Breast implants need to be centered behind the breast mound in order to achieve the best results. However, in some cases implant malposition occurs. Sometimes this is a result of technical error, sometimes due to tissue characteristics, sometimes implant characteristics (implants that are too large), and sometimes a combination of all of the above.
There are different types of implant malposition. Bottoming out and symmastia (uniboob) are two types of implant malposition that I have discussed in prior blog entries. I would like to now address lateral malposition.
In lateral malposition the implants fall out to the sides and usually down a bit too. This is most noticeable when the woman lays down. It causes a wide gap between the breasts. The cause can sometimes be technical, if the implant pocket is created too laterally. This is noticeable soon after the surgery. In a majority of the cases, the cause of lateral malposition is due to tissue and implant characteristics. Overly wide or large implants are placed in women with thinner skin or subcutaneous tissues and overtime the lateral breast stretches out to accommodate causing the implant to fall out to the sides.
This is a case of a patient who presented with lateral malposition of her implants. See the large gap between her breasts. The gap is so wide that the indentation seen on both sides is from her ribs coming off of the sternum. Also notice that the implants are not centered under the breast mound. They have fallen out to the sides.
In mild cases, internal sutures may be enough to close the implant pocket on the outer sides in order to push the implant medially back under the breast. However, the long term results of just using internal sutures may not be very good as there is a high incidence of recurrence. In more moderate and severe cases, not only should internal sutures be used, but also a product such as Strattice, which is acellular pig dermis. This will reinforce the repair as well as provide additional coverage over the implant because most of these patients tend to also have rippling on the sides as well.
In these photos you can see the same patient in the operating room. The left breast has been corrected with internal sutures and Strattice and the right breast has yet to be corrected. Notice the dramatic difference in breast shape and fullness now that the left breast implant is placed back behind the breast mound. Also the same size implants are being used in this case.
Here are the before and after photos of the same patient. Note the dramatic difference in breast shape as well as implant position. This is a long lasting, durable result.
To learn more about breast implants and revision breast surgery and to view before and after pictures visit my website at drdadvandplasticsurgery.com.