Breasts are indented lying down. Can I fix this with bigger implants? (Photo)

Question

Hi, I don’t like that my breasts look this way when I’m laying down. They’re indented, especially on the side I pointed to in the picture. Can this be fixed with bigger implants? They’re under the muscle. I was thinking of fat transfer, but I’m concerned it won’t last for years to come.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  The fix would perform a internal bra/capsulorrhaphy procedure getting implants closer together. I wrote the very first paper on how to do this in 1999. I have been in practice for over 30 years and revisionary breast surgery is a large part of my practice. You should be able to get exactly the shape and size that you desire. Best wishes to you.

Finny George, MD · Answer

Hi, thank you for sharing your question.  This indentation is likely due to the implant falling to the side and likely requiring more lateral support. While you can mask the problem with fat or a larger implant, this will likely only be a temporary solution. An inferolateral mesh will likely be a better solution.

Daniel Barrett, MD · Answer

Dear Pioneering953696,

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

Donovan Rosas, MD · Answer

As time passes, an implant will create space and become more mobile as the pocket stretches. A medial depression when recumbent/lying down is typically the result of implant migration laterally.

This can be corrected by revision capsulorrhaphy with the aim of closing the the lateral space and reposition the implant centrally.

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

Michelle Zweifler, MD · Answer

Breast augmentations not infrequently benefit from a revision.  If the implant moves to the side when lying down, bringing the implant towards the chest with capsule repair or mesh may smooth the contour.  Additionally, a larger implant and/or fat grafting may help the breast depression.

Gulcin Nujen Cardak, MD, FEBOPRAS · Answer

Hello, thank you for sharing your photos.Upon reviewing your pictures, I noticed that there is a malpositioned implant. In my experience, using a larger implant will not solve the issue &mdash; it is very likely that the same problem will recur.My recommendation is to tighten the capsule, and possibly consider fat grafting as well.

John Reilly, MD, FACS · Answer

Hi, sorry you're having an issue with your implants. It could be because the tissues on the side of the breast towards the armpit have weakened allowing the implant to fall towards the armpit allowing the area in question to look "deflated". Tightening the "capsule" can help push the implant back towards the middle. Fat grafting can camouflage that area but is not the best treatment since it is not a lack of fat but a malpositioned implant. Best of luck.

Kamol Pansritum, MD · Answer

I recommend replacing your current implants with ones at least 50–100cc larger, along with a capsulectomy to release tight tissue. This should improve contour and fullness.
Fat transfer isn’t necessary in your case, as implant revision alone can provide a longer-lasting and more effective result.

Mats Hagstrom, MD (license on probation) · Answer

It’s not completely certain of what is causing this.
My best guess is that it’s related to how your implant pocket was dissected.
It’s possible to tightening the pocket might limit this.
My best guess is that it will not.
It’s also possible that larger implants will improve this situation.
Generally speaking anytime we use successively large implants the chance of undesirable side effects, complications, and need for revision surgery will go up.
There are issues with using bigger implants.
 Sometimes there is no straightforward easy explanation.
Sometimes revision surgery can fix things like this and sometimes it doesn’t help.
Without having done the procedure or the luxury of seeing things from an intraoperative perspective, it may be difficult to give you a certain explanation. 
I don’t think that transfer is going to fix this problem.
Dynamic changes tend to be the most difficult to correct.
This mean, if the problem only happens with certain movement or certain positions, it’s usually harder to correct.
The implant sliding towards the side when you lay on your back is not uncommon, but it usually doesn’t create an indentation.
It’s not causing that on the other side, which makes me think there is another explanation.Best,
Mats Hagstrom MD

Breasts are indented lying down. Can I fix this with bigger implants? (Photo)

Answers (9)

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