Is this possible lateral displacement? (Photos)

Question

7 weeks post op, silicone overs. Starting to worry about how my boobs lay/fall when I lie flat. When laying flat, the skin at the bottom/center of my boobs is saggy. I’ve got a large gap now. I wear a bra 24/7, underwire during the day & sports bra at night. When they fall into my armpits it’s almost painful. My nipples are also starting to point out. Could this be lateral displacement? I’m planning a revision to go larger & hoping to add more projection & upper pole fullness.

Christopher V. Pelletiere, MD · Answer

All implants should be able to move a little bit, just like a regular breast does.  However, if the implants are falling more and more into the armpits when laying down then this is a problem.  This is generally not something that gets better on its own and would require securing the pockets internally to not allow that much movement.  At the same time, you could also change to a more projecting implant.  I would discuss this with your surgeon or have a second opinion with a board certified plastic surgeon who does lots of breast revision work.  I hope this helps.

Daniel Barrett, MD · Answer

Dear AlexandriaInTexas,I understand your concern and it is quite normal to be concerned about the outcome following a breast augmentation surgery. However, you are still in the very early stages of the healing process at 7 weeks  post op.Your will need to be patient at this moment and follow what your surgeon has instructed you to do post operatively.At the early stage of the healing process, the tissues around the implants are still swollen. Once the swelling subsides and the implants drop to their final position, you will be able to see the final result of your breast augmentation surgery.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Robert D. Wilcox, MD · Answer

Dear AlexandrianTexas, 
  
It is normal for a woman’s breast to fall to the side whether she has implants or not.  If it becomes excessive with the implants, that can be problematic.  What you might consider doing at this early stage is wearing a bra 24/7 for the next six weeks with a small dish towel laterally to keep the breasts centered as much as possible and hopefully the capsule will accommodate that position.  If not, and you are dissatisfied with the movement, I am afraid it would require revisional surgery to tack down the pocket laterally.  I hope this has been helpful.
Robert D. Wilcox, M.D.

Emily B. McLaughlin, MD, FACS · Answer

Thanks for your question and your awesome photo editing. Love it! It is early...only 7 weeks; probably feels like an eternity to you but very early. Implants naturally fall to the side when supine (on your back). The discomfort you are having in the upper part of the breast is likely the implant pulling on the early capsule that has formed. Sounds like you're doing everything right with your bra. That you are planning a revision for larger with concern for implant position this soon after primary augmentation is a little concerning. Keep in mind to effect larger, heavier implants have on the tissues...more tissue stretch and possibly more implant malposition. Give yourself more time to heal before making a decision for implant exchange. I'm sure your surgeon has recommended just this. Good luck and happy healing!

Ven Erella, MD · Answer

Thank you for your question. It is normal for breasts to fall sides. If it is excessive then worry and need a physical exam to determine that. You are early in healing phase. Please express your concerns and follow up with your PS and ask for evaluation.

Tom J. Pousti, MD · Answer

I am sorry to hear about the problem you are experiencing. You demonstrate your concerns nicely. 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.   Correction may be even more important if you are planning on "going larger".
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 (capsulorraphy) 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 helps.

Brooke R. Seckel, MD, FACS (retired) · Answer

You are early in recovery and in your photo you are raising your arms above your head and both of these maneuvers can cause the implants to move to the side.  If when you lay down with the arms at your side the implants dropped to the same position and create a wide space between your breast that you may be developing lateral displacement but in my experience it is very unusual to see this so early in recovery.  I would urge you to see your plastic surgeon for an examination and opinion.

Is this possible lateral displacement? (Photos)

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