What Does It Take to Lower a Sub-muscular Implant Pocket? Can It Be Done in the Office?

In general, it is easier to lower an implant then raise one.  It all depends on what is holding the implant higher.  Does the pocket simply need to be released from the inframammary area to allow the implant to sit lower?  Does the entire capsule need to be released and scored for the entire pocket to change?  These things are hard to say without seeing you in person.  Certainly this can be done in an office under sedation if your surgeon has an operating suite in their office and is comfortable with it.  I hope this helps.

It is quite straightforward to lower a breast implant pocket. However, I do everything in a fully accredited outpatient surgery center, and would not attempt this in an office setting. There are risks of implant damage, it would need to be removed and replaced for the pocket adjustment, bleeding, infection, etx, and all these risks would be minimized in an operating room. Plus, patient comfort is important!! 

Lowering the implant would most likely be accomplished with a capsulotomy after excluding the possibility of capsular contracture as the cause of your elevated implant. I would prefer performing this in an operating room or operating suite.

It sound like you may have either a capsular contracture or inaccurately developed pocket at the time of surgery. Regardless, the capsule needs to be released so that  the pocket can be reshaped and the implant repositioned. If you mean it would be performed with local anesthesia only then this is not an office procedure.

Dr. ES

I've encountered this complication, and managed it in the operating room under sterile conditions and under anesthesia. The issue is that the supporting infra-mammary fold and perhaps also the pectoralis muscle needs to be modified. To do this under direct surgical vision may require removing the breast implant. I would be wary of a surgeon that suggests doing this revisionary breast procedure under 'a little local in the office'.

Lowering the fold on onse side for minor asymmetries( which in most cases is normal) probably should be avoided to avoid the risk of forming a double bubble.  This has to be done int he operating room.

It is difficult to answer your question without photos and examination.

You may have capsular contracture, which is the tightening of the capsule around the implant.

I highly recommend having the surgery done under anesthesia in an accredited surgery center.  It is a painful procedure if done in the office and will increase the risk of damage to the implant.

Your question addresses two separate issues:

1. How to lower an implant

2. Appropriateness for in-office surgery

How to lower an implant that is placed sub-muscularly depends on why the implant is sitting high.


Is there an element of capsular contracture?

Was the implant placed via a transaxillary incision and the pectoralis was not released inferiorly?

Is the right breast fold anatomically higher than the left?


It is definitely possible to lower an implant by treating the cause of the elevation. Whether or not you have this in an office setting depends upon the office. For those with a certified surgery center, this is essentially an operating room with the same standards of sterilization. I would not recommend a corrective surgery of this type to be done outside of an operating room because of issues of sterility and the use of implants.

When you ask can such a surgical revision be accomplished "in the office" the answer depends on how well equipped your surgeons office operating room is. The operation to reposition an implant requires a surgery that in many ways is equivalent to the original augmentation operation. The same equipment and the same anesthesia is necessary to successfully lower your right implant as was required to insert it originally. Many surgeons have office operating facilities designed to accommodate primary augmentations or secondary procedures to correct complications from the primary. If your surgeon does not routinely perform these procedures in his office operating suite then I would question the wisdom of attempting to correct your problem at that location.