Breast Implant Falling out of Pocket? Extreme Pain...

Question

I got 350cc saline breast implants under muscle in 2002. I went from a 36 full B to full D. I was 20 yrs old 125 lbs, and 5'9 . A yr and half later I had to get my right implant redone due to falling out of pocket. I guess they stitched the pocket back close. Anyways its been fine these last 10 yrs except maybe 4 different times I was in pain n felt like it was leaking or dropping but then itd get better. These last 2 months though ive been in extreme pain and it feels like its falling out. Help

Richard H. Tholen, MD, FACS · Answer

I'm sorry to hear of your difficulties. Leaking would be easily diagnosed by gradual decrease in breast size, increased rippling, and eventual deflation. Pain would not usually be associated with a saline implant leak or deflation, and the saline inside your implants is identical to intravenous saline and is harmlessly absorbed.

	Bottoming out occurs when the scar capsule around your implant is so thin and pliable that your breast pocket opens up (scar capsule stretches or tears through) in an undesired direction--in this case, inferiorly. Sometimes the pocket can open up laterally or in the armpit, allowing sideways implant displacement. When too-tight push-up bras (or overly-dissected pockets centrally) stretch the cleavage tissues from the breastbone, symmastia ("uniboob") occurs. Inferior pocket stretch or downward implant malposition is called "bottoming out" and requires suturing the internal capsule (capsulorrhaphy) to tighten and close off the pocket and raise the implant back into normal position.

	But bottoming out usually does not cause pain, unless a small skin sensory nerve is being stretched by the dropped implant's pressure. (Possible, but truly unusual.)

	Bottoming out is visible by looking at your implant position in the mirror. If its position has been good for 10 years, it is unlikely to have "suddenly" dropped too low. Perhaps it's been moving that way gradually, and now your occasional pain becoming two months of more severe awareness has drawn your attention to it.

	Without exam or photograph it is impossible for any of us online to tell, but even you can make the diagnosis of deflation or malposition. If you think there's a concern, go see your plastic surgeon, or find another ABPS-certified plastic surgeon for a quick exam. If you are simply worried about your 10-year-old implants, there is really no need to be concerned unless you do indeed have leakage or malposition. SImple implant replacement or pocket repair can solve these issues with an easy re-operation.

	Pain can also sometimes be part of capsular contracture, which can be late and unilateral, and starts out as pain and/or firmness. This may be more subtle at first, but your plastic surgeon will be able to determine if this is an issue.

	If you need or want new implants, I would suggest the newest generation of cohesive silicone gel implants (by any of the three FDA-approved implant manufacturers). They do not "leak," and I believe they most emphatically do NOT require MRI scans every 2-3 years to look for "silent rupture." But they are softer, have less rippling, feel more natural, and can never deflate. (And you can change size too, if you wish.)

	Go see your PS or a new one and relieve your concerns! Best wishes!

Kenneth Hughes, MD · Answer

If the pain moves from the lateral chest wall to the nipple areola complex, then the implant or scar around it may be irritating the nerve. A local anesthetic block may help in the diagnosis. This may be the result of capsular contracture, but, without any increase in firmness of the breast, this is unlikely. Sometimes, the pain is not related to the implants at all. Obviously, a physical exam could put many of these concerns to rest.

Ellen A. Mahony, MD · Answer

Hello Avalynn,

	There is no time like now for a follow up appointment!  The best help you can get is from your surgeon or if you have moved, a board certified plastic surgeon.

	Thanks for asking!  Dr Ellen

Suzanne M. Quardt, MD · Answer

I would encourage you to schedule a visit with a Board Certified
Plastic Surgeon immediately to determine the exact source of your
discomfort.  You will certainly require a
clinical examination and may also require additional imaging studies such as an
ultrasound, mammogram, and/or MRI.  If
these indicate a rupture, your surgeon will likely encourage you to proceed
with surgery.

Adam David Lowenstein, MD, FACS · Answer

Your description can be an indication of many different issues, but most certainly I would recommend seeing your surgeon for an exam. There can be many reasons for these sensations including both related and unrelated to your implants. An consultation with a knowledgable plastic surgeon should at the very least alleviate your concerns.

Jeffrey Zwiren, MD · Answer

If your implants are submuscular then the lower outer quadrant is the weak spot. If your implants are too large for our soft tissue to support they will ultimately cause a stretch deformity drifting of laterally. This can cause a stretching of the nerves and thus your pain. It sounds like you had procedure in the past to close down the lateral pocket. It is possible that this type of procedure would be appropriate again or consider using a material know as acellular dermal matrix or Alloderm or Strattise. This material can be used as a sling to support the implant and keep it in the correct position.

Steven Wallach, MD · Answer

Without an exam it is difficult to ascertain what the cause of the pain is.  It is best to discuss this with your doctor during an exam.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Based on your description, it may very well be that you are experiencing a recurrent breast implant displacement problem. I would suggest that you seek consultation with a well experienced board-certified plastic surgeon in your area. He/she will be able to give you more precise advice after physical examination.

	 If a breast implant displacement problem is present, internal sutures ( capsulorrhaphy) may be necessary to repair the breast implant pocket and correct the breast implant position.

	 Best wishes.

Breast Implant Falling out of Pocket? Extreme Pain...

Answers (8)

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