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?

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.

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

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

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.

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.

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

Answers (10)

Answer: Implant Malposition - When the Implant Sits Too High

Answer: Implant Malposition - When the Implant Sits Too High

Answer: High implants

Answer: High implants

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

Answers (10)

Answer: Implant Malposition - When the Implant Sits Too High

Answer: Implant Malposition - When the Implant Sits Too High

Answer: High implants

Answer: High implants

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Recommended reading

Everything you need to know about Breast Augmentation

Our mission is to create a world where every investment in modern beauty is Worth It.