Big Pocket Under Arm After Breast Augmentation

I have Saline implants under the muscle and my right implant has always been a little off to the right. If I flex my chest muscles, my right implant goes under my arm. When laying on my back, it almost touches the bed. About the 4th day I had them, I was trying to shave my under arm and couldn't. There is a big pocket under my arm. Is it possible that it was put under the wrong muscle?

Doctor Answers 13

Muscle junction repairs necessary to support the implant

As the other doctors mentioned the pocket for your breast implant was made too large and too far laterally (on the side).

The symptoms you describe occur when the junction or attachment of two muscles--the Serratus Anterior Muscle and the Pectoralis Major Muscle--is violated or pulled apart during surgery to place the breast implant. Normally, these two muscles are fused together on the side of the rib cage and prevent the implant from sliding out to the side under your armpit.

These muscle attachments can be repaired to push the implant medially (toward the center of your chest) and provide support to keep the implant from sliding out under the arm.

This is a fairly sophisticated and technically difficult procedure, but done correctly can solve the problem.

You need to find an experienced, board certified plastic surgeon who does a lot of breast implant surgery and who has done this procedure successfully before.

Seek the opinion of two board certified surgeons and ask specific questions about their experience with this technique. The surgeon you select should use permanent sutures for the repair, and taping and or support garment to protect the repair for about 2 weeks after surgery.

Your pocket is to wide

Sometimes a saline implant can drift laterally if your chest wall angles outwardly. If you noticed this immediately after surgery when shaving, the pocket was made too wide during the surgery. The only was to improve this is to surgically tighten the lateral pocket with sutures. This is not always as easy as it might seem so be sure the surgeon who does this has lots of experience. Good luck!

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

It requires a surgical procedure to tighten the pocket

Implants that slide off the side of the chest are caused making the pocket too big to begin with or using the muscle too much or having heavy implant that stretch the tissue. When the implants are put under the muscle the weakest part of the pocket is the outer aspect. The creation of the pocket has to be done in a careful manner not to over dissect the outer aspect. If you do too much heavy lifting and contracting of the muscle it will push the implant to the side. And if you have large, heavy implants the ribs may slid it to the side when you are laying down. These are the causes of implants that have fallen to the side.

To correct the wide pocket you have to either redo the pocket or close the wide open pocket on the side of your chest. This is done inside the pocket and does not require additional scarring on the outside skin. Each surgeon will have different levels of experience as well as techniques for correcting this issue. Feel free to have an open discussion with you surgeon to get a good understanding of what needs to be done.

Marcus L. Peterson, MD
Saint George Plastic Surgeon
4.6 out of 5 stars 38 reviews

You need revision of breast augmentation pocket.


When your breast implants were put in, the right pocket was made too large to the side. So the implant slides under your arm.  You need a revision to close off the outer lateral part of the implant pocket.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Not likely.

Without getting too technical or boring, the muscle (pectoralis major) is a large fan shaped muscle overlying the anterior chest. It attaches to the upper arm and helps move it.

When the implant is placed under this muscle, it must first be lifted off of the ribs and a "pocket created" for the implant to reside.

What it sounds like to me is that the dissection was carried out too far laterally, and as a result, gravity or muscle action causes the implant to displace to your arm pit, or too far to the side. Alternatively, the dissection could have been done properly, but the tissues were weak and the pocket stretched. Curious that the other side did not.

In any event, it sounds like the bottom line is that you have a malpositioned implant, and it will likely require a revision.

I hope this helps.

Scott E. Kasden, MD, FACS
Dallas Plastic Surgeon
4.7 out of 5 stars 101 reviews

Lateral migration of the implant is a difficult problem

Lateral and inferior migration of the implant is one of the biggest complaints about breast implants surgery. The weak spot, when the implant is placed under the muscle, is the lower outer quadrant. There is no muscle at this point. It is possible to raise a portion of the serratus muscle along the side to give an additional "buffer" to block lateral migration.

Time, weight, gravity, muscle activity, physical activity, your anatomy, elasticity of your skin, and shape of your ribs can all contribute to this outward displacement. This can be corrected by an internal capsule procedure; sometimes this requires tightening the capsule laterally and releasing it medially. The hope is that your muscle is now stretched out and has formed over the implant so that the repair will reposition the implant and prevent future displacement.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Please see your treating plastic surgeon

Thanks for your question. I think it is imperative that you continue your follow up with your plastic surgeon. He certainly understands your anatomy and the procedure he/she performed. What you described sounds like the implant has migrated laterally and the “pocket” may be oversized. If revision surgery is required, I usually wait about 90 days. Again, please see your treating plastic surgeon to discuss your concerns! I hope this helps to explain your concerns.

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

Forced pectoralis contraction can shift implant outside

When the implant is placed under the muscle, forced contraction of the pectoralis can shift the implant to the outside. I would discuss this with your surgeon. In the meantime, you may want to consider (after consulting with your surgeon:)

1. Avoid pectoralis contraction: bench press, push-up, or pec deck exercises;

2) Take an underwire bra and cut out the cup so that the breast pops out where the cup used to be and is held in place, so that it does not shift to the outside especially at night when supine. Wear this 24/7. This may allow the breast implant to heal in place and the pocket to contract, especially in the early phase of wound healing. I hope this helps

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Big pocket under arm can be fixed

From your description, it sounds like the pocket was made too far lateral. By placing a row of internal stitches under the arm and opening the pocket on the inside, the implant will be repositioned to a more natural position. Ask your surgeon.

Robert M. Jensen, MD
Medford Plastic Surgeon
4.8 out of 5 stars 40 reviews

Get back to your surgeon immediately and show him/her


I am assuming that you are very early out from your surgery, in which case you should return to your surgeon post haste.  He/she may be able to tape the outer pocket closed to keep your implant pushed to the center of your breast before your permanent capsule develops.  Good luck!

Kenneth R. Francis, MD, FACS
Manhattan Plastic Surgeon
4.6 out of 5 stars 47 reviews

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.