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Malposition of Breast Implants and General Dissatisfaction



The most important factor to remember before getting a breast augmentation is that enlarging what nature has given you is basically all that is going to happen.  So if you have flaws going into this surgery, and they are not addressed during the procedure, then you will be able to see these flaws more pronounced. 

Asymmetry with the breasts is usually addressed during the procedure, so that you will end up with a more aesthetic look – however, it is imperative that you address your problem BEFORE the surgery with your plastic surgeon.  Each patient is unique and is like a canvas to the plastic surgeon.  What you might see in a magazine might not be feasible with your own anatomy, so understanding this before the surgery will allow you to make a more rational and informed decision with getting implants.

Of course if the plastic surgeon has chosen the wrong implants for you or the wrong placement, then this can lead to overall dissatisfaction.  However, in general all women undergoing this procedure are normally very happy with their end result they achieve.



               Malposition of breast implants

Patient has a very wide space in-between the cleavage area both pre op and post op.

This is due to the patient's anatomic features of her breasts.





                                         2010 Copyright Dr. Tom Pousti, San Diego, CA

                         Before and After photo of Breast Augmentation Revision with

                                           the proper implant placement and implant size





Implant displacement and asymmetric position is the second most frequent complaint by the patient after augmentation.  Implant positioning that is too high, too low, or too lateral after an appropriate waiting period may require a surgical procedure to improve the pocket location.

Breast implant mal-position sometimes happens, and can be the cause of an inappropriate choice of implant, technical surgical error at the time of surgery, or implant displacement at a later time due to factors related to the implant such as weight.  Mal-positioned implants become displaced also due to capsular contracture

Postoperative elastic banding to the upper poles of the breast help to prevent implants from remaining high after sub-pectoral placement.  Normally a period of one to three months may be required for the strap to be worn continuously in order to improve this problem before considering any surgical intervention.  As a general rule, most plastic surgeons do not like to perform a secondary revision surgery before six months and depending on the patient, it might be longer.

Rotation of anatomical implants that produces a noticeable deformity sometimes is treated first with "taping" of the breast mound for several weeks to allow for a capsule to form around the textured implant. If this fails to help keep the implant stationary - a revision surgery is performed to secure the pectoral fascia or the pocket by suturing to create a tighter fit around the implant.


Implants that are malpositioned can be:

  • too high

  • too low

  • too lateral

  • too medial 


If both implants are too medial (near the sternum) where the implant pocket is over-dissected, then symmastia can occur.

Sometimes a patient might exhibit a combination of mal-positions that are noted to a greater degree in certain postures or positions than others, such as lying down versus standing up.  Significant lateral implant mal-position is often more accentuated in the supine position (lying down) in which the entire implant literally falls off of the chest wall into the arm pit area.  The medial area of the implant in the supine position tends to appears to look empty or flat.



                  Photo A                                       Photo B                                       Photo C


Lateral implant malposition in patient who is 3 years post operative from breast augmentation with the trans-axillary incision - under the muscle - smooth shell saline implants. Both sides have malposition, however; is worse on the right side. 

Photo A:  Patient has wide spaced cleavage and the right implant is sitting off to the side.

Photo B:  The right implant is accentuated laterally with the arms in the raised position.

Photo C:  Also in the "supine" position or lying down.  Implants are falling into the armpits.


Most surgeons will agree that implant malposition is not uncommon, and is seen quite frequently.  Implant dislocation is the second most common reason for a revision surgical procedure.





The most common causes are the following:

If a patient needs a revision to fix any problems, most plastic surgeons will give their existing patients a “returning patient discount”.  Make sure what the plastic surgeon’s policies are before the actual procedure, so that you are always on the same page with communication.





Some plastic surgeons, depending on the case might have you in a "strap" after surgery.  The strap is placed above the breasts in a tight compression bandage which will help the breast implant to drop down into the pocket.  If you are instructed to wear the strap to help with the dropping of the implants, make sure you wear it according to your surgeon's instructions.  The sooner the implant drops into place, the better it is for the patient.


   Compression Bandage or strap for breast augmentation      Compression bandage or strap for breast augmentation

                                          2010 Copyright

                                                          Patient wearing the "strap"




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