Is This Lateral Displacement? If So, Early Enough to Stop It from Getting Worse? (photo)

Breast augmentation surgery makes you a larger version of yourself. If you start with a wide bony cleavage gap and lateral flare of your breasts and nipples you typically retain that anatomy. Some patients are predisposed to lateral displacement which is essentially a normal effect from gravity. Women with sloping chest walls or with widely spaced breasts who go with larger implant sizes or have poor skin tone should realize that lateral descent of the implant is always a possibility over time. Implants do not defy gravity which is not only downward, but also lateral when you lie down. I do recommend underwire bra support day and night, and using those clips that secure the bra as a racer back seems to close the gap. However, this is an anecdotal experience, and there are no studies proving bra support helps or prevents this condition.  You appear to have a satisfactory result and would not advise you to have surgery at this time based on your photos.

During breast implant surgery a #pocket is created carefully to maintain certain folds on the sides and bottom of the breast. Occasionally, the space for the breast implant becomes too large on the #side of the chest or the tissue stretches and the implants fall too much to the side. This is most easily seen when the patient is lying on her back. At times, the implants can move towards the patient’s armpit.Yes, it is possible you are experiencing displacement. However, it may be due to your anatomy. Also,  it is still early into your healing  which will continue for 2-3 month. In fact,  it can be up to one year see your final result which is why it's best to wait to see the results.  It's usually best to wait 6 to 12 months depending on the reason for #revision and there is no guarantee another surgery will improve upon your current situation. Right now, it's best have patience and if there are any causes of concern, ask questions of the doctor or the nursing staff.

Hello W,

You have a very lovely result, especially given your lean body and smaller breasts. You have some lateral displacement in the breast opposite the arm holding the camera; the other breast looks to be in good position.  I don't think 24/7/365 bra will do much over time, and things will settle as they will settle regardless.

The problem is tissue expansion and loss of elasticity from the implant; this issue is made worse by saline filled implants, which have more density and a greater elastic component compared to silicone gel filled, worsening this expansion effect.

I think it would be reasonable to wear a bra as much as possible for the next month or two, while the implant scar capsule is still maturing and strengthening.  After that, just regular support. Also, please don't sleep on your belly!!

Best of luck!

Most likely you are experiencing “lateralization” or “malposition”of your implants. Lateralization is a phenomenon that is quite common in those who had smooth walled implants placed at their original surgical procedure. Smooth implants do not adhere to the surrounding tissues. As a result, they can slide, thereby increasing the size of the implant pocket over time. Fortunately, there is a solution to this problem. It involves the use of a textured implant and what is known as the Popcorn Technique.Before the introduction of textured gel implants into the US market 4 years ago, I found it quite difficult to surgically treat lateralization. Typically, treatment would involve trying to move the implant pocket towards the center of the chest. This involved placing sutures in the sides of the pocket. The process was time consuming and frequently would result in puckering of the sides of the breast with an unnatural look. Many times the repair would fail, resulting in asymmetry or recurrence of the problem. The only alternative was to use a dermal matrix, which is a biological sling derived from cadavers. Dermal matrices are extremely expensive and may introduce a higher chance of infection. They can also be technically challenging to use for this purpose. The Popcorn technique eliminates these issues. It is technically simple to perform, and the results are natural and long lasting.

Yes BUT. The standing result is so very good that messing with further surgery would or could cause a possible worsening of the result. 

Its natural for implants to fall to the side when laying down.  Your result is good and you should check with your surgeon for further advice.  If you absolute abhor the lateral movement, you can consider changing to textured anatomic implants that don't move much at all when supine.  Remember, your results are very good!

No.

This is a nice result. Your breasts are naturally wide spaced, and the implants can only be placed where the breasts are. By two months, your capsules are well formed, and I see no necessity for wearing a bra 24/7, but do check with your surgeon. I really see nothing to revise. 

All the best. 

Hello 'wannabme4me', thanks for your question.  Although your augmentation looks aesthetic when you are upright, I understand your concerns when you are lying down.  You have several risk factors for this lateral displacement effect, which is ultimately due to lateral sagging of the implants in their pocket due to the effects of gravity.  The risk factors include the use of larger implants and placing them under a thin and deflated breast tissue envelope which lacks sufficient support for the implants.  This may be exacerbated by over-dissection laterally in the implant pocket.  The fact that you have saline implants also puts you at higher risk of noticeable rippling laterally, especially when you bend at the waist.  Although wearing a snug support garment initially may help limit the implant pocket space laterally, at 2 months I would say the vast majority of healing has taken place and will not affect pocket size.  However, I do recommend continuing to wear a support garment to prevent gradual stretching of the implant capsule further due to gravity, which can worsen the lateral displacement effect with time.  Although you are probably OK for now, you may need a revision in the future if it gets worse, which usually entails providing lateral pocket support with the combination of capsulorrhaphy sutures and/or placement of acellular dermal matrix tissue, such as alloderm or strattice.  Be sure to maintain your close followups with your board-certified plastic surgeon, who should be well-trained and adept at handling these postop issues.  Good luck! -Dr.92660