Right breast shifts significantly to the right when I lie down, almost in my armpit? (Photos)

I am already dealing with capsular contracture on my left breast. Ive been on singulair since July and am 8 month post op. The plan is to do a revision on the left and now I'm concerned about the right which is the smaller implant at 550cc. The implant seems to slide into my armpit when I lie down. It leaves a serious gap in my chest and I almost feel like I should wear a bra at night to keep it from sliding. Can this be fixed? Does it need to be fixed? Is it normal? Pics were the best I could do.

Doctor Answers 10

Breast asymmetry and capsular contracture

Of the two, the left breast is likely to require surgery. It is common for breasts, with or without implants to move medially (toward the center) when one leans forward and to move laterally (toward the armpit ) when one lays down.....even if there are no implants present. The left breast doesn't move. It is stuck in place because of the capsular contracture.

Treatment involves capsulectomy and implant exchange on the left. Surgery on the right is plus/minus such that the packet modification on the right is optional. 

Big implants

Those implants look big for your frame. If you don't wear a bra at night there will always be a tendency for the implants to move laterally as the chest wall slopes laterally in most cases. If you are right handed this also plays a role in "squeezing" the implant laterally. It's common if you do a lot of chest work as well.

The problem with larger implants is that they are associated with greater complications or issues like the ones you are experiencing. You may want to consider smaller implants that are more likely to work with your body type/dimensions. The use of ADM (acellular dermal matrix) may help a little but I doubt it is going to do the job you want. The interesting aspect of a breast contracture is that the implant will not move and you don't have to worry about it going to the side like a soft, mobile implant. The downside is the stiff breast. I don't know of any non surgical successful treatment of an established implant contracture.

Needs a capsulorraphy

A tightening of the side of the breast capsule, called a capsulorraphy is indicated in your situation. With heavier breast implants in the 500 mL range, I will commonly recommend that we add something that is less likely to stretch than your intrinsic capsule tissues. Gala flex and Strattice have been useful in this situation. Ask your chosen plastic surgeon about these options at your consultation. Best of luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 45 reviews

Capsular Contracture and Implant Malposition

Hello,

Is your surgeon an ABPS certified/ASAPS member surgeon that specializes in revision breast surgery? If not, go visit a few who are. You'll need a total en bloc capsulectomy through an inframammary incision on the left and a capsulorrhaphy through an inframammary incision on the right. Revision surgery carries a higher risk of capsular contracture than primary surgery, so it is imperative that every step is taken to reduce the risk of recurrence. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

When implants are to large

as you suggest yours may be, they can be made smaller with more surgery.  Its not easy to recover from and predictability is also elusive, depending on the technique your surgeon employs to correct your problems.  If it isn't excessive, best to do nothing until you have to deal with your left sided contracture.  Your photos look great from the front at this time.  In the end, it comes down to how much does it bother you and are you accepting of the risks and costs of more surgery.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Capsule repair

Yes, it is possible to repair the capsule a bit so that the implant does not drift to the armpit or lateral chest. 

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Revision

Good morning!

I would perform a capsulectomy for your CC side, and for your lateral displacement in the other side I would perform my Internal Bra procedure.

It can be fixed

while your surgeon has you on the table to fix the cap con on the left, he/she should be able to open the right side and tighten the lateral portion of the capsule. Realize that as your implants are fairly large(and wide) this problem will have a tendency to recur over time. 

Revision

Thank you for the photos and sorry for your complication and YES both sides should and can be fixed.


Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 60 reviews

Breast implant shifts significantly when I lie down...

I am sorry to hear about the problems you are experiencing after breast augmentation surgery.


 Although some “falling to these sides” of breast implants is quite normal when you lie down, if this occurs “excessively”, it may be a concern to patients.  This phenomenon is called lateral displacement of the breast implant;  it may be of concern from the visual and the discomfort standpoints. Surgical correction is an option.



Generally, the lateral breast implant displacement can be corrected using an internal suture technique, decreasing the size of the pockets and moving the implants toward the midline.    In my practice, I use a 2  layered suture technique to close off the space laterally (towards the axilla). The use of acellular dermal matrix is an option ( although not usually necessary)  especially if significant implant rippling/palpability is present.  I hope this, and the attached link (dedicated to revisionary breast surgery concerns), helps.  Best wishes.  

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.