Is there any way to get my implants to stop flipping? Need revision, not sure which way to go.

Question

I have HP415 implants above muscle. The left keeps flipping so the flat side is facing out. My surgeon flipped it back manually 2 times, but now he can't. I've seen a few 'revision experts' & the simple solution offered by one was to go in and make the capsule a little bit smaller to prevent it from flipping back. I've also been told full capsulectomy and switch to textured implants or put under muscle. I need a revision, but which is best? How do you fix an implant that keeps flipping?

Eugene Kim, MD · Answer

There are many options to prevent an implant from "flipping."  You can choose a larger size, adjust the pocket to make it smaller so there's no room for the implant to flip, create a new pocket under the muscle or use textured implants.  You can also use a combination of these different options.

Gerald Minniti, MD, FACS · Answer

Hello,
When a device is roughly the shape of a ball, you can imagine there is little impediment to flipping, because it's really just rolling or spinning. Combine this with a subglandular pocket that will always expand beyond the dimensions of the implant, and you can see how this could happen, over and over.  There are a variety of fixes that may or may not suite you, but if you are going to have a revision surgery, I would want it to be your last for a very long time, and I'm sure you feel the same way.  The best, most durable fix would be to remove the implants and their capsules, and create a new subpectoral space for implants that are lower profile if round and smooth, or shaped and textured, my preferred device (lowest complication and re-operation rate of all implants). There are plenty of surgeons to visit in this town, but only a few who are ABPS certified/ASAPS member surgeons who specialize in revision breast surgery, and have done so for decades. Best of luck!

Anita Patel, MD, FACS · Answer

If the implant is continually flipping, it is really a combination of factors that are involved. One important factor is the size of the pocket that the implant is in. Other important considerations  are the profile of the implant, and the width of the implant in relation to your breast diameter. The higher the profile the rounder the implant, making it theoretically easier the flip. Also, the greater the discrepancy between the implant diameter and your breast diameter, the higher the chance of it moving or flipping (meaning if the implant chosen is narrow compared to the width of the breast, it has a lot of wiggle room) Smooth texture also does not adhere to the adjacent tissue, whereas a textured implant does. However, this does not mean you need a full capsulectomy and changing to a texture implant. If you go back for surgery, the first matter is confirming proper implant choice, and the second matter is choosing the location of the implant. I prefer placing implants under the muscle for reducing the risk of capsular contracture, allowing easier visualization of breast tissue during mammogram, and providing a less obvious implant look. Thus, assuming the implant size and profile is appropriate, I would likely recommend moving the implant to behind the muscle (or "dual plane") position, rather than doing the "quick fix" of reducing the size of the pocket, though that is also an option. You would really need to be seen in exam to give definitive recommendations since the above is based on limited info and no exam. Make sure the surgeon you choose is a board certified plastic surgeon (certified by the American Board of Plastic Surgery) who has experience doing implant revisions.

Ritu Chopra, MD · Answer

I think you have answered your own question. Things that can prevent flipping are a smaller pocket, decreased profile implant and a textured implant. Any and all of these things will help with your problem. The best thing to do is discuss all  the options with your surgeon to come up with a game plan. I hope this helps!

Daniel Barrett, MD · Answer

Dear candyapples478,it is hard to tell for sure without an examination. Generally speaking, the main of implant flipping is too big implant pocket. In most cases, a simple surgery to reduce the size of pocket should prevent it. If you are considering a revision surgery, I would suggest you to consult your plastic surgeon. Only after a thorough examination you will get more information and recommendations.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Tim Sayed, MD, MBA, FACS · Answer

As others have said, techniques to help you get your implants to remain stable in position without rotation can include:1. Going into a submuscular/dual plane - the muscle may help limit the implant's ability to move2. Tightening the pocket around the implant - this will give it less room to move around3. Increasing implant size - this can reduce the mismatch between implant diameter and pocket width4. Using a textured implant - these may stick to the chest wall in position more reliably, though they have risks including higher likelihood or leakage, ALCL, and other issuesExam in the office allows the surgeon to assess the factors at play and formulate a cohesive plan.

Lisa Cassileth, MD, FACS · Answer

Implants can flip with bigger pockets, it's pretty rare as they usually like to lie with the flat side toward your chest wall. I've fixed these with capsullorrhaphy, which is just making the implant pocket smaller, and that has always worked. If your surgeon wants to go gangbusters and make it IMPOSSIBLE for it to flip, then "roughing up" or removing some of the capsule and switching to textured implants, that stick in place like velcro, would really be effective. Personally I hate textured implant as they ripple and doing a whole capsulectomy is a big surgery to fix a small problem, so that would only be a last resort for me.

Tom J. Pousti, MD · Answer

I am sorry to hear about the problem you are experiencing. Careful physical examination and communication of concern/goals would be necessary to provide you with good treatment plan. Having said that, I think that it is likely that conversion to the sub muscular space ( creating a new "pocket") will likely be in your best interests.  The other option you mentioned is also possible:  closure of the current breast implant pocket (capsulorraphy) such that the breast implant has less space to move in.My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with (with revisionary breast surgery). Then, communicate your concerns and goals carefully, as well. Working together you will come up with a good plan to achieve your goals. 
 Best wishes.

Frederic H. Corbin, MD (license restricted) · Answer

Sorry for your problem and would go on some complimentary consultations with experts and compare recommendations and become fully informed about the desired procedure after a full examination Dr Corbin

James McDonough, MD (retired) · Answer

The simplest is to replace with round smooth implant.  The have the same profile front and back so if they flip they will look the same

Is there any way to get my implants to stop flipping? Need revision, not sure which way to go.

Answers (10)

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