Why are some implants still high years later in cases without mesh/internal bra?

Question

hey doctors! so i know that any implant placed behind the muscle will settle and get pushed down over time, leading to a lower placement of the implant (typically way below armpit level) over time. ive also been told that using a mesh/ internal bra prevents the muscle from pushing the implant down too much. however, i have seen cases where even without the mesh/ internal bra, the implants are still high (above armpit level) after years. why do you think that's the case for some people?

J. Timothy Katzen, MD, FACS · Answer

Dear magicskymagic,

Thanks for your excellent question about breast implants. It's natural to wonder why some implants stay high, even years after surgery, without the use of mesh or an internal bra.

While it's true that implants placed behind the muscle usually settle and become lower over time, not everyone experiences this to the same degree. Some implants may remain high because of a too-small or too-tight pocket, or if they were placed too high during surgery. Other factors like a patient's unique anatomy can also play a role.

While mesh or an internal bra can help prevent the implant from settling too low, it's not necessary for everyone. Each person's body is unique, and a skilled plastic surgeon will evaluate their specific anatomy and goals to determine the best approach for achieving their desired outcome.

I hope this response helps address your concerns.

Best regards,
Dr. Katzen

Randal Haworth, MD, FACS · Answer

There are several reasons why breast implants may remain high or shift position over time, even without the use of a mesh or internal bra. Some possible factors include:

Implant size and shape: The size and shape of the implant can affect how it settles over time. Larger implants may be more likely to remain high, while teardrop-shaped implants may be more likely to shift position.
Surgical technique: The surgical technique used to place the implant can also affect its position over time. If the implant is not placed properly, it may be more likely to shift or remain high.
Tissue quality: The quality and elasticity of the patient's breast tissue can affect how the implant settles over time. If the tissue is thin or lacks elasticity, the implant may be more likely to remain high.
Healing process: The healing process after surgery can also play a role in how the implant settles. If there is excess scar tissue or if the patient does not follow post-operative instructions, the implant may be more likely to remain high.
It is important to note that every patient is unique, and the factors that affect the position of breast implants can vary from person to person. If you have concerns about the position of your breast implants, it is important to consult with a board-certified plastic surgeon who can evaluate your individual situation and recommend appropriate treatment options.

I hope this helps,
best of luck !

Daniel Barrett, MD · Answer

Dear magicskymagic,
I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Ashley B. Robey, MD · Answer

There are a few reasons why an implant can be positioned too high. One can be because of incomplete pocket dissection - i.e. the surgeon didn't completely open the pocket inferiorly. This is more common with an areolar or axillary (arm pit) incision.

Another reason for high implant position is capsular contracture; if the lining around the implant (capsule) contracts, it is common for the implant to look like it is sitting too high because it is contracted into a higher a chest wall position.

A third reason would be noncompliance. When an implant is placed in a under-the-muscle pocket, it is common for the muscle to transiently "push" the implant up high because of the muscle fiber length. As the pectoralis muscle becomes accommodated to the new length, it will stop pushing the implant up so high on the chest wall. During this period, it is helpful to avoid activities that would prevent the muscle from relaxing (i.e. heavy lifting); if the muscle remains tight and continues to push the implant up high, it is possible that the previously opened inferior portion of the implant pocket would close off. Thus, the implant will maintain a high position.

Jon S. Wilensky, MD · Answer

Breast implants that remain high or have not settled into a more natural position years after surgery can occur for several reasons. It's important to remember that every individual's body responds differently to surgery, and factors influencing implant position can vary. Here are some potential reasons why implants might remain high:1.) Muscle Tightness and Tension: If the implants are placed under the muscle, the muscle itself can exert pressure on the implants, preventing them from fully descending. Muscle tightness and tension might persist, keeping the implants in a higher position.2.) Capsular Contracture: Scar tissue naturally forms around breast implants as the body's response to a foreign object. If this scar tissue contracts excessively, it can cause the implant to be displaced and appear higher. Capsular contracture might require corrective surgery.3.) Implant Size and Shape: The size and shape of the implants can influence how they settle. Larger or heavier implants might have a harder time descending. Implants with certain profiles might also affect how they sit within the breast pocket.4.) Surgical Technique: The surgical technique used to create the implant pocket and place the implants can impact how they settle. If the pocket is too tight or too high, the implants might not descend as expected.5.) Healing and Tissue Response: Healing is a complex process, and individual variations in tissue response can lead to different outcomes. Some individuals might naturally experience more tissue contracture, leading to a higher implant position.6.) Lifestyle and Activity Level: Activities that involve chest muscles, such as weightlifting or certain exercises, might contribute to implants staying higher over time.7.) Implant Type: The type of implant used, such as smooth or textured, might influence how it interacts with surrounding tissues and settles over time.8.) Gravity and Ageing: While breast implants do settle to some extent over time, the effects of gravity and the natural aging process can also play a role in their position.9.) Weight Fluctuations: Changes in body weight can impact the distribution of breast tissue and the way implants sit within the breast pocket.If you're concerned about the position of your implants, it's best to consult with a skilled cosmetic surgeon. They can assess your individual situation, consider your surgical history, and recommend appropriate options. In some cases, if the implants are significantly high and causing discomfort or aesthetic concerns, revision surgery might be considered to adjust their position and improve the overall result.

Ahmad H. Ahmadi, MD · Answer

Many reasons can cause 'high' implants.  Inappropriately sized implants compared to the breast can cause this.  Not following the postop instructions to wear breast straps or massaging the implants can also be a reason.  Certainly, fibrous capsular contracure should be ruled out.

Derek Fletcher, MD · Answer

The most common reasons for hight implants years after surgery are capsular contracture, restrictive tissues within the breast (most common in tuberous breasts and with total muscle coverage), and implants that are too large for the patient's breast/frame.

Camille Cash, MD · Answer

There are many factors that can influence the way implants look over time.  One of the major ones is genetics.  Some people are born with better skin elasticity than others.  Size of implant is a factor.  Others can include weight loss/gain as well as pregnancy and breastfeeding.

Connie Hiers, MD, FACS · Answer

The capsule or scar tissue that forms around the implant is holding the implant up high. For some women, this is not a problem.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.

When a breast implant fails to drop and is still high after many years there are more than one potential cause.

Capsular contracture can cause a breast implant to lift to a higher position on nthe chest.

Another potential cause is that the implant pocket was placed too high during surgery and the tissues wil not allow the implant to drop.

Why are some implants still high years later in cases without mesh/internal bra?

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