Breast implant malposition, often referred to as rotation or flipping, occurs when the prosthetic device shifts from its intended position within the surgical pocket. This complication is particularly noticeable with anatomical, or teardrop-shaped, implants because their specific contour is designed to mimic the natural slope of the breast. When an anatomical implant rotates, it can lead to a visible distortion or an unnatural change in the breast’s shape.
Understanding Implant Rotation
Implant rotation happens because the pocket created during the augmentation procedure is slightly larger than the implant, allowing room for movement. The risk of visible malposition is significantly higher with anatomical implants due to their asymmetrical shape. Conversely, a round implant can rotate without causing an obvious change in breast contour because its shape is uniform in all directions.
Common causes for an implant to rotate include insufficient rest following the surgery or early, vigorous activities. Trauma to the chest or the formation of a capsular contracture can also lead to displacement. Capsular contracture is the hardening of the scar tissue capsule that naturally forms around the implant, and its tightening can squeeze and push the implant out of alignment. The quality of the initial surgical pocket dissection also plays a substantial role in the likelihood of rotation.
Indications and Safety for Manual Repositioning
Manual repositioning is an option only for minor, recent rotations and must be performed exclusively after consultation with the operating surgeon. Your plastic surgeon is the only person qualified to determine if the implant rotation is suitable for this non-surgical technique. This method is typically advised for temporary or occasional flipping that occurs without other complications.
There are important situations where manual manipulation should never be attempted, as it can cause harm to the implant or surrounding tissue. If you experience severe or sudden pain, notice signs of infection, or suspect the implant may have ruptured, you must seek immediate medical attention. Rotation caused by a severe capsular contracture is also a contraindication, as forceful movement against hardened tissue is unlikely to succeed and may cause further damage. The application of pressure must remain gentle and controlled, never causing significant discomfort or bruising.
Step-by-Step Non-Surgical Manipulation
When a surgeon has approved this method, the first step involves positioning the body to naturally encourage the implant to move. This often means lying supine on a firm surface or leaning forward to create additional space in the lower breast pocket. Creating this space reduces the pressure on the implant, making it easier to manipulate.
The next step is to locate the rotated edge of the implant, which often feels like a firm or flat area where the breast contour is distorted. Using the pads of your fingers, apply slow, gentle, and sustained pressure to the side of the implant that needs to be moved. The movement must be a slow, steady push rather than a quick, forceful turn, which could damage the capsule.
Once the implant is felt to be back in the correct position, your surgeon will likely advise using a supportive garment or medical tape to stabilize the breast. This stabilization period is important to allow the surrounding tissue to settle around the implant and potentially reduce the chance of immediate re-rotation.
Professional Intervention When Manual Flipping is Ineffective
If manual repositioning is unsuccessful or if the implant repeatedly rotates, a medical professional will need to intervene with more definitive methods. One non-surgical option a surgeon may perform is an external capsulotomy, where they apply more aggressive, targeted pressure to the implant. This technique is carried out by the physician and aims to break up or stretch the tight scar capsule that is holding the implant in the wrong position.
When rotation persists, surgical revision is generally the next step to correct the problem permanently. During a revision, the surgeon may perform a pocket modification, which involves using internal sutures to tighten the space around the implant. This reduction in pocket size physically restricts the implant’s ability to turn.
Alternatively, the surgeon may recommend replacing the anatomical implant with a round implant, which eliminates the visible aesthetic problem of rotation altogether. In some cases, the surgeon may use an implant with a textured surface, designed to encourage tissue adherence and minimize movement within the pocket. These surgical solutions address the underlying cause of the rotation, offering a lasting solution to the issue.