Implant Malposition Correction
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 immediately obvious whether the issue lies with the implant itself, the tissue envelope, or both. A careful in-person evaluation is essential to determine the cause and the most appropriate correction.
What are the types of breast implant malposition?
There are four recognised types of implant malposition, each with 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 a sensation of the 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 (under the muscle) implant 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.
What causes implant malposition?
Several factors can contribute to implant malposition, often in combination:
- Capsular contracture. Tightening of the scar tissue capsule around the implant can force it out of position.
- Skin laxity. Changes due to aging, pregnancy, or significant weight loss can allow the implant to shift over time.
- Pocket issues. A breast pocket that has become too wide or too constricted will affect implant position.
- Implant plane. Whether the implant was placed above or below the pectoral muscle influences both the risk and type of malposition.
What are the treatment options for implant malposition correction?
The right surgical approach depends on the type of malposition, its underlying cause, and your anatomy. This is always discussed in detail during your consultation once a full evaluation has been completed. Options include:
- Pocket modification. Adjusting the breast pocket by tightening or releasing the capsule to reposition the implant within the correct boundaries.
- Implant plane change. Moving the implant from above the muscle to below, or vice versa, to achieve better support and positioning.
- Mastopexy (breast lift). Removing excess breast skin to redrape and reposition the breast tissue around the implant.
- Biologic or synthetic support. Acellular Dermal Matrix (ADM) or specialized synthetic mesh can reinforce the pocket and provide long-term structural support.
- Conversion to or addition of autologous tissue. For patients who want a permanent solution, replacing or augmenting the implant with your own natural tissue (flap reconstruction) eliminates the implant entirely and provides a softer, more natural, lifelong result.
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