Lateral Displacement? Could it be skin, implant type, position, pocket too large? What corrective action is needed? (Photos)

Question

I am 37 - 5’3” 125lbs 22.1 BMI, lost 80 lbs, had a tummy tuck and breast augmentation (Mentor XTRA 450cc High Profile, sub-muscular w/inframammary incision) on 10/2024. My right breast (indicated with arrows on images) to me has always felt different than my left breast. I can remember as early as 3 days post op feeling so much more discomfort on the side of my right breast compared to my left one. I am left hand dominate so I just figured that was the reason for the difference. At my 1 month post op surgeon noticed my right one dropping more so than my left, same observation at 3 months. By my 6th month they were pretty even however my right one has always looked lower. Even my nipples aren’t on the same plane although just marginally. I’ve noticed since about 6 months that my right breast slides significantly when laying down which I know is to be expected however it lays so much more differently than my left. I also have rippling when standing on my right which is worsened when bending over. When bent over I can feel the shell of my implants folding and I can push the corner around. When I mentioned the difference in how my right breast falls my surgeon just said it is side boob. When hugging I can feel it slide whereas the left just pushes in. I go back to see him in 2 weeks and I really want to push to correct my right breast but I don’t know what corrective action is needed. Could it be skin, implant type, position, pocket too large? Any advice is greatly appreciated.

Donovan Rosas, MD · Answer

Over time an implant can displace to the sides as aging and gravity take effect.

Correction of  a laterally displaced device typically involves re-operation and pocket revision by closing off the lateral expansion of the pocket with suture to prevent the implant from slipping. Alternatively, in some cases mesh may be employed.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Daniel Barrett, MD · Answer

Dear gogil11,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ira H. Rex III, MD · Answer

It is very common to have significant asymmetries with breast surgery.  Many times these can be explained by anatomic features including the width and shape of the bony chest wall, muscle insertion differences, even skin tone.  Overall, it seems you have a very nice result.  If over time an implant becomes very lateral, internal sutures can sometimes position that toward the middle.

Dino Mendez, MD · Answer

Hello,
A physical exam would be needed to confirm, but this looks like there might be some mild lateral stretch of the right capsule/breast implant pocket, leading to a mild lateral displacement/malposition. Unfortunately, the only way to fix this would be surgery - closing down the lateral pocket with sutures (capsulorraphy) +/- mesh (e.g. galaflex "internal bra"). If you are very bothered by this, I think surgery would be a good option. But if not bothered, you can observe for now and just make sure to try and always wear bra support

Sean Hill, MD · Answer

Answer from Dr. Sean Hill, Board-Certified Plastic Surgeon at Lone Star Plastic Surgery in Frisco, TX:
Thank you for your question and for including photos &mdash; they’re incredibly helpful in evaluating your current results and concerns.
First, I want to say your results look very good overall, especially in upright positions. That said, I can understand your concern about the asymmetry and the implant shifting when lying down &mdash; particularly if it feels unnatural or uncomfortable.
In patients with a history of significant weight loss, the soft tissue support around the implant can sometimes weaken over time. What you’re describing sounds like possible lateral implant displacement, where the implant migrates too far outward on the chest wall &mdash; something that can become more apparent in thinner patients or after tissue changes.
If this bothers you or is progressing, you may benefit from a revision surgery with internal support, such as the placement of surgical mesh (internal bra). Mesh can help reinforce the implant pocket, reposition the implant to a more ideal location, and prevent it from shifting &mdash; especially when lying down or over time.
At Lone Star Plastic Surgery, I frequently see patients seeking revisions after weight loss or implant-related issues, and the goal is always to restore both aesthetic balance and long-term stability.
A full in-person evaluation is the best next step to confirm if mesh is appropriate and to review your implant positioning, capsule integrity, and tissue support. And as always, be sure your surgeon is board-certified and experienced in revision breast surgery for the safest, most effective outcome.
Warmly,Dr. Sean HillBoard-Certified Plastic SurgeonLone Star Plastic Surgery – Frisco, TX

Tuan A Truong, MD, FACS · Answer

Thank you for your question. Congratulations on your weight loss and upkeep, which can be difficult to achieve. Perfect symmetry can be difficult to achieve after surgery, as any discrepancies can be accentuated by large implants. Pocket position, skin quality, and native breast tissue are just few innate qualities that can be a huge factor in determining positioning. Overall, there appears to be an excellent results. However, if you are unhappy with the results, definitely bring it up with your surgeon. Some of the more aggressive options are going back to surgery for correction, either with internal sutures or an internal bra technique. Be prepared for some of these out-of-pocket costs as well. Good luck on your journey!

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  Your photos show that you are having some lateral displacement.  It's not uncommon for the breasts to each "behave" a little differently.  Though it's impossible to create perfect symmetry, there are options to improve discrepancies.  You can address displacement by surgically tightening the pocket. For the nipple asymmetry a lift would be recommended to raise the nipple to better match the other.

Darryl J. Blinski, MD · Answer

I really enjoyed reading your clinical history from your perspective and the excellently posted series of photos. Initially I want to complement the surgeon on an excellent result, because you before photo show, there is slight asymmetry initially, and your postop result over the ensuing months. Shows a very good result, though there are some slight differences noted. The adage they are sisters, not twins applies to your breast. They will never be perfectly identical. But in that instead, I would recommend a unilateral right donut lift to even out the nipple complex levels and they open per prosthetic capsule or fee to tighten the right lateral pocket using different techniques, including possibility of a mesh. Few range depending on if a mesh is used or not in the techniques to tighten the capsule would be without mesh fee would range 6000 with mesh fee would range 12,000. Best of virtual consult with for better understanding regards.

Mats Hagstrom, MD (license on probation) · Answer

If you look carefully at your preoperative pictures and follow the midline up, you’ll see that the left breast overall sits closer to the midline, while the right breast deviate away from the midline laterally.
This anatomy may be contributing or be part of the issue.
It’s possible your plastic surgeon open the pocket further laterally on the right side as well.
The two breast have slightly different positions on the chest wall and slightly different degrees of a of divergence. 
My best guess is some of it is your anatomy and some of it is how the procedure was done.
Each plastic surgeon does these procedures their own way.
There are a number of variables that can be contributing.
Does this bother you enough to have another operation?
Follow up with your provider or schedule in person second opinion consultations with other plastic surgeons in your community.
For second opinion, consultations always bring before and after pictures for your previous procedures and copies of the operative reports which are part of your medical record that you can request.
Best,
Mats Hagstrom MD

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