pocket is made in front of the muscle, beneath the fascia where this is suitable. Where the old capsule or tissue is not suitable, a fresh pocket (neo-pocket) may be used.
5. Placing the implant. A new implant is inserted, and the pocket is sized to hold it in position. Fat transfer or a mesh to add cover may be considered in thin patients.
6. Closing. The wound is closed with dissolvable stitches and you are fitted with a surgical bra.

At Centre for Surgery, breast revision is a day-case operation under TIVA (total intravenous anaesthesia) given by a consultant anaesthetist. Operating time depends on what is needed: around 2 to 3 hours where capsulectomy or pocket repair is involved, and longer if a lift is added. You go home the same day with a responsible adult staying with you for 24 hours. Our guide to anaesthesia for cosmetic surgery explains what TIVA is like.

Should the implant be replaced at the same time?

Often yes. A new pocket is usually combined with an implant exchange, since the implant has to be removed to change the plane, and a fresh implant lets you revisit size, shape and profile. Our breast implant options page explains the choices that sit alongside placement. If you are thinking of going larger, tissue stretched by one implant has limits, and a much bigger implant can speed up sagging, rippling or bottoming out.

How Long Is Recovery After Changing Implant Placement?

At Centre for Surgery, recovery after revision depends on how much is done:

• Straightforward exchange: desk work after 5 to 7 days, no heavy lifting for 2 weeks and full exercise from 4 to 6 weeks.
• With capsulectomy or pocket repair: desk work after 7 to 10 days, no heavy lifting for 3 to 4 weeks and full exercise from around 6 weeks.
• With a lift: desk work after 7 to 10 days and full exercise from around 6 weeks.

A plane change usually involves a new pocket and repair of the old one, so expect it to sit towards the longer end. You wear the surgical bra day and night for six weeks, and the final shape settles over three to six months as swelling falls and the implants soften and drop. Our guides to breast implant replacement recovery and support garments after breast surgery cover the weeks in detail, and your surgeon will give you written aftercare specific to your operation.

Stop smoking and nicotine for four weeks before and after surgery, and avoid aspirin for two weeks beforehand.

What Are the Risks of Changing Breast Implant Placement?

Revision is more complex than a first augmentation, with scar tissue and a stretched pocket to work around. Risks that apply to a plane change include:

• Rippling or a visible implant edge, because cover is thinner in front of the muscle.
• Malposition, where the implant drifts or sits too low or too wide, as the muscle no longer supports it.
• Capsular contracture returning, since nearly every treatment carries some risk of recurrence.
• Asymmetry, bleeding (haematoma), infection, changes in nipple sensation and scarring, any of which can need further treatment.
• Animation that is reduced but not always gone, and the need for further surgery.

Your surgeon explains the risks that apply to your plan, and our guide to breast implant safety sets out the wider picture, including common breast implant problems. If a new implant turns or shifts after surgery, see breast implant flipped or rotated.

How Soon After Breast Augmentation Can You Change Implant Placement?

Unless there is an urgent problem such as infection or a haematoma, surgeons usually wait at least three to six months, often longer, for the implants to settle. Implants that look high or firm in the first weeks commonly soften and drop without surgery, and operating on swollen tissue gives a less predictable result. After pregnancy, wait at least three months after you finish breastfeeding before your consultation.

What About Changing Implants After Surgery Abroad or at Another Clinic?

A large share of our revision patients had their first operation elsewhere, including overseas, and we assess and treat these cases with or without the original records. Bring whatever you have, such as the implant card and any operation notes. If you have none, your surgeon can still examine you and may arrange an ultrasound before planning surgery. Our guide to breast augmentation in Turkey covers what to check and what to bring if you need a second opinion.

How Much Does It Cost to Change Breast Implant Placement?

Cost is confirmed in writing after consultation, because it depends on what your operation includes, such as capsule removal, pocket repair, a lift or fat transfer, the implants chosen and the operating time. When you compare quotes, check whether the anaesthetist, implants and follow-up are included. Our breast implant replacement cost guide explains each factor, and our finance options page sets out how payment can be spread, subject to status.

What Happens at a Breast Implant Revision Consultation in London?

Your consultation is with a GMC-registered plastic surgeon at our CQC-regulated hospital on Baker Street, and the surgeon who assesses you is the surgeon who operates. They examine your breasts, the capsule, your skin and the thickness of tissue over the implants, and explain what has gone wrong, whether a plane change would address it, and what other options exist, including leaving things as they are. If a rupture is suspected you may have an ultrasound or MRI first, and it helps to bring your implant card, operation notes and any scans. We recommend a two-week cooling-off period between consent and surgery. You can see how patients’ results look in our breast augmentation before and after photos gallery, and the wider procedure is covered on our breast augmentation page.

Frequently Asked Questions

Changing Breast Implant Placement in London

If your implants are under the muscle and you are wondering whether a different position would help, a consultation with a plastic surgeon will tell you whether a change would solve your problem, and whether it is worth it. Read more about breast implant replacement and revision at Centre for Surgery.

Phone: 020 7993 4849 | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule a consultation

References

1. Dyrberg DL, Bille C, Gunnarsson GL, Frandsen TF, Salzberg CA, Sørensen JA, Thomsen JB. Breast animation deformity. Archives of Plastic Surgery 2019;46(1):7–15. doi:10.5999/aps.2018.00479 ↗
2. Holland MC, Lentz R, Sbitany H. Surgical correction of breast animation deformity with implant pocket conversion to a prepectoral plane. Plastic and Reconstructive Surgery 2020;145(3):632–642. doi:10.1097/PRS.0000000000006590 ↗
3. Boyd CJ, Chiodo MV, Lisiecki JL, Wagner RD, Rohrich RJ. Systematic review of capsular contracture management following breast augmentation: an update. Plastic and Reconstructive Surgery 2023;153(2):303e–321e. doi:10.1097/PRS.0000000000010358 ↗
4. Dyrberg DL, Bille C, Koudahl V, Gerke O, Sørensen JA, Thomsen JB. Evaluation of breast animation deformity following pre- and subpectoral direct-to-implant breast reconstruction: a randomized controlled trial. Archives of Plastic Surgery 2022;49(5):587–595. doi:10.1055/s-0042-1756337 ↗
5. Maxwell GP, Gabriel A. Non-cross-linked porcine acellular dermal matrix in revision breast surgery: long-term outcomes and safety with neopectoral pockets. Aesthetic Surgery Journal 2014;34(4):551–559. doi:10.1177/1090820X14528207 ↗
6. Gould DJ, Shauly O, Ohanissian L, Stevens WG. Subfascial breast augmentation: a systematic review and meta-analysis of capsular contracture. Aesthetic Surgery Journal Open Forum 2020;2(1):ojaa006. doi:10.1093/asjof/ojaa006 ↗
7. Yuan M, Kim P, Gallo L, Austin RE, Lista F, Ahmad J. Outcomes in subfascial versus subglandular planes in breast augmentation: a systematic review and meta-analysis. Aesthetic Surgery Journal 2024;44(9):NP639–NP644. doi:10.1093/asj/sjae118 ↗
8. Munhoz AM, de Azevedo Marques Neto A, Maximiliano J. Subfascial ergonomic axillary hybrid (SEAH) breast augmentation: a surgical approach combining the advantages of incision, pocket, silicone gel, and fat grafting in primary and revision breast augmentation surgery. Aesthetic Surgery Journal 2021;41(6):NP364–NP384. doi:10.1093/asj/sjab029 ↗