This is an excellent question, as it is a question which arises frequently, and you are correct that ladies with thinner tissues and greater physical activity are probably a bit more at risk for this problem. While there is no way to absolutely prevent any complication like this with breast implants, there are a number of things that can be done to help minimize the chances that your implants will displace laterally, or fall out toward the armpits, some of them are your surgeon's responsibility, and some are yours. The first thing that must be considered is that an appropriate implant must be selected. This means size as well as type. It is well known that the larger, thus heavier, that the implant is, the more stress it will impart on the tissues. The more stress on the tissues, the more chance there will be that they will weaken under that stress and lose support for the implant. The second implant related consideration that should be made is that textured implants, whether shaped or round, should be considered. One of the advantages of textured implants is that the texturing process creates some friction against the tissues, and this helps to maintain the position of the implant and prevent migration. Thus, between you and your surgeon, the choice of implant will be of the utmost importance, as it is likely to have a huge impact on this issue for you.The next couple of considerations are very important considerations, and they fall entirely on your surgeon. The first of these is that it is absolutely imperative that the pocket not be over-dissected, or made too large, especially laterally, by the surgeon. This is a more common mistake than you would think, and it is very hard to recover from once the natural attachments of the tissues have been violated. The way to control this is for the surgeon to appreciate the natural anatomical borders of the breast pocket and respect those perimeters. I typically mark the limits of my complete dissection, especially medially and laterally, on each patient prior to surgery, and this is based upon base dimension and desired placement of the implants. Additionally, I use a dual plane dissection on just about everyone, as this allows me to see the entire border of the pectoralis muscle, especially laterally, and this is one of the most important landmarks in guiding proper pocket dissection. Second, the pectoralis muscle must not only be detached completely at its lower border, but it must be released properly at the lower inside corner, and then weakened enough along the sternum for the height of the pocket to decrease animation effects on the implant when flexing the muscle, but not so much that symmastia (commonly called "uniboob") is risked. Once we decide to put implants under the muscle, activity of the lower muscle is our enemy, and we should carefully attend to this. In addition to preventing displacement of the implants, this also creates a generally more natural look, too, in my opinion.Next, you're back in the hot seat, as the next couple of things are on you! First, you should get used to wearing good supportive bras most of the time. Sorry, but this is not the time to be a bra-burning feminist like in the 60's and 70's! The breast tissues will need support to fight against the deforming forces of the heavier implants. This means good bras during the days and good sports bras for athletic activities. I personally think sleeping without a bra is just fine, although sleeping with a comfortable lightly supportive cottony bra seems like it would give an extra measure of security, too. I also think the occasional weekend braless in a tee shirt, or an evening in a nice strapless gown is fine too. I just mean you shouldn't make it a habit of not wearing a bra anymore. In addition to that, I have made the recommendation to my patients, including those who are fitness instructors, professional figures and bikini competitors, martial artists and MMA fighters, and other similar athletes, that we have now made a trade-off with beautiful breasts in exchange for any ambitions of really huge, well developed pecs, and therefore, we need to modify our pectoralis strengthening activities in order to limit that downward and outward force on the implants. This doesn't mean necessarily no bench press or pushups, but we need to do only enough for tone and even strengthening of the shoulder girdle, and not in excess to specifically develop the pecs. I'm a big fan of flyes as a chest exercise for ladies with implants, as those tend to elongate the pecs and stretch the capsules, as opposed to the opposite. Back exercises, like pull-ups, lat pull-downs, rows, and the like are all just fine, as they won't isolate the pecs in general.So, those are my recommendations, and although nothing is 100% fool-proof, I can tell you that I don't have a problem with lateral displacement or bottoming out of implants in my practice, and in Southern CA we have a lot of patients with very active, sports-minded lifestyles. These things seem to work for me, so I hope this information is useful for you too. Good luck.
