The phrase “fall out of place” regarding breast implants refers to implant malposition or displacement. This does not mean the implant physically exits the body, but rather that it shifts significantly from its intended position within the surgically created pocket. This movement affects the aesthetic outcome, leading to asymmetry, distortion, or discomfort. Understanding how an implant can move and the reasons behind the shift is important for individuals considering or currently living with breast implants.
Specific Patterns of Implant Malposition
Implant malposition manifests in several distinct ways, each altering the breast’s appearance and contour. One common form is “bottoming out,” where the implant descends below the inframammary fold, the natural crease beneath the breast. This causes the nipple to appear positioned too high on the breast mound, resulting in an elongated look and a bulge low on the chest.
Another significant pattern is horizontal shifting, categorized as lateral or medial displacement. Lateral displacement occurs when the implant moves toward the armpit, creating an unusually wide gap between the breasts. Conversely, medial displacement, known as synmastia, involves the implants shifting too close together across the midline of the chest, sometimes eliminating the natural cleavage and creating a “uni-boob” appearance.
Rotation primarily affects shaped or anatomical implants, which are designed to be wider at the bottom and narrower at the top. If a shaped implant rotates, the intended contour is lost, leading to visible distortion. Smooth-shelled implants are more prone to rotation and shifting than textured-shelled implants, which adhere more firmly to the surrounding tissue.
While not a direct displacement, rippling is a related concern where the edges of the implant become visible or palpable under the skin, often as a result of movement or insufficient tissue coverage. An implant can also ride too high, known as superior malposition, which makes the upper pole of the breast appear overly full and unnaturally prominent.
Underlying Reasons for Implant Migration
Implant migration results from a complex interplay between surgical factors, the body’s healing process, and external forces. A primary cause rooted in the initial surgery is the creation of an inadequate surgical pocket. If the pocket is made too large, it provides excessive space, allowing the implant to move freely in any direction, such as laterally or inferiorly.
A biological response that can force an implant out of place is capsular contracture, which involves the formation of a tight layer of scar tissue around the implant. This capsule can harden and contract over time, squeezing the implant and pushing it into an abnormal position, often resulting in superior malposition or a hardened feel.
External forces also play a role, particularly post-operative trauma or excessive physical stress. Heavy lifting, impact, or aggressive chest movements too soon after surgery can disrupt the developing scar tissue, damaging the integrity of the implant pocket and causing the implant to shift.
Over time, natural changes in the body, such as tissue laxity and weight fluctuations, can contribute to displacement. The stretching of the skin and breast ligaments, especially with larger implants, can weaken the support structure. This lack of support makes the implant more susceptible to the pull of gravity, often leading to bottoming out.
Options for Surgical and Non-Surgical Correction
Correcting implant malposition depends on the specific pattern and the underlying cause of the shift. In mild cases of slight rotation or early shifting, non-surgical methods may be attempted. These include external manipulation or targeted massage techniques, sometimes combined with specialized compression garments, to gently guide the implant back into position.
For significant or permanent displacement, surgical revision is typically the definitive treatment required to restore proper position and contour. The most common surgical approach involves adjusting the size and shape of the implant pocket. This procedure, often called capsulorrhaphy, tightens or repairs the existing capsule to restrict the implant’s movement.
Surgeons frequently use internal sutures to stabilize the implant and define the boundaries of the pocket, specifically reinforcing the inframammary fold to prevent bottoming out. If the malposition is due to an overly large pocket, the surgeon may place sutures to reduce the pocket size, anchoring the implant in the desired location.
In some revision surgeries, the type of implant may be changed to better address the issue, such as switching from a smooth to a textured implant to promote tissue adherence and reduce the risk of rotation or migration. The surgical plan may also involve placing the implant into a new plane, for example, from a subglandular to a submuscular position, to gain better support and control over the implant’s final resting place.