One of my Implants Has "Slipped" out from Under the Muscle

Question

One of my implants slipped out from under the muscle 2 mo postop. This has been evidenced after 2nd mammo 18 mo post op. How should I approach my surgeon. I saw him approx 10 times postop but he denied slippage. Now my breast is migrating out and down as if it is not supported.

Otto Joseph Placik, MD · Answer

I would discuss this with the surgeon. IF you have already done this, your next option is to discuss the revision and possible charges. Alternatively you could get a second opinion to confirm your suspicions.

Joseph M. Perlman, MD · Answer

Although all plastic surgeons would like all of their cases to  have a perfect outcome, it doesn't happen. The reasons may be many including incomplete release of the lower portion of the muscle, where it attaches to the ribs and lower portion of the breastbone or it may be that the overlying breast is not satisfactorily supporting the weight of the implant. The other possibility is that the dissection on that side was carried too far below the inframmary crease but that would be something, that you would see immediately.

	In patients that I see with your problem, the most common reason is that supporting structures of the inferior half of the breast don't support the weight and give way. In this situation I will re-operate on the patient and reinforce the inferior pole ,either using tissue within the breast or  adding a graft made of synthetic dermal matrix. Always consult with your original surgeon and get his opinion. If you're not comfortable with the answer then you should seek a secondopinion

Peter A. Aldea, MD · Answer

"Bottoming Out" the inferior slippage of breast implants are often associated with progressive loss of superior muscle coverage of the implant. This can be caused by several factors acting alone or together. Usually any weakening or over-dissection of the lower aspect of the implant pocket combined with large implants and failure to wear support could result in inferior implant movement with time.

	Correction would need to be an operation in which the lower implant pocket is strengthened either with sutures, or much more reliably with an acellular graft sheet (strattice or Alloderm). Discuss this with your surgeon.

Darryl J. Blinski, MD · Answer

Sorry for your issue. Seek additional opinions from boarded plastic surgeons in your area. Otherwise you may have to travel to get correction.

	From MIAMI DR. B

Steven Wallach, MD · Answer

With time, some implants can migrate downward and lead to bottoming out.  In this case, you should talk to your surgeon to see about a revision.

Michael C. Edwards, MD, FACS · Answer

It is always best to return to your operating plastic surgeon to see how your are doing and if there is a need for a revision surgery. Our goal, as plastic surgeons, is a great result and a happy patient but sometimes there are things that would benefit from correction. I recommend you follow-up with your plastic surgeon to discuss your concerns and then you can develop a plan.

	I wish you well.

	Dr Edwards

John Whitt, MD (retired) · Answer

I agree that you should discuss your concerns with your operating surgeon and obtain a second opinion if he/she is not helpful. However, most implants are not covered by muscle inferiorly as most surgeons release the muscle from its origin inferiorly and medially to a degree. So there is likely another explanation for your asymmetry.

One of my Implants Has "Slipped" out from Under the Muscle

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