4 Weeks Post-op. Implants Move to the Side When I Lay Down. Revision Needed?

Question

I Had a BA 4 Weeks Ago, Subglandular 350cc Gel. When I Lay Flat my Implabts Move to the Side. 5 foot 1 inches 120 pounds.. Was a 34 deflated c due to 3 breasted children..

Ronald Schuster, MD · Answer

Four weeks after surgery is a little early to be convinced that the implants are too far to the side. Even if they are, at this time you might be able to salvage the position by wearing a good bra continuously for at least 6 weeks. Before anything you should return to your surgeon and discuss the situation. Good luck.

Tom J. Pousti, MD · Answer

Thank you for the question.

	I would agree with the previous respondents, that it is too early to be concerned about the need for revisionary surgery and about the potential usefulness of a relatively snug  fitting bra ( keeping the breasts  implants immediately positioned).

	 If the lateral displacement of the breast implants  does  become a long-term concern, then revisionary surgery may be necessary. This breast implant displacement can be corrected using an internal suture technique decreasing the size of the pockets and moving the implants toward the midline.

	 I hope this helps.

Milind K. Ambe, MD · Answer

At just 4 weeks post op I wouldn't be too worried about your implants moving to the side when you lay down. At this early stage your capsule hasn't completely formed yet. I would highly recommend that you wear a really supportive bra for the next two months (the first three months post op) to help keep your implants in a good position while your capsule fully forms. Beyond this you need to ask your surgeon for suggestions. Best wishes to you!

William B. Rosenblatt, MD · Answer

Women who have breasts find that they move too --- when you lie down they go out to the sides. This can be a normal finding. Talk to your doctor

Raj S. Ambay, MD · Answer

Its likely fine. I would not be thinking revision and you should make sure you communicate with your plastic surgeon. If they are in the correct position when you stand and do not fall to the side then there is little to worry about.

Robin T.W. Yuan, MD · Answer

This is normal since the ribcage curves and the implants should naturally fall towards the side. This occurs more than with submuscular implants which are a bit more constrained. If they fall too far to the side then that might be a problem. But if they look like they are in the correct position when you stand up, chances are they are in an appropriate position.

	Robin T.W. Yuan ,M.D.

Peter E. Johnson, MD · Answer

With a subglandular augmentation the breast and implant should feel and move as one, and indeed a natural breast will fall slightly to the side when you lay down. If they move together then a revision is unlikely, however if your breast stays put and the implant slides out from under and moves off the side you might need an adjustment.

Jourdan Gottlieb, MD · Answer

Natural breasts of sufficient size drift to the sides, as do implants in many or most patients. This is not a sign of need for revision.

	Follow up with your surgeon, always better than this level of answer done without benefit of examination or at least photos.

	Thank you for the question, best wishes.

Robert M. Grenley, MD (retired) · Answer

It all depends on how far they move. It is normal for a breast to flatten out and move to the side when you lie on your back. If the implants do not move and stay very prominent when you lie down, then that is unnatural. But if they move too far to your side and that is bothersome to you, then you may ultimately benefit from having the lateral aspects of your pockets sutured closed. If so, your surgeon may want to wait until your scar tissue capsule lining the pocket is well established so that it will hold the repair properly. I have had success in patients whose pockets are unpredictably stretching too far laterally by having them wear a supportive sleep bra that holds the implants closer together when they are lying down. I have seen lateral pockets close down over a few months, and since you are so early after surgery and your pockets are not yet mature, this might be worth a try. I would suggest wearing this for a few months, and in fact I now recommend that all my augmentation patients wear a sleep bra for a few months just in case their pockets may be prone to this lateral stretching effect.

Scott L. Replogle, MD (retired) · Answer

Assuming the problem is not just natural breast flattening and falling off to the side and is the implant moving out but not the breast, I would say this may well be a problem and I view it as one more common to subglandular placement of implants. 

	I disagree with some of the responses. The capsule of scar tissue that heals around the implant is there by 10 days or so but like any scar tissue, can mature, stretch, or contract. I doubt that at four weeks a discrepancy between the implant and the pocket will correct itself by bra splinting or any external maneuvers.   

	Subglandular placement of implants leaves very little control over the tissues containing the implant until the capsule is formed. If the pocket dissected for the implant was too wide for the implant or the implant placed was too narrow for the pocket, then the implant will float around in the pocket and not stay behind the breast like a foot that is too small for a shoe. Very stretchy tissues can do this over time even with subpectoral placement but it shouldn't be there at four weeks. 

	The correction for this problem by altering the existing subglandular capsule is not an easy one and sometimes the best solution is to not alter the capsule but replace the implant with a wider one that fits the capsule space better. Another solution is to redo the capsule space (or part of it) by redoing the augmentation to a subpectoral placement of the implant. 

	I would certainly wait at least to the three months point to be fairly certain the tissues are fully recovered and aren't going to change any further before making a decision on a revision.

4 Weeks Post-op. Implants Move to the Side When I Lay Down. Revision Needed?

Answers (13)

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