Why Did One Of My Implants Never Settle? Was It Place It Too High?

Question

Three years ago, I had teardrop implants placed transaxillary. My left one never settled all the way, at my post-op my surgeon only recommended intensley massaging it. My question is: is there anything that can cause it to drop? Three years after, I still catch myself massaging it! Did he not place it low enough or is it because I'm left handed? I can flex my pec muscle and move my implant up on the left, the right one is perfect

Richard H. Tholen, MD, FACS · Answer

Teardrop implants are textured because their shape means positioning is critical to achieve a "normal" appearance. (Imagine a teardrop implant upside down, for example!) Once the texture is "adherent" to the adjacent tissues, it does not move, and it is designed NOT to. Textured implants, BTW, should NOT be massaged, so if in fact you do have teardrop implants, they are almost certainly textured, and massage is nonsensical and should never have been recommended initially, or as a "solution" to too-high implant position. Flexing causing movement tends to confirm adherent texture as well, but does not make sense on the "normal" breast.

	This too-high position can also be due to capsular contracture, which can occur more commonly with an axillary incision (because of potential exposure to axillary bacteria causing a biofilm which stimulates your body to produce a tight firm scar). This would have occurred gradually after surgery, and surgical revision is necessary to treat this.

	After 3 years, you need a revision, regardless of the cause. Your surgeon may recommend a crease incision to facilitate the capsular contracture treatment (removal of the capsule in most cases). I'd recommend smooth cohesive silicone gel (5th generation) implants. Best wishes!

Tom J. Pousti, MD · Answer

Unfortunately, sometimes one side settles into the pocket and one side doesn't.  It is very common for one side to settle faster than the other but if you are 3 years out of surgery, things are not going to change with massage.  I find that aggressive massage can help within the first year after surgery. Without examining you, I wouldn't be able to say what is happening but if one side is sitting higher than the other, you may benefit from revisionary breast surgery.  Please make sure that you see a board certified plastic surgeon with experience in revisionary breast surgery.

David Bogue, MD · Answer

There are several reasons why your implant never "settled." Most likely, the pocket was not dissected to the correct position. Teardrop implants require precise pocket dissection and placement so that no rotation occurs with the device. Some surgeons will routinely use drains to eliminate any fluid accumulation to prevent implant rotation. Another possibility is capsular contraction, however this is usually an elevation of the implant from a previously lower position on the chest.

	At this point in time, your implant is very unlikely to change in position and a surgical procedure is likely required to release the lower capsule to lower the implant position.

Peter E. Johnson, MD · Answer

If your implant has remained high after three years it is going to stay that way. The fact that the implant moves upward instead of down and outward suggests that the muscle and fold were not released and that your implant never really had a chance. The pocket must be released and revised to set things straight.

	Best of luck,

	peterejohnsonmd

Eric T. Emerson, MD, FACS · Answer

We commonly see implants somewhat high during the first several months after surgery.  The implants usually drop, however.  Now that you are 3 years out from surgery, I would not anticipate any improvement with massage.  The cause of the asymmetry may never be determined.  It may be due to problems with placement or with capsular contracture.  If you developed a capsular contracture on the left side, it is likely to keep your implant riding high.  I would recommend that you schedule another appointment with your surgeon to discuss revisional surgery.  Best wishes.

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Why Did One Of My Implants Never Settle? Was It Place It Too High?

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Answer: High breast implant after three years

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