Breast implants can shift or “fall out of place,” a condition medically known as implant malposition or displacement. Although modern surgical techniques create a stable pocket, the implant can move due to the body’s natural response to surgery, changes in anatomy, or external forces. This movement can occur immediately after the procedure or develop gradually over many years. Understanding how an implant can shift and the underlying reasons is crucial for identifying problems early.
Understanding Implant Malposition and Types of Displacement
Implant malposition describes any instance where the breast implant moves away from its intended anatomical location, affecting the overall symmetry and contour. The specific direction of the movement determines the type of displacement.
- Bottoming out: The implant drops too far below the inframammary fold, causing the upper breast to lose fullness.
- Lateral displacement: The implant moves sideways toward the armpit, resulting in an excessively wide gap between the breasts.
- Symmastia: Occurs when the implants move too close together, compromising the separation between the breasts.
- High riding: The implant remains positioned too high on the chest wall, making the upper breast look unnaturally full.
- Rotation: Specific to anatomical (teardrop-shaped) implants, where the implant flips or turns within the pocket.
Factors That Cause Implants to Shift
A primary factor contributing to implant shifting is capsular contracture, the tightening of the scar tissue capsule that naturally forms around every breast implant. This excessive tightening can squeeze and distort the implant, forcing it out of position, potentially years after the initial surgery.
The size and creation of the implant pocket during surgery plays a significant role in long-term stability. If the surgical pocket is over-dissected and made too large, the implant has excess room to move freely, increasing the risk of displacement. Larger and heavier implants exert greater pressure on surrounding tissues, which can lead to stretching of the pocket boundaries and eventual shifting, particularly bottoming out.
Patient anatomy, such as thin skin or poor tissue elasticity, can also provide insufficient support. Anatomical implants require a precise pocket to prevent rotation, a risk not present with round implants. Placement choice also matters, as submuscular implants can sometimes shift due to strong pectoral muscle contractions, a phenomenon known as “implant animation.” External physical trauma, such as a forceful impact, can also acutely dislocate an implant.
Recognizing the Physical Signs of Displacement
Recognizing implant displacement often begins with noticing a visible change in the appearance of the breasts. The most common sign is asymmetry, where one breast appears higher, lower, or wider than the other, changing the post-surgical balance. A noticeable change in the overall shape or contour, such as a loss of fullness in the upper pole or an unnatural bulge, suggests a shift in the implant’s location. Patients may also experience palpable movement, feeling the implant shift abnormally when changing positions. In cases of bottoming out, the nipple-areola complex may appear to sit too high. Discomfort or tenderness can also be associated with displacement, especially if the cause is capsular contracture. Any sudden or gradual distortion should prompt a consultation with a plastic surgeon.
Treatment Options and Strategies for Prevention
Correcting implant malposition typically requires revision surgery to restore the implant to its proper anatomical position. A frequent technique used to address an overly large pocket is capsulorrhaphy, which involves using sutures to tighten and reshape the existing scar tissue capsule around the implant. This procedure effectively reduces the space, preventing the implant from shifting.
If the malposition is caused by advanced capsular contracture, a capsulectomy—the surgical removal of the hardened scar tissue capsule—is often necessary before repositioning or exchanging the implant. In some instances, the surgeon may perform an implant exchange, switching to a different size or shape to better suit the revised pocket. For severe cases or poor tissue quality, supportive material like acellular dermal matrix (ADM) may be employed to reinforce the new implant pocket.
Prevention strategies start immediately after the initial surgery with careful adherence to post-operative instructions, including wearing specialized support garments for the recommended period. Patients must strictly avoid strenuous activities or physical trauma that could destabilize the healing pocket during the recovery phase. Choosing a board-certified plastic surgeon with experience is also a long-term preventative measure, as proper pocket creation and implant selection are foundational to avoiding malposition.