Breast implant lateral displacement - is this because of placement of implants or anatomical issues? Can it be fixed? (Photos)

Question

I have some concerns about my breast implants. I’ve had them for over two years now, but I feel like they sit too far to the sides. I asked about it and was told it’s because I have a wide chest/rib cage, but honestly I’m worried they may have been placed incorrectly. They don’t hurt, even when I lie down — I just don’t like how they look. Based on this, does it sound more like an anatomical/chest structure issue, or could the implants have been placed incorrectly?

Emre Guvercin, MD, FEBOPRAS · Answer

Based on your description, this sounds much more like an anatomical characteristic of your chest and breast footprint than a surgical problem. Not all breasts naturally point straight forward, and patients with a wider chest wall, greater intermammary distance, or laterally positioned breast footprints often continue to have breasts that sit somewhat toward the sides even after augmentation. If the implants are comfortable, symmetrical, stable, and have looked the same for more than two years, that argues against significant implant malposition or a pocket problem.Many patients expect implants to create cleavage or bring the breasts closer together, but implants can only fill the existing breast footprint&mdash;they cannot completely change where the breasts originate on the chest wall. Based on your description, there is no indication that the implants were placed incorrectly, and what you're seeing is likely the expected result given your underlying anatomy. Unless there is obvious asymmetry, excessive implant movement, pain, or progressive changes over time, I would not consider this a complication. In other words, this sounds like a normal result for your breast anatomy rather than a surgical issue that requires correction.

Frank Agullo, MD · Answer

You are experiencing two problems simultaneously: the wide dimensions of your chest and a lateral pocket which, in all likelihood, was too extensively separated during the augmentation with your previous surgeon. Wide chests have considerable horizontal surface area for the implant to move out into. The fact that you have tight cleavage in the standing position is reassuring, signifying that the issue lies not with the actual structure of your body. Instead, the issue appears to be a migration of the outer edges of the implants into the periphery of the pockets, too far out to either side, creating the noticeable separation between your breasts. In such cases, I use a capsulorrhaphy procedure to suture the lateral parts of the pocket together using permanent stitches. To ensure that the reconstructed pocket will not expand again over time, it is usually additionally reinforced with either GalaFlex or P4HB mesh. If the base of your implant is also far too broad for your chest, I downsize the implants at the time of the revision. While subfascial placement is often helpful for narrowing wide chests, in your situation, the pocket reconstruction takes care of the majority of the work required to achieve this result. No pain at two years is reassuring and the look is fixable.

#StayBeautiful,

@RealDrWorldWide

#StayBeautiful,

@RealDrWorldWide

John LoMonaco, MD, FACS · Answer

If you liked the original result after surgery, it probably means your pockets stretched and allowed the implants to move more to the side.  This can happen more quickly in patients with larger implants or if the skin is stretchy.

An exam would tell me if your implant pockets are loose.  In that case, a suregry to reposition and reinforce the area would probably improve the problem.

Vasileios Vasilakis, MD, FACS · Answer

Hello,
Thank you for the question. Your result is very good. If anything, you might benefit from a small adjusting inside the pocket, which your plastic surgeon can certainly perform. 
I wish you the best. 
Vasileios Vasilakis, MD, FACSDouble Board Certified Plastic SurgeonHouston, TX.

Daniel Barrett, MD · Answer

Dear FranaDubois,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Carlos Alberto Ríos García, MD · Answer

Based on your photos and description, this appears more likely to be a combination of:
* your natural chest/rib cage anatomy* implant pocket positioning* and the way the implants settle laterally when lying down or relaxing
The reassuring part is that I do not see obvious signs of a dangerous complication such as severe capsular contracture, rupture, or major bottoming out. Your implants actually appear relatively soft and mobile.
That said, I do understand your concern about the breasts sitting too far toward the sides and leaving less fullness toward the center of the chest. In some patients, this can happen because:
* the chest wall is naturally wide* the breast footprint starts laterally* the implants are too wide for the frame* or the implant pockets were dissected too far outward during surgery
Often, it is not purely “bad placement” nor purely anatomy, but rather an interaction between both.
The good news is that this type of issue can often be improved if it truly bothers you. Depending on the anatomy and implant dimensions, revision options may include:
* lateral pocket tightening (capsulorrhaphy)* changing implant size or width* changing implant plane* or improving cleavage support internally
In our practice, we frequently evaluate patients with concerns about implant positioning and breast asymmetry, and one of the most important things is distinguishing between normal anatomical limitations versus a pocket that can realistically be improved surgically.
At two years post-op, what you are seeing now is likely close to the stable long-term result, so if the appearance continues bothering you emotionally, it would be reasonable to seek an in-person revision consultation with an experienced breast revision surgeon.

Breast implant lateral displacement - is this because of placement of implants or anatomical issues? Can it be fixed? (Photos)

Answers (6)

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