Wrong Implant Placement? Right Nipple Turning Outward and Implant Moving Toward Middle of Chest? (photo)

Question

I had my augmentation Aug 2012. 350cc in left 375 in right. About 3 months post-op I began noticing my right implant "bulging" toward the middle of my chest & my nipple turning outward. Went to my surgeon & he dismissed it, telling me to come back in 6 months & if it persisted, I could have surgery again to "stitch up" the implant pocket. My appointment with him is this week. Any advice on what this is or how to go about fixing it? I provided pictures pre-op, 6 days after surgery, & now. Thanks!

Richard H. Tholen, MD, FACS · Answer

Over time, your right implant has been "pushed" against the tissue attachments to your breastbone, and these tissues have become stretched and/or partially detached. At the same time, your lateral pocket has gradually healed and closed off, causing this slow and now-visible displacement of your right implant towards (and even a bit past) the midline.

	The most common reason for this is wearing of an overly compressive brassiere, such as a push-up bra, day in and day out (and even at night) in some patients, who are told to wear  a bra to "keep your implants in position." Except that over time what that bra does is push one (in your case) or both of the implants medially, causing unilateral or bilateral symmastia.

	Unfortunately, this sometimes occurs to the best of us, and the "fix" is straightforward, but involves another operation to open-up the pocket laterally and suture the pocket medially to reposition your implant beneath your nipple/areola complex more accurately. Fortunately, it appears as if your left implant did not suffer the same fate as the right, and nothing likely needs to be done on this side. But that is for your surgeon to decide.

	Perhaps your surgeon did not "dismiss" your concern, but was simply (correctly) asking you to wait for a full 6 months to allow your tissues to heal and scar tissues to mature before recommending any sort of re-operation. Once that length of time has elapsed, you can safey and successfully undergo revision of your right pocket. Your surgeon should have discussed his touch-up or re-do surgery policies with you prior to your first surgery, so you know that you will (probably) be charged only operating room and anesthesia fees (no surgeon's fees) for this surgery--if he does like we do in my office surgery facility.

	This should work out just fine; if you sense any hesitancy from your surgeon, get one or more second opinions from ABPS-certified plastic surgeons who do lots of breast surgery. We have all seen and "fixed" this. Best wishes! Dr. Tholen

Barry L. Eppley, MD, DMD · Answer

While your initial early breast augmentation was quite good, you have developed either contracture of the right implant or a pocket that is too medial as it has healed. This is unfortunate and uncommon (most implant problems are either too high or too low) but a known risk of breast implant surgery. This will require an open capsulotomy to release the scar tissue on the side and allow the implant to move back more to the side. You may also need a piece of dermis sewn into the sternal side of the pocket to prevent recurrence.

Curtis Wong, MD · Answer

can occur and your result is more due to your implant position rather than what you started with.  Your 1 week post-op photos showed excellent early results.  But  with time, your right breast implant is being pushed medially, presumably by contracture of your lateral capsule on that side.  If you were my patient, correcting this would require a open capsulotomy at minimum (and even more could be done) and I hope your doctor has a good revision policy for you.  Remember, you brought this to your doctor's attention 3 months post-op in case there is a time limit.  Best wishes with your appointment.

Steven Wallach, MD · Answer

Implants only magnify the differences between the two breasts and in your case the right one was flatter and pointing to the side more.

Peter E. Johnson, MD · Answer

Just as a pocket can give way and allow an implant to bottom out, the inside edge of the pocket can give and allow an implant to shift to the center of the chest, sometimes called symmastia as the breasst run together in the middle. This is less common than a low implant as the chest muscle will prevent the implant from shifting. There are ways to repair the pocket and center the implant that your surgeon will discuss with you.

Wrong Implant Placement? Right Nipple Turning Outward and Implant Moving Toward Middle of Chest? (photo)

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Answer: Breast asymmetry

Answer: Breast implant has shifted to the middle

Answer: Breast implant has shifted to the middle

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Wrong Implant Placement? Right Nipple Turning Outward and Implant Moving Toward Middle of Chest? (photo)

Answers (7)

Answer: Breast asymmetry

Answer: Breast asymmetry

Answer: Breast implant has shifted to the middle

Answer: Breast implant has shifted to the middle

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Recommended reading

Everything you need to know about Breast Implants

Our mission is to create a world where every investment in modern beauty is Worth It.