Breast implant rotation, or malposition, occurs when an implant shifts from its intended position within the surgical pocket. This is primarily a concern with anatomical (teardrop-shaped) implants because their asymmetrical design requires precise orientation to maintain the breast’s natural contour. Even a slight shift of a teardrop implant can result in a noticeable distortion of the breast’s shape, often appearing upside down or sideways. Attempting to manually flip an implant without the supervision of a plastic surgeon is strongly discouraged due to the potential for serious complications. Only a qualified medical professional should assess and manage implant position changes.
Causes of Implant Rotation
Implant rotation often happens when the surgical pocket created to house the device is not precisely the correct size for the implant. If the pocket is too large, the implant has excess room to shift, rotate, or flip within the space. This movement can lead to a visible change in breast shape, especially with a teardrop implant that is designed to be fuller at the bottom and tapered toward the top. Rotation rates are estimated to occur in a range of 3% to 14% of patients with implants, though this figure is less clear for round implants as their symmetry makes rotation aesthetically unnoticeable.
The type of implant surface also influences the likelihood of rotation. Textured implants were designed to encourage surrounding tissue to adhere to the shell, which helps anchor the device and reduce the risk of rotation. Smooth-shelled implants, on the other hand, have a greater degree of mobility, making them more prone to movement within the pocket. Post-surgical trauma, such as a direct impact to the chest or overly vigorous exercise before the implant pocket has fully healed, can also force a stable implant to shift.
Another factor contributing to implant rotation is the development of capsular contracture. This condition involves the scar tissue capsule that naturally forms around the implant becoming abnormally thick and tight. While capsular contracture often causes the breast to feel firm or hard, the tightening of the capsule can also physically displace or rotate the implant within the confined space.
The Professional Manual Repositioning Procedure
When an implant rotation is identified, a plastic surgeon may first attempt a professional manual repositioning, also known as an external manipulation. This non-surgical procedure is typically performed in the surgeon’s office and involves the physician using their hands to apply controlled, external pressure to the breast. The goal is to gently guide the rotated implant back into its correct anatomical orientation within the existing pocket.
Manual repositioning is most often considered a temporary solution, especially when the rotation is a recurring issue or the implant pocket is clearly too large. The success of this technique depends on the flexibility of the tissue and the degree of rotation, and it is usually painless or only mildly uncomfortable. In some instances, for patients with recurrent, minor rotations, a surgeon may demonstrate a specific technique that allows the patient to perform the external adjustment themselves. However, this self-manipulation is only appropriate if specifically authorized and taught by the surgeon, and it does not fix the underlying cause of the instability.
Risks of Attempting Self-Manipulation
Attempting to manually manipulate a breast implant without a surgeon’s guidance carries significant risks that can lead to severe medical complications. Applying uncontrolled or excessive force to the breast tissue can cause the implant shell to tear or rupture. This risk is particularly elevated with older implants or those with compromised integrity, potentially leading to the leakage of silicone gel or saline into the surrounding tissue.
Unregulated pressure can also damage delicate blood vessels, leading to the formation of a hematoma (a collection of blood) or a seroma (a collection of clear fluid). Both conditions cause significant pain, swelling, and bruising, often requiring a surgical procedure to drain. Furthermore, aggressive manipulation can traumatize the scar tissue capsule surrounding the implant, which may trigger or accelerate the development of capsular contracture. Uncontrolled force can also distort the implant pocket, worsening the malposition problem and increasing the likelihood that surgical revision will be necessary.
When Surgical Correction is Necessary
When manual repositioning fails to correct the issue or the implant rotation is chronic, surgical correction is the definitive next step. The most common surgical approach involves a procedure known as pocket revision, which is designed to stabilize the implant’s position. During this procedure, the surgeon tightens or reshapes the overly large or misaligned pocket that allowed the rotation to occur.
The pocket can be secured with internal sutures or reinforced with surgical mesh or a biological matrix to create a more restrictive, appropriately sized space. If capsular contracture is the underlying cause of the rotation, a capsulectomy is performed to surgically remove the entire thickened scar tissue capsule. Another option for chronic rotation is an implant exchange, replacing the asymmetrical teardrop implant with a round implant. Since a round implant is symmetrical, its rotation is not visible, which permanently solves the aesthetic problem caused by malposition.