Wide gap when lying down after breast augmentation. What can be done?

Question

I had a BA 4 months ago (silicone,round,smooth,under,500cc mod profile (5'10,135lbs)). I love the way they look when I stand up, I have maybe a one finger space. But when I lay down they fall to the side and I have an almost 4 finger gap. I already spoke to my doctor and he says its normal, it's just the gel shifting and nothing can be done. But it feels like the whole implant is moving to the sides because the gap is not there when I stand up. I'm seeing another doctor soon but want more opinions.

George Volpe, MD · Answer

All breasts to the side of bit when lying on one's back. However if the gap between your breasts is too large this can be surgically corrected utilizing sutures that close the outer portion of the implant pocket. A big question is whether this is worth it to you that is should one undergo a surgical procedure with inherent risks to improve this situation. If you are happy with your breasts when you're standing upright, you may wish to thank about all your options. Discuss this with your surgeon regarding risks and possible benefits.

Jose M. Soler-Baillo, MD, MS · Answer

Thank you for your question.  What you are experiencing is not necessarily uncommon.  The implants falling to the side can be correct by a pocket revision.  This would require another surgical procedure, so please take this into consideration given that you like your results when standing up.All the best,Dr. ResultsMiami, FL

Franklin D. Richards, MD · Answer

To have some separation in the middle of the breast after breast augmentation surgery is normal, but excessive width could be due to pocket expansion.  If the pockets have expanded laterally you will need to have a surgical repair known as capsulorraphy where the surgeon will go in using an internal suture to close the pockets laterally, pushing the implants inward to minimize the gap.

Young R. Cho, MD, PhD · Answer

Thank you for your question.  It sounds like from your description that the lateral (outer) pocket may be too large allowing the implant to displace.  This can be corrected by narrowing the pocket down, or by creating a new pocket and being mindful not to oversize it.  Good luck.

Nelson Castillo, MD · Answer

Thank you for your question, and I am sorry that you are having difficulty with your implants.  Without a photograph, or in-person examination, it is difficult to know exactly what is taking place.  It sounds as if the pocket within which your breast implants are sitting is too large.  This can occur either at the time of surgery with over dissection of the pocket, or over time with larger implants as they can stretch the tissues.  I would recommend you see your plastic surgeon for an examination. They will best be able to make treatment recommendations.

Vincent N. Zubowicz, MD · Answer

From the description it's possible that the pockets are larger than needed for your breast implants. If over dissected laterally gravity will pull the implant out of position when you're in the recumbent position. This is something your plastic surgeon can discuss with you.

Jed H. Horowitz, MD, FACS · Answer

This can be common after breast augmentation if the implant is smaller than your implant capsule or pocket. You didn't mention if your augmentation was a primary surgery or a revision of a previous implant? In either case, to correct implant movement requires revising the pocket that the implant is sitting in so that it does not have as much space to shift with your body movement. #PlasticSurgery #BreastAug #Implants #Implantmovement #recovery

Nana N. Mizuguchi, MD, FACS · Answer

What you are experiencing is lateral migration of the breast implant.  Some lateral migration is natural and normal and impossible to avoid because of gravity.  Some women are more prone to it because of the nature of their chest wall that slopes downward when they on their back.  Thinner patients are more prone to this. Surgical planning is important because when they are too close, you can get uniboob.  Textured silicone gel implants may be helpful.  For my patients, I encourage them to wear a sports bra at night for the first year and avoid any chest exercise.  Some patients will still get some lateral migration.  I have included a video of a lady one year out with minimal lateral migration.Best wishes,Nana Mizuguchi

Nathan W. Patterson, MD, FACS · Answer

While I can't be certain without an examination in person, it sounds like your implants are moving laterally when you are in certain  positions.  This situation can happen with wide implants, wide pocket dissection, weak tissues, or just over time.  Various repair methods exist but all involve surgery - cauterize the lateral pocket for a small improvement, suture the lateral pocket for more improvement/stability, strengthen the pocket with a mesh or ADM (Flex HD, Alloderm, Strattice), change the implant, or a combination of methods.

Patrick C. Wilson, MD · Answer

Your description sounds like you have had an over-dissected breast implant pocket during the surgery, although a physical exam is required to know for certain.  I would recommend getting a second opinion from a board certified plastic surgeon.  The most affective means to correct this problem is with a biological mesh, such as Strattice, to form a hammock to push your implants back towards the center of your chest.  I wish you the best with your problem.

Wide gap when lying down after breast augmentation. What can be done?

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