What Is Breast Implant Malposition and Breast Implant Flipping?

What Is Breast Implant Malposition and Breast Implant Flipping?

breast implant malposition and rotationBreast augmentation surgery using implants is a common surgical procedure to change the size, shape, and contours of the breast. Breast implants are placed in a surgically created pocket made either in front or behind the Pectoralis major muscle. Breast implant malposition is a known complication of breast augmentation surgery.

Historically breast implants with textured surfaces were commonly used in Australia. As a result of a rare type of lymphoma (ALCL) found growing in the capsules of textured implants, these implants are no longer available for use in Australia. The textured surface of these implants would stick to the walls of the pocket and lead to issues with malposition.

All implants now used in Australia have smooth surfaces which make the implants more mobile than the previous textured implants. Surgical techniques have needed to be changed to keep these implants in an appropriate position. Dr Doyle uses a number of deep non-dissolvable internal sutures to make an internal bra which limits the outwards and downward movement of the implants. This stops the implants moving into the armpit when you lie flat and gives much better cleavage in all positions.

Breast implant malposition is the condition following breast implant surgery that results in one or both implants sitting in a position different from where it was originally placed.  Breast implant flipping on the other hand occurs when the implant/implants rotate in such a way that the back surface of the implant faces forward. It often occurs when the pockets are large, making it easier for the implants to rotate/ move freely. This rotation of implant in the pockets causes distortion of breast shape. It is not uncommon for the patients with this problem to be able to flip their implants back into position themselves.

Causes of Breast Implant Malposition

flipped breast implant
Image sourced from MYA Cosmetic Surgery (www.mya.co.uk)

1. Capsular Contracture

Capsular contracture is the most common cause of implant malposition. When a foreign object is placed inside the body, the bodies reaction is to make scar tissue around the foreign body to keep the body safe. This occurs in all patients. Normally the scar tissue is soft and it is not possible to feel. In some cases, this protective capsule of the scar can harden and the scar shrinks, squeezing the implant which can be painful, makes the implant feel firm and causes the implant to move out of position.

2. Lack of attention in the early post-operative period

The first 4 weeks following your surgery are a very important part of the healing process. Failure to follow post-operative instructions can lead to implant malposition. If you commence heavy lifting or commence exercise too early, this can result in swelling, pain and implant malposition. Inappropriate massage can also have a similar effect.

Wearing an underwire bra during the early phases of recovery can hamper the healing process; the underwire can press on the lower breast pocket forcing the implant upwards resulting in high malposition.

3. Size of the Implant

Larger implants have an increased risk of low malposition as they have the possibility to thin the tissues of the lower part of the breast as a result of gravity and move downward.

4. Shape of the chest

Any underlying asymmetry or deformity of the chest wall can lead to malposition of the implants.

Types of Implant Malposition

  • Implants can sit too high, too low, too close together or sit in the armpit.
  • Symmastia occurs when implants become too close to each other in the centre of the chest, sometimes forming one breast (mono boob). The skin between the breasts lifts off over the breast bone (sternum). It is the rarest form of implant malposition and can be the most difficult to correct.

How to know your breast implants have displaced or flipped?

  • Your breasts were symmetrical after surgery but are now asymmetrical.
  • Nipples have become asymmetric.
  • Change in shape of your breast when lying on your back or standing up.
  • Your breasts feel different to the touch.
  • Your breasts have a distorted appearance.

Treatment of Displaced or Flipped Implant

A flipped or mal-positioned implant may require revisional surgery or implant removal surgery. Breast revision surgery is done to reposition the implants and tighten and decrease oversized breast pockets.

Breast Augmentation Revision surgery

In breast implant revision surgery, Dr Mark Doyle manipulates the capsule of scar tissue that forms around the implant and/or the pocket of tissue surrounding the capsule using permanent stitches in such a way that the implant will be in a better location and won’t move around as much. This involves tightening or loosening different areas of the pocket. Dr Mark may need to replace your existing implant, with an implant that has a different projection, a different level of firmness, or that of a different size, which can help change how it sits in the chest. The size of the implant for the surgery is chosen such that it is proportionate to your body size.

Breast Explantation Surgery

If you do not want to replace the implants, breast implant removal (en bloc) surgery can be done to remove the implants. It involves making sub mammary incisions areola through which the implant is removed. It is commonly combined with a breast lift for best results following breast implant removal.

Constant Breast implant flipping and mal-positioning are associated with discomfort and breast distortion. There is a loss of breast aesthetic which can lead to issues related to self-image, and surgical methods are the permanent methods of its treatment. These surgeries require great skills to give you the perfect breast size with or without implants; Dr Mark has the experience and skills necessary to perform such surgery.

Breast Implant Malposition and Rotation FAQs

bottomed out breast implant revision

Is it possible for a breast implant to flip?

Flipping of a breast implant is a known complication following implant placement. It is not a common condition but is not rare either. Breast implants can flip if the pocket created during implant placement is larger than required, which gives enough room for the implants to flip/ rotate. This results in distorted breast shape. In addition to large pockets, vigorous exercise and massage of breasts during the recovery phase following surgery may also cause the breast implants to flip over.

How do you fix a flipped breast implant?

You can easily flip back the implant yourself. To reposition a flipped implant, you must lean forward making space for the implant to reposition itself.

If the implant is flipping constantly and bothering you constantly surgical management should be sought. It can be treated by changing the size of the pocket and/or implant removal or implant exchange surgery.

What holds breast implants in place?

Your body tissues form a protective capsule of soft scar tissue around the implant and/or the implant pocket which helps to hold it in place. The capsule made of scar tissue may undergo degenerative changes as one ages or in response to gravity, leading to the implant malposition. In some women, these scar tissues may not be properly developed leading to early bottoming out of implants in them. Choosing properly sized implants and making implant pockets of appropriate size can be done to hold implants in place.

What is bottoming out of the implant? How to know if my implant has bottomed out?

Bottoming out of implant is a condition following breast implant placement surgery in which the lower portion of your breast bulges outward and appears out of proportion with your breast shape or the upper pole area of your breast.

You can know if your implants have bottomed out if:

  • Your lower pole of the breast seems longer compared to the upper pole. A visible imbalance is apparent.
  • Your nipples are pointing upward, different from their usual positioning.
  • Your breasts were symmetrical after surgery but are now asymmetrical.

How often should breast implants be checked?

Breast augmentation surgery done with silicone implants should undergo MRI screening three years after the procedure and every two years after that. The MRI helps to check for any tears, rupture, or rotation of the implants.

For patients with saline implants, the checkup schedule is a bit different. In the case of a rupture of a saline implant, the patient will know right away because the breast will instantly lose volume. Medical attention should be sought immediately if saline implants rupture. If you are happy with the way your breasts look and are not experiencing any problems, getting your implants checked every five to ten years is reasonable. More regular check-ups are required for those patients with textured surface implants.

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About Dr Mark Doyle FRACS (Plast) – Queensland Plastic Surgeon

Servicing patients in Gold Coast, Brisbane, Sunshine Coast, Cairns and New South Wales NSW – Northern Rivers, Byron Bay, Ballina, Lismore and more.

Dr Mark Doyle is a Specialist Plastic Surgeon with over thirty years of experience performing BreastBodyFace and Nose surgery. As a highly esteemed plastic surgeon, Dr Mark is driven by an intense passion for helping patients achieve a happier, more beautiful self through advanced cosmetic surgery procedures.

He maintains a strong commitment to achieving the best possible results for all his breast, body, face and nose patients, both men and women.


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