I have had saline implants (under the muscle, axillary insertion) for 11 years; however, I am having pain with the left implant. It seems like the left pocket has opened & the implant is sliding into the arm pit (when supine). I am very active & this inhibits my ability to do certain exercises. Can this problem be repaired w/out replacement? The pain is a radiating & dull pain in the axillary & arm.
Implant Sliding into Axillary Region. Can This Be Repaired or Does it Have to Be Replaced?
Doctor Answers 11
Implant malposition correction
Thank you for the question.
One of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla).
Based on your description you are experiencing lateral (outwardly) displacement of the breast implants. This can be corrected using an internal suture technique decreasing the size of the pockets and moving the implants toward the midline. I have seen this repair help patients with the pain symptoms that you describe.
I hope this helps.
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It is likely that you will need to have the breast pocket revised
It is likely that you will need to have the breast pocket revised. This can be achieved without having to replace the implant but there is a chance that it can be damaged during the procedure. Since the life expectancy of breast implants are generally 10 years, the chances of having to replace them to due to complications such as a rupture, etc are very high. Since you will be undergoing surgery to revise the pocket, it may be wise to have one or both sides replaced. I recommend discussing your options with your surgeon as soon as possible since you are experiencing discomfort.
If repairing a breast implant augmentation after 11 years, you might as well replace implant
Yes, this could be repaired without replacement but why? Any surgeon will have to temporarily remove the implant in order to perform a capsulorrhaphy. This is done to avoid damaging the implant. If you are temporarily removing 11 year old implants, why would you not replace them with new ones at that time?
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Implant sliding up in the axilla
this is a unfortunate late potential complication, but yes you are right: with the contraction of the pectoralis muscle when you exercise, it squeezes up the left implant into the axilla.
maybe because the pocket was a little larger to start with towards the axilla, then it healed that way, allowing the implant to slide up easily.
The pain is from the discomfort and pressure onto the muscle. also maybe compressing the brachial plexus which would explain the pain radiating down your arm.
This should be addressed surgically:
the implant should be removed, and the pocket closed smaller internally. you should have the choice of incisions, either peri-areolar or inframmary. If you can afford it, the implants should be replaced since 11 years old now. Maybe silicone if ok with you, and maybe a smaller size since you seem to be very active physically ? you should discuss all your options with your surgeon.
I usually recommend no exercise for 3 weeks post-operatively, as well as therapeutic Ultrasound treatments to ease the pain and post-op oedema.
Florence Mussat, MD in Chicago
Exercise and breast implant malposition needs revision of breast implant surgery
This is unusual after 11 years, but can occur after overly vigorous exercise such as using a Nautilus machine for pectoral muscle development, or doing push-ups or other similar exercise.
The lateral aspect of the pocket may have been too large, or has expanded to the implant being pushed out by the contraction of the pectoral muscles by activities stated above.
This can be corrected by a revision surgery to re-release the pectoral muscle at the breast bone and closure of the lateral (outside) aspect of the implant pocket.
Breast Implant Sliding Out of Position and Associated Pain
The left implant pocket would likely need to be repaired. If you implant is intact (which it likely is as there is no evidence of deflation), it likely does not need to be replaced.
It sounds like your implant pocket is too large. This can often be adjusted. If you have had the same implants for 11 years, I would probably change them at this point.
Implant malposition and correction
When the pocket for an implant becomes larger than the implant in any dimension it allows the implant to slide. It is not often the cause of pain but more an aesthetic concern. It can be corrected by internal suturing techniques and probably implant replacement since you have had your implants for 11 years. I would recommend you seek consultation with a board-certified plastic surgeon with experience in breast revision.
I hope this helps. Happy Holidays,
Lateral displacement of implant
This lateral superolateral displacement of the implant can indeed be corrected. It generally involves opening the pocket via a periareolar (around part of the nipple) or inframammary (beneath the breast) incision. The opening of the pocket can be repaired with sutures alone or with a dermal matrix implant and sutures. This will hold the implant in place. It may be wise to undergo this repair and change the implants since they have been in place for 11 years. It is not an absolute necessity to change them when they are not broken, but this would be a convenient time to place new implants. You would not want to undergo this repair and then require an additional procedure to have you implants replaced in a few years. Good luck!!
Regarding: "Implant Sliding into Axillary Region..."
One of the more common risks of placing breast implants through an axillary incision is malposition of the implant. With contraction of the pectoralis muscle, the implant can be pulled upwards towards that incision because the tunnel that was created to insert the implant in the first place resulted in a path of least resistance allowing the implant to move. It is possible that this is the cause of your discomfort but it may be unrelated.
The best solution is to remove the implant, preferably through an incision under the breast or next to the areola, and close the tunnel with sutures. It is possible to perform this surgery through the axillary incision but it is more difficult and there is a higher risk of failure of the procedure.
As your implants are 11 years old, you may want to entertain the possibility of replacing your implants, particularly if you have an interest in a different size or possibly changing to silicone.
Although you would have to take it easy for a couple of weeks, there is good news. Your recovery from this surgery should be remarkably easier than with your original surgery. Most of the pain from breast augmentation surgery is in creating the pocket for the implant. Once that is done, to change implants, modify the pocket, etc. is generally much easier and less painful.