Is my implant pocket too big and the implant too small? (Photos)

Question

I had breast augmentation 7 months ago and I got 285cc Motiva ergonomix demi otm. Now when I lay on my back especially the right side of implant move to the side and looks separate from my natural breast tissue. It looks very weird and unnatural. The implants also feel somewhat too small for my chest/breast width and seem to move around a lot. My natural breast width is approximately 13 cm, which makes me wonder if the implant diameter may be too narrow for my anatomy. Could this be fixed with bigger and wider implant and pocket tightening or moving the implants under the muscle? Thank you for the answers

Daniel Barrett, MD · Answer

Dear Sophieee1,

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

Frank Agullo, MD · Answer

Both points are technically right: the implant feels small and the space created around it is too big. That migration when you lie down is the giveaway. It is not because the implant itself is too small. It is because the lateral border of the pocket is not sufficiently supported, allowing the implant to migrate sideways. When you lie on your back, gravity pulls it toward your armpit.

You have a natural breast width of 13cm. The Motiva demi OTM (285cc) likely only spans about 11.5 to 12cm across the base. That leaves almost 1cm of missing width on each side, and that empty space is where the implant moves.

My solution is a lateral capsulorrhaphy combined with sizing up to a wider, fuller implant that actually fills the base of the pocket. Mesh reinforcement with Galaflex.

Submuscular conversion is probably overkill unless you are also seeing rippling along the upper pole. Pure displacement is usually handled by reshaping the pocket and using a properly sized implant.

#StayBeautiful,

@RealDrWorldWide

Mehmet Ozdemir, MD · Answer

It sounds incredibly frustrating to deal with implants that feel unstable and separate from your natural tissue, but your anatomical intuition is actually spot on. A 285cc Motiva Ergonomix Demi implant typically has a base diameter of around 11.5, which is significantly narrower than your 13cm natural breast base width (BW). Because the implant is too narrow and placed "over the muscle" (OTM), it doesn't adequately fill your natural breast footprint, leaving a physical gap that causes that unnatural "separation" and allows it to slide around laterally when you lie down. Your proposed solution is exactly what a plastic surgeon would consider: a secondary revision involving internal pocket capsulorrhaphy (pocket tightening) to stop the sliding, combined with swapping to a wider, slightly higher-volume implant that matches your 13cm base width. Additionally, moving the new implants to a submuscular or dual-plane position would provide a much thicker layer of tissue coverage over the top and inner edges, blending the implant seamlessly with your natural breast and giving you the stable, cohesive look you originally wanted.

Waylon Zeng, MD · Answer

Hi there thank you so much for your question and sharing your photos. You are correct in that the implant pocket is too big. I don't think the implant is necessarily too small for your frame, but the pocket is too large. This can sometimes occur during the surgery when the pocket was overdissected and then during healing phase when the implant shifted a bit more, causing the capsule to be more enlarged. The difficult part of Motiva implants is that because the capsules are so thin (it's less inflammatory to the body), dissection needs to be very limited to prevent the implants from moving too far out to the side. If it shifts too much to the side, the pocket capsule may need to be tightened on the side to prevent it from moving so much. Hope that helps!

Is my implant pocket too big and the implant too small? (Photos)

Answers (4)

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