Breast Implant Malposition after Breast Augmentation
After breast augmentation, there are several problems that can develop. Some are related to the healing process. Others are related to the look of the enhanced breasts. Malrotation and asymmetry are both issues with the look of the enhanced breasts. When either occurs, it may require surgery to correct.
Breast Implant Malrotation*
Breast implants can move or rotate within the breast. This fact is the basis for the issue of malrotation. When a tear-drop implant rotates within the breast, it may rotate in such a way to cause the breast to appear misshapen or asymmetrical.
First, let’s look at some background on breast implant shapes. There are two shapes to choose from: round or tear-drop. Tear-drop shaped implants were first made to address the desire for a more natural shape. In this type of implant, the bottom of the implant will be larger than the top. This allows it to fill to a larger size at the bottom. This is meant to look most like the natural breast shape. They must be positioned very carefully to achieve this result and not move. Thus they always have textured shells. This is to reduce the risk of malrotation. Since the scar sticks to the surface of textured implants, this can reduce the implant’s ability to move inside the breast. This can help, but it does not always prevent the problem. To further reduce the risk, the surgeon can create only a small implant pocket. This gives less space for rotation to occur. This again can help, but does not prevent the problem in all cases.
The problem occurs when that position changes. Malrotation happens when a tear-drop implant rotates. It can turn sideways. It can even rotate upside down. This makes the breast look misshapen.
If one or both breast implants rotate and become misshapen, this must be fixed with surgery. Often this means the tear-drop implants are removed and replaced with round ones. If a round implant rotates within the breast, it does not cause any problems.
If a tear-drop implant rotates and it is not quickly discovered, this can cause the breast tissue to stretch. It stretches to fit the new implant position. This is a problem because that tissue will remain stretched. This is true even if the implant is moved back into place or replaced. This will make the problem harder to fix. It may also mean that a new round implant may now cause the nipple to appear to be in an odd position. This is because the breast tissue has been stretched in one direction. This might be a problem on both breasts; it will be more of an issue if they’ve rotated in different directions.
Breast Implant Position Asymmetry*
Breast asymmetry simply means that the two breasts are not identical. This might be in terms of:
- Breast shape.
- Breast position on the chest. One breast may appear to sit higher or lower than the other. The location of the bottom crease or breast folds may differ as well. This will make one breast may appear to be lower than the other.
- Breast size.
- Nipple position asymmetry. For example, one breast may sag more than the other making the nipple be below the crease. Or the nipples may face slightly different directions.
- The areolas may not be the same size or shape, this is areolar asymmetry.
- Placement on the chest. One breast may sit further out than the other. This issue is more prevalent for someone with scoliosis. So it could be a curved ribs difference or a curved spine cause.
It is important to note that natural breasts are often asymmetric. In fact, the asymmetries described above can all happen naturally. This may be the entire reason breast augmentation is performed. Natural asymmetries may or may not be able to be removed completely. Some may be able to be improved. That said, some natural asymmetries will even be more pronounced after breast augmentation. It is important to note that a very minor natural asymmetry may be much more noticeable after surgery.
Also, sometimes a different asymmetry is created when correcting the first one. For example, in breasts that are a different size, making them the same size might mean the nipples are not aligned in the final result. In fact, any time the nipples are not aligned before augmentation, this may be more obvious after.
Besides pre-existing asymmetry, enhanced breasts can still become asymmetric for many reasons. It can be because of the breast implants settling differently. It can also be caused by an error in placing the implants.
Implant asymmetry can take many forms. These include:
- The two breasts may be different sizes.
- The two shapes may differ slightly. Or the two shapes may differ a lot, such as with malrotation of a tear-drop implant.
- One may sag more than the other.
- The nipple position may be different. Choosing an implant that is too large can make nipples look to be in an odd position. Placing breast implants too high can make the nipples point downward and vice versa. The same can occur if the implants are too far to the side; the nipples may point to the middle.
- The two breast creases may be at different positions causing the breast implants to sit differently on the chest.
- Scar tissue may form around the implants at different rates. This can cause them to have different shapes. Capsular contracture can also cause distortion in one or both breasts.
- There may be differences in appearance due to different original breast sizes. For example: if one breast sagged more, it might now show ripples in the implant. The other one might not.
- One or both implants may not descend fully after surgery. This may make one or both breasts appear to be too full in the upper half. This can also mean the implant has moved upward.
- Sometimes the breast implant descends too low over time. This can happen in one or both breasts. It happens when the breast implant is too heavy or the tissue gives way. This is called bottoming out. It occurs more often when the implants are placed above the muscle instead of below it.
- The implants may be too far apart, causing them to have a wide gap. It may result in one implant facing further outward than the other.
- Saline implants can deflate after forming a leak. This will result in one side looking flat.
Some asymmetries are caused during the breast augmentation. This may be because the pockets created to place the implants do not match. Or the pockets might be in slightly different positions. This allows the implants to sit in different positions on each side. Using an incision in the armpit to place the implant may result in an increased risk in asymmetry. This is because the implant must be placed without direct access to the breast.
More obvious asymmetries might mean a corrective surgery is needed. Be aware though that the revision surgery may be more difficult than the original surgery. Corrective surgery might mean:
- Replacing the breast implants. This might mean changing the type, shape, profile, or size. The surgery might also change the position or move the implant under the muscle.
- Releasing or removing the scar tissue (if scar tissue is causing the problem). This could be either a complete removal of the scar tissue or making incisions so that the tissue will relax.
- A breast lift may be needed to completely fix the problem.
George Washington University Professional Center
The Loudoun Center for Plastic Surgery
45155 Research Place, Suite 125
Ashburn, VA 20165