Is this lateral displacement? Can the lateral/inferior/medial border be secured w/ perm stitching? (Photos)

Thank you for your question. Based on your concerns and the photos you provided, it’s important to distinguish between normal lateral implant movement and a true widening of the pocket that may require surgical correction. Implants can naturally shift slightly outward when you are lying down, particularly in cases of over-the-muscle placement, because they are not supported by the pectoral muscle. If your implants slide significantly outward when sitting or standing, or if you notice tenting in the medial skin, asymmetry, or difficulty maintaining cleavage, this may indicate an excessively expanded lateral pocket. If an in-person evaluation confirms the widening of the lateral pocket, you might need capsulorrhaphy (internal permanent sutures) or reinforced sutures or mesh, such as GalaFLEX.

Hello. Thank you for your question.
It is not uncommon to repair the capsule with absorbable sutures. However, if the capsule is particularly thin, the repair may not be durable, regardless of what type of suture is utilized. In patients with compromised soft tissue support ( thin capsule and poor skin elasticity), it is often helpful to utilize absorbable mesh to help reinforce the capsular repair. I hope this helps. Good luck.

Dear Energetic425057,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Yes, permanent sutures can be used in these areas. It seems you have a very complicated case with different forces in effect, and placement of sutures and one area can certainly effect a negative outcome in another area. It is probably best to listen to your plastic surgeon carefully and understand the expectations of a tricky case.

Thank you for providing photos. It is very normal to have some lateral movement of implants when laying down. To properly diagnose a widened lateral pocket, an in-person evaluation is necessary. If your breast pocket is too open laterally, there are procedures to go in and tighten the pocket down and aid in keeping the implant in appropriate position on the chest wall.

Permanent sutures can be used to repair but you would also benefit from pocket repair and exchange. I recommend placing the implant behind the muscle and repair the pockets inferiorly and laterally to prevent lateral dislocation. The other alternative is explantation, allow everything to heal and then consider fat transfers or smaller implants.

Best Wishes,

Gary Horndeski, M.D.

I often see patients with similar concerns who come in for revision breast augmentation concerns. I typically change the profile of the implant if bottoming out and lateralization concerns are both happening. Combined with a slow dissolving or permanent suture capsulorrhaphy and a breast splint that is worn for 3 weeks continuously and then 6 more weeks at night.

the photo in flat position seems to show lateralization of the right implant. This can occur for a variety of reasons including surgical technique and native tissue strength among other considerations. Depending on the timing of your previous surgery, you should allow for at least 4-6 months for healing before considering additional revisionary surgery. However, displacement can be addressed with adjustments to the internal capsule. Additionally, an absorbable mesh (internal bra) could be considered to further strengthen this repair to better support the implants over time.
Sean Fisher Aesthetic Plastic Surgeon Seattle, WA

Breasts with or without implants do fall to the sides when you lay down. This is natural. However, if you want, the lateral pockets can be tightened so that there is less movement. The medial borders could also be tightened if you wanted. Although your photos are not ideal, the inferior borders seem fine. Go back to your surgeon and discuss your concerns. I do not suggest going larger.

There are several techniques, one would be with a special suture to close up the lateral side of the pocket (I prefer barbed suture) , another option would be the use of a mesh (Galaflex) that will work as a inner bra to give support to the implant, and work as a scaffold to avoid bottoming out/displacement. I would also do some fat grafting to the inner poles of the breast to increase the tissue that cover up the implant specially on the inner aspect of the breast.