Breast Implant Shifted or Moved? Malposition Correction

What is implant malposition?

Implant malposition occurs when a breast implant sits in an incorrect position relative to the chest wall and surrounding breast tissue. It can develop at any point along the reconstructive journey, sometimes shortly after surgery, sometimes years later.

Because there is a dynamic relationship between the implant and the surrounding tissue, it is not always obvious whether the issue lies with the implant itself, the tissue envelope, or both. A careful in-person evaluation determines the cause and the right correction.

What are the four types of implant malposition?

Each type has distinct visual and physical characteristics:

• Inferior malposition (most common). The implant drops too low, creating a "double bubble" appearance with parallel folds beneath the breast, a nipple that appears too high, or a lack of fullness in the upper pole.
• Lateral malposition ("telemastia"). The implant shifts toward the armpit, creating the sensation of an implant sitting under the arm and a loss of natural inner cleavage.
• Medial malposition ("symmastia"). The implants migrate toward each other, eliminating the natural sternal border between the breasts. More common with submuscular placement.
• Superior malposition. The implant rides too high on the chest wall, contributing to a "waterfall" or "Snoopy" deformity in which the breast tissue hangs below the implant.

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What causes an implant to shift?

Several factors contribute, often in combination: capsular contracture forcing the implant out of position; skin laxity from aging, pregnancy, or significant weight loss; a breast pocket that has become too wide or too constricted; and the implant plane itself, since placement above or below the pectoral muscle influences both the risk and the type of malposition.

How is malposition corrected?

The right approach depends on the type, its underlying cause, and your anatomy:

• Pocket modification. Tightening or releasing the capsule to reposition the implant within correct boundaries.
• Implant plane change. Moving the implant above or below the muscle for better support and positioning.
• Mastopexy (breast lift). Removing excess skin to redrape the breast tissue around the implant.
• Biologic or synthetic support. Acellular dermal matrix or specialized mesh to reinforce the pocket for long-term structural support.
• Conversion to or addition of your own tissue. For a permanent solution, replacing or augmenting the implant with natural tissue eliminates the implant entirely and provides a softer, lifelong result.

Often correction is combined with implant exchange in the same operation. What matters is treating the cause, not just the position, because an implant repositioned without addressing why it moved tends to move again.

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