They Are Still Really Nice Standing but Lying Down the Breast Shifts Down and Towards my Underarm. Should I Be Alarmed?

From your description this is not bottoming out.  Some lateral movement is normal with soft implants and an implant pocket of a certain size.  Another surgery (to tighten the pocket laterally) should reduce this displacement.  But I am not sure you want to do that.  You describe the results as "awesome" when you are standing.  You might consider accepting the lateral displacement if it doesn't increase further.

Do check with your plastic surgery!  Best of luck,

At size 36 each 200 cc's of implant corresponds to 1 cup size change.  You went up approximately 2 1/2 cup sizes from a B to a D-DD.  However, these implants weigh about 1 lb each and after 8 months your breasts stretched laterally and will stretch inferiorly.  These implants are too heavy and I predict further problems.  Unfortunately, you have not provided any photographs or stated whether the implants are in front or behind the muscle.  I recommend a new technique called Implant Exchange with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to exchange your implants for smaller ones, reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage.  Aligning the areola, breast tissue and implant over the bony prominence of the chest wall gives maximum anterior projection with a minimal size implant.  Small silicone gel implants placed retro-pectoral look and feel more natural, are more stable long term, less likely to ripple or have complications needing revision. 

 

Best Wishes,

Gary Horndeski, M.D.

Pictures would be helpful.  Per your description, this not bottoming out.  The outer pocket is a bit larger so the implants migrate that way when you lie down.  This is normal.  If you like the way that the look when standing then I would not mess with the result.

Dr. ES

Normal breasts usually will move toward the armpit when the woman lies down.  Normal vs. abnormal is a matter of degree.  If they move far too much, the pocket may have stretched out laterally.  Best to see your plastic surgeon and see what he/she thinks.

This is not bottoming out.  It is fixable.  You didn't do anything wrong.  Having larger implants, or over-dissection of the pocket or even your own skin/tissue laxity can cause this to happen.  Good thing is that it can be corrected if it bothers you, but you did say they are awesome standing so it's a personal decision and it is another surgery to consider.  Go see your surgeon for a follow up appointment, go over your concerns and go over your options to correct it at that time.  ac

It is normal for breasts and implants to move sideways when we lie down.  Depending on how much the implants shift down towards armpit, your plastic surgeon may or may not need to tighten the implant pocket.  I would advise you to see your plastic surgeon so that she/he can evaluate you and to see whether lateral movement is normal or warrant any revision surgery.

The easy part of the answer:


You did nothing wrong

This is not bottoming out


Without a photo, I can't really tell if this is "normal" or not.  

Larger breasts, implanted or not, fall to the side when laying down. If the pocket is too large either by design or by post-surgical stretching, this can be exaggerated and may be bothersome.  And if so, this is fixable by tightening the pocket in the operating room.

All the best. 

It appears that the breast implant pocket is too large or has been stretched by the size of the implant.   Although this is not bottoming out, it will require an outpatient surgery to correct.  This involves the placement of sutures along this area to prevent the implant from falling into the armpit.   It is often reinforced with a dermal substitute to add strength to the repair.  

I wish you a safe and healthy recovery.

 

Paul S. Gill, M.D.

Thank you for your question. This is nothing to be alarmed about. Your implants have migrated too far to the outside of your chestwall and hence the position when you're lying down. This is not truly bottoming out, however surgical correction is warranted. This can be corrected by placing internal sutures to close this region and occasionally using Strattice to strengthen the repair in this region.  Please see a board certified plastic surgeon with expertise in this area to help you with this procedure.

The problem is time, weight and gravity.  A large implant coupled with soft tissue that can not support the weight of the implant causes the down and out phenomenon.  Every woman with implants wants up and in but if the implant can not be supported it will eventually cause this stretch deformity.    This can be corrected with a lateral capsuleopexy, in extreme cases a smaller implant may be indicated.