Permanent Sutures for Breast Implants Pushed out to the Side?

I've had 350cc saline implants under the muscle for 2 years now, and have bottoming out. I'm muscular with little body fat, 5'2", 104 lbs. My implants have gotten further apart, and pushed out to the sides, with extremely visible side rippling. My implants look bottomed out from the side, and become very deformed anytime I flex. My doctor suggests I do silicone under the muscle, open up muscle in the center more, put permanent sutures around the sides and bottom, and go smaller. If my chest muscles flexing caused this, I think it will happen again even with sutures. Any suggestions?

Doctor Answers 14

How to fix your rippling implants

If you are already rippling on the sides, the last thing you should do is go in front of the muscle. That would risk rippling all over. Maintain as much tissue coverage as you can!

You do need to have a lateral capsulorraphy, which means closing off the outer pocket. BUT, you must understand that pockets can passively widen due tot he stretch of your tissues over time. But it shouldn't get to the point that it is deforming. My point is to emphasize to you that there is always a drift of implants to the side over time.

I disagree with those who told you not to exercise. That's as silly as when a doctor says to "breathe normally." You should be able to do every activity you want after breast augmentation.

You do need to go smaller, however. At 5'2" and 104lbs, your implants are undoubtedly too large for you and fundamentally the cause of your problems. While silicone ripples less than saline, it still can ripple. The reason you have a rippling problem is that you have large implants under thin skin. So you need a smaller implant, and you are better off with silicone.

Good luck. And remember....don't have your surgery done by someone who just tells you what you want to hear. you need to do what is right. Accept that you need to go smaller!

Los Angeles Plastic Surgeon
4.5 out of 5 stars 48 reviews

Avoid pectoralis strengthening exercises following submuscular "under" breast implants

All the other surgeons have made excellent comments here that do not need to be repeated.

However, I would strongly advise avodance of exercises that result in pectoralis major contraction. This generally inculdes: bench press, wide stance push ups (narrow stance are ok) and the "pec dec" or butterflies. You will be able to build up all the surrounding muscles without truly effecting your routine.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 82 reviews

Breast Implant Revision

Breast revision surgery can be very complicated without guaranteed results. As far as the deformity you have with muscular contraction, that is the result of having the implant under the muscle. You are very thin and already have rippling, so I dont think it is an option for you to have had the implants placed in front of the muscle. That is the only way to avoid the "animation deformity".

You are having bottoming out and the implants have gone to the side, so you need what is called capsulorrhaphy. Meaning suturing the lateral pocket closed and the inferior pocket closed to help the bottoming out. In these instances to make this work your have to be very diligent and wear an undewire bra all the time. You will probably need to go maybe a little smaller to decrease the weight of the implant and switch to silicone to decrease the rippling, but not eliminate.

Hope that helps.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 78 reviews

Seconday breast revision

Your secondary revision should include implant exchange, revision of the infra mammary fold and the lateral breast fold. This could be done with sutures but also ideally with a sling of dermal substitute( like alloderm). This will act as a strong hammock that will prevent future sagging. It crucial in revision surgery to have a clear operative plan to avoid any future revisions.

Since you are already under the muscle ,pocket exchange might not be very helpful. Muscle splitting will not help be helpful but could weaken the muscle support. Hope that helps!

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews


Without examining you, I would suggest that your implants are too big for you. Your chest wall is not flat but convex. The larger the implant relative to your chest, the more they will drift to the side or "fall off the chest." I suspect your implants are wide enough to be located far enough outside the perimeter of your normal breast and your thinness lacks coverage for the implants that you will have visible rippling and lack of support. Many of the problems that come with implants are due to women having implants that are simply too large for their frames and natural breast anatomy. I would have your surgeon look at your original size and dimension and chose an implant that more closely fits your anatomy. It may not give you the fullness you want, but it will be safer.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Implant position and rippling

The concerns you describe are related to an implant likely too large for you body and having a saline implant. If you have an implant too large for you body the tissues covering the implant will get over stretched and become thinned out. Therefore, you will see the implant more. Saline implants will ripple and if there is not enough tissue coverage such as on the sides or bottom of the breasts, you will see the rippling. The ideal situation is to have a smaller implant placed and use a dermal substitute such as Alloderm or Neoform (there are others and this is an expensive route but may be the best choice) to revise the pocket and add bulk to the tissue coverage over the implant. Both of these changes will improve the rippling and poor positioning you are describing. Discuss this with your surgeon and remember that size of the implant is not the only criteria for hapiness. Long term results are also important. The smaller implants have less of these issues than if you choose to go with an implant that is larger than your tissues can tolerate.

Bahram Ghaderi, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 21 reviews

Permanent sutures for breast implants pushed out to the side?

Thank you for your question!  Given your history of failed attempts at revision to correct symmetry and shape issues, consideration for either an acellular dermal matrix or mesh-type substitute is reasonable.  A capsulorrhaphy would be needed for revision of your breast pocket. If you do need such, the use of a dermal matrix or mesh may be considered if your tissue now has significant laxity that is failing in support or a significant deformity in which recreation of the breast pocket is required along with adding additional support and coverage of the implant.  Certainly, the larger the implant, the heavier the weight...thus, it may be useful to consider placement of a matrix or mesh. Otherwise, capsulorrhaphy for pocket revision using your native tissue should suffice.  It has been used safely and effectively to correct synmastia, restore the inframammary fold, mask implant issues (e.g., rippling, wrinkling, etc.), and improve aesthetic results in revisionary breast implant and reconstructive procedures.  However, only by physical examination would one be able to make recommendations on the benefits over the risk of using a matrix or mesh in your situation. 

Consult with a plastic surgeon well-versed in breast procedures and the use of dermal matrices and mesh in breast procedures who will assist you in determining which procedure(s) would be the best for you.

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Rippling of breast implants

I would agree with many of the answers you've been given by the other doctors. 1) revision surgery with SILICONE implants, under the muscle,  2) consider slightly smaller implants,  3) enlarge the inner sides of the pockets,  4) partial capsulectomy, and closing down of the outer sides  5) correct the bottoming out by repositioning the implants and the fold beneath the breast.     I have patients avoid bench presses, "flys", and pushups for at least 6 months post op. In your case, you might consider avoiding them permanently.

William J. Vasileff, MD
Birmingham Plastic Surgeon
4.5 out of 5 stars 4 reviews

Modified muscle technique for implant problems

The problem you describe is a very common one in muscular women, and something in which I have a special interest. Every time you flex, the muscles push the implants apart and down, and whether the sutures are permanent or not this will continue to occur. You can prevent it by going above the muscle but then the rippl;ing is worse. One technique I have had success with is a variation on the subfascial technique called the split muscle technique. Here are some resources to check it out:, and

I hope this helps, I can also put you in touch with a paytient who has had this done.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 54 reviews

Deformed appearance of breast implants

Hi naturelover. You describe several issues. First, many patients have rippling on the lateral sides. This is where we have thin tissue overlying the implant and thus this area is prone to visible rippling. Silicone implants ripple less than saline but they still ripple. The deformity when you flex happens in some patients and can only be corrected in my experience by placing the implant on top of the muscle. If you are very thin on the upper, inner aspect of your breast, as in you have very visible ribs in this area, you are at risk for having a visible edge of the implant if the implant is placed on top of the muscle. However, silicone implants are more compressible than saline and thus visible edges are usually less of a problem. Without pictures it is hard to know if you are a candidate for above the muscle implants. There are other things to consider as well when choosing implant position. Bottoming out and lateral displacement can be difficult to correct. Sometimes a new pocket makes a big difference. Permanent sutures can help also. I find in a lot of my patients that using Alloderm or Neoform to reinforced the lateral and inferior pocket can really help. Make sure your board certified plastic surgeons performs a lot of breast revision surgery as it can be tricky. Hope this helps.

Tracy M. Pfeifer, MD, MS

Tracy Pfeifer, MD
Manhattan Plastic Surgeon
4.8 out of 5 stars 29 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.