My implants shift to the side, making it painful to sleep on my back. Do my issues seem correct and of concern? (photo)

- When lying flat, implants shift to the side almost entirely, making it very painful to sleep on my back - Severe visible keloid scarring - shooting pain & itchy - Implants seem to have bottomed out - Rippling - No cleavage without bra Surgery was Feb 2008. Over the muscle, 360cc saline implant overfilled to 375cc. Dissolvable stitches weren't used. I want silicone implants for a more natural feel, under the muscle, and scar revision. My breasts feel like bags of water with air pockets. Would travel for right Doctor. 27, 5'4, 108 lbs, petite.

Doctor Answers 14

Lateral displacement of implant

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Based on your photos I would agree with the other surgeons that you need internal pocket reconstruction (or  capsulorraphy) to bring the implant more to the midline.  At that time you can switch the implants to silicone implants under the muscle and have scar revision performed bilaterally.  Make sure you see a Board Certified Plastic Surgeon who performs a lot of revision breast surgery for an in person consultation.  Best of luck to you!

My implants shift to the side, making it painful to sleep on my back. Do my issues seem correct and of concern?

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Thank you for the question and pictures.

Although it is not possible to give you precise advice without direct examination and a full communication of your goals, it is likely that you will be a good candidate for revisionary surgery.

Generally, lateral breast implant displacement (and bottoming out) can be corrected using an internal suture technique, decreasing the size of the pockets and moving the implants toward the midline.   In my practice, this repair is done with a 2 layer suture technique. 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.

Implants shift to the side

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This is not an uncommon problem over time and is caused by stretching of the capsule in the horizontal dimension (medial or lateral side or both) such that the diameter of the implant is now too small for the capsule and falls to the lateral side when lying on the back (supine). This usually doesn't cause specific symptoms but doesn't look great even if the implant/breasts look fine in the upright position. You should also be aware that few breasts, particularly larger ones, look good when lying on your back. Large natural breasts also tend to fall to the side when lying flat. If you think about it, you rarely see topless pictures of breasts in that position. 
Although surgical correction would involve making the capsule smaller, this is not simple or straightforward and there is one other solution that has worked in my experience that I don't see in the responses here. 
Normally I am concerned with putting in breast implants that are too wide for the base of the breast and stretch or distort it. In this case the width/diameter of the implant may be fine but the capsule has stretched. If you don't mind going larger you can change your round, smooth surface implants for ones with a wider diameter (with or without changing the forward volume/profile). This can be done easily and doesn't involve doing anything to the capsule. The new implant should fit the width of the capsule better and not fall to the side as much. It may not change symptoms but again I don't usually see symptoms caused by implants falling to the side.  In my experience it also doesn't cause the capsule to stretch further as it was not disturbed with the simple exchange for a wider implant. 
Obviously you need an exam and a plastic surgeon who is experienced with implant changes and dimensions before confirming that this is a reasonable option for you. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Pocket expansion

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Hi.  Based on your story and photos, it looks like you have lateral pocket expansion, and perhaps some inferior pocket expansion.  This can be repaired surgically.  Usually internal suturing to close down the expanded area at the sides is used.  Switching your implants to under the muscle can also help.  In some cases, ADM reinforcement is needed.

Best to see a surgeon who is familiar with implant revision surgery.

About Breast Implant Displacement

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During breast implant surgery a #pocket is created carefully to maintain certain folds on the sides and bottom of the breast. Occasionally, the space for the breast implant becomes too large on the #side of the chest or the tissue stretches and the implants fall too much to the side. This is most easily seen when the patient is lying on her back. At times, the implants can move towards the patient’s armpit.

Treatment will generally require closing the space with a procedure called a #capsulorrhaphy. In this case, the capsule is closed off internally much as we do when we are trying to raise the breast fold. The capsule is closed with sutures and at times Acellular Dermis Matrix (#ADM) or other soft tissue substitutes would be used to further support this correction. 

However, it is best to consult with your Plastic Surgeon to better determine with an in-person exam. 

Implant Exchange with Mini Ultimate

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From your photographs, your implants are bottoming out and you have more breast tissue below the nipple than above.You lack upper pole fullness and when you lie down the implants displace even further laterally.I recommend a new technique called Implant Exchange with Mini Ultimate Breast Lift™.Using only a circumareola incision it is possible to reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage.At the same time, the implants can be removed from in front of the muscle and placed behind your muscle.Aligning the areola, breast tissue and implant over the bony prominence of the chest wall maximizes anterior projection with a minimal size implant.Small round textured silicone gel implants placed retro-pectoral look and feel more natural, are more stable, less likely to ripple or have complications needing revision.Implant profile is irrelevant in the retro-pectoral position since the muscle compresses it.

Best Wishes,

Gary Horndeski, M.D.

Implant malposition

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In my opinion, the pocket for your implant is too large, too low and too lateral.  Ideally your implants would be switched to silicone and the pockets revised so that the implants will be in the correct position.  SERI would be useful to reinforce the pocket revision.

Hawaii is a bit far from Toronto, but it would make a great holiday for you!

Implant space revision would be beneficial

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A revision of your breast augmentation would be beneficial... The purpose would be to close off the breast space (pocket) in which the implant sits.  Over time it's not unusual for the space to stretch out allowing implants to fall off to the side.
correction of this is achieved by securely closing off the sides, and then wearing a protective garment to keep the repair from breaking apart during the initial 6 week healing period.  It will be crucial that you avoid any physical activity that can damage the repair.

Breast implant malposition

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Your breast implants are displacing in an unfavorable manner.  I think a revision with some type of ADM is in order.   It also appears the implant is not the right one for your chest shape and size.  

Internal capsule work needed

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Thank you for your pictures. The pocket for your implants has become larger than the implant itself. This allows the implants to move outside of the normal position of a breast. What you need to do is to have the implants removed. You can have silicone implants placed. The implants can be placed beneath the muscle. The pocket needs to be tightened Internally around the implants. This will give you better breast volume and shape.

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.