Breast implants are medical devices that are placed under the breast tissue or under the chest muscle to increase breast size or reconstruct the breast. The implant pocket is the space created by the surgeon to hold the breast implant in place. In some cases, breast implants can move out of this pocket, which is known as a breast implant malposition.
What is a breast implant pocket?
When a patient gets breast implants, the surgeon carefully creates a pocket, or space, under the existing breast tissue or chest muscle. This pocket is sized and positioned to hold the breast implant in the ideal placement to achieve the desired look and feel. The pocket walls are formed by suturing the surrounding tissue together, creating a closed space.
There are two main types of implant pockets:
- Subglandular pocket: Behind the breast gland but in front of the chest muscle
- Submuscular pocket: Behind the chest muscle
The subglandular pocket placement allows for easier implant placement and typically leads to a rounder, fuller breast shape. The submuscular placement can be more difficult surgically but may have a more natural feel and appearance.
What causes breast implants to move out of the pocket?
Although the implant pocket is carefully crafted to securely hold the breast implant, there are some factors that can cause the implant to shift out of position over time:
- Capsular contracture: Scar tissue forms around the implant, tightening and squeezing it out of position
- Trauma or intense physical pressure on the breasts
- Poor initial pocket dissection or suturing by the surgeon
- Weight changes, pregnancy, or aging can alter the breast and surrounding tissue
- Implant rupture or deflation
- Gravity and time can naturally allow implants to descend
Younger patients typically have tighter skin and tissue that help hold implants in place. As women age and breast tissue becomes lax, implants may begin to move even if the pocket itself remains intact.
Can implants completely come out of the pocket?
In most cases, breast implants do not completely come out of the pocket. More commonly, they will slide down out of position, rotate to the side or flip upside down. However, there are rare instances where the pocket has been disrupted enough to allow the full implant to come out of position and no longer be contained behind the breast tissue or muscle.
Some reasons this may occur include:
- Severe capsular contracture leading to extreme tightening and compression
- Trauma such as a car accident or hard impact that tears open the pocket
- Device failure if the implant shell ruptures, bursts or deflates
- Abscess or infection that erodes the pocket tissues
- Following extreme weight loss that leaves excess loose skin
If the implant fully comes through the tissues, it may be visible as a bulging lump under the skin. The appearance would be very deformed and asymmetrical.
Can ruptured implants come out of the pocket?
Ruptured or leaky breast implants are at greater risk of shifting out of place since they may deflate and lose volume over time. When the implant flattens, the pocket becomes too large and can’t maintain the device in the proper position. Furthermore, a compromised implant shell may allow the silicone or saline filler material to leak out into the breast.
Signs that a ruptured breast implant is moving out of the pocket include:
- Asymmetric or changing breast shape
- Implant edge or ridge becoming visible or palpable
- Breast size decreasing
- New lumps or a change in tissue
- Pain, tenderness or swelling in the breast area
If a rupture is known or suspected, the implant should be replaced right away to avoid further damage from the leaking implant. During the replacement procedure, the surgeon will examine the pocket for any weaknesses and reinforce it as needed.
Can implants move out of the pocket without rupturing?
Intact, non-ruptured breast implants can still potentially shift out of position or rotate in the pocket if adequate tissue support is lost over time.
Factors that allow an intact implant to malposition include:
- Capsular contracture placing pressure on the implant
- Loosening of the natural ligaments over time
- Weight loss, gain or fluctuation
- Pregnancy, breastfeeding
- Gravity causing descent of breast tissue
- Poor initial pocket dissection
Even if the implant surface remains sealed and unbroken, these influences can allow the device to sag, tilt or displace. It is even possible for intact implants to spin horizontally or upside down in some cases if the pocket dimensions are much larger than the implant.
Can the implant pocket rupture?
The breast pocket is created by suturing the surrounding breast tissue or muscle borders together. While the tissues are healing, the pocket should be tightly closed and secure. However, over time, those sutures can loosen.
Pocket rupture is rare but can be caused by:
- Capsular contracture that compresses the pocket
- Infection that spreads to the pocket
- Trauma or intense impact
- Activity too soon after surgery before the pocket is fully reinforced
- Very thin or weak breast tissue
If the pocket lining begins to fray or separate, it can allow openings through which the implant may protrude or leak. This will lead to visible breast distortion as well as migration of the implant.
Can the pectoral muscle suture come undone?
For submuscular breast augmentation, the implant pocket is created underneath the pectoralis major chest muscle. The surgeon must suture the lower edge of the muscle to the chest wall to form the lower portion of the pocket space.
In rare instances, this suture line can unravel, which may allow the implant to push below the muscle boundary. Factors include:
- Excess pressure on the muscle
- Weak suture material
- Poor suturing technique
- Trauma that stresses the muscle
- Muscle changes due to aging
If the stitches come undone, the muscle can no longer hold the implant in the proper anatomical position. This may allow the implant to sink down further on the chest than desired.
Can implants move out of the pocket when lying down?
Some women notice that their breast implants seem to shift position when they lie down. When standing upright, gravity pulls lightly on the breasts and implants. However, when reclining, the implant may settle back towards the chest wall into the pocket space.
It’s normal for implants to move slightly within the pocket when the body position changes. However, pronounced movement visible at the implant edges likely indicates a pocket that is too large or has weakened over time. This can allow the implant to sink or drift when upright positions are resumed.
Can implants rotate out of position?
Breast implant rotation or flipping is a common type of malposition that can occur if the implants are able to move too freely within the pocket. Saline implants seem more prone to rotation than silicone versions.
Partial rotation may go temporarily unnoticed by the patient. However, if an implant rotates completely upside down, the fullness is distributed in the wrong direction, which is quite visible. One breast may appear fuller on top with the other projecting more at the bottom.
Rotation occurs most often in subglandular placements but can also happen in submuscular pockets if scar tissue is minimal.
Can implants move after a mastectomy?
After a mastectomy to remove breast cancer, a breast reconstruction is performed to rebuild the breast shape. This often involves placing a breast implant in a newly created pocket under the chest muscle.
The tissues following mastectomy are more fragile and prone to capsule formation. In addition, radiation therapy can damage skin integrity. For these reasons, implants may be at higher risk of shifting position after reconstructive breast surgery compared to cosmetic augmentation.
Careful pocket dissection and planning helps support the implant. Some surgeons also recommend using sutures or mesh materials to reinforce the pocket.
Can breast implants reposition themselves?
Unfortunately, breast implants cannot spontaneously move back into proper alignment on their own. Once an implant shifts out of position, surgical revision is required to re-center and re-support it.
Some minor rotation or settling may be temporarily corrected by gently pressing the implant back into place by hand. However, the underlying factors that allow excessive mobility must still be corrected surgically to prevent recurrence.
Can moving the implants back into place cause damage?
It’s tempting to try pushing implants back into position when they shift or rotate in the pocket. However, excessive force applied to implants can potentially damage them and is not recommended.
Applying too much pressure may:
- Cause the implant shell to rupture
- Increase risk of silicone gel bleed
- Compromise the valve on saline implants
- Exacerbate scar tissue formation
- Trigger capsular contracture
Rather than attempting to reposition implants manually, it is safest to undergo a revision surgery so the pockets can be surgically reconstructed and the devices properly re-seated.
How are malpositioned implants corrected?
When breast implants move out of place, surgery is required to re-center and support them. There are several surgical techniques to address implant malposition:
- Capsulotomy – Releasing constricting scar tissue
- Capsulectomy – Removing old scar capsule and creating new pocket
- Pocket repair – Tightening loose pocket walls and edges
- Sutures – Securing the implant base and lateral edges
- Mesh – Reinforcing thin pocket tissue
- Muscle re-suturing – For submuscular placements
In severe cases where the implants have completely extruded, removal and replacement may be necessary. New pockets will be created from scratch.
After malposition surgery, restriction of activities is required during the healing process. Compression garments are typically worn for 4-6 weeks to help maintain implant position.
Can a breast lift help re-support implants?
Women with sagging breasts may opt for a breast lift (mastopexy) to elevate and tighten breast tissue. Combining this with implant malposition surgery can help reinforce the new implant pockets.
The breast lift procedure involves:
- Reshaping loose, overstretched breast skin for a perkier contour
- Raising the nipple/areola complex to a more youthful height
- Removing excess breast tissue
- Suturing breast tissue internally for support
By tightening the breast envelope and elevating tissue, there is less weight dragging implants down. In addition, the breast lift surgery helps renew breast firmness.
What can be used to reinforce breast pockets?
Various reinforcing materials may be inserted during implant malposition surgery to add structural support within the newly reconstructed pocket:
- Mesh – Synthetic mesh can be anchored to thin tissue areas prone to repeated stretch
- Biological Matrix – Derived from donor tissue and offers scaffolding for cellular growth
- AlloDerm – Purified human dermal matrix that integrates into tissues
- Suture Techniques – Internal sutures strategically support the implant base
These types of scaffolds help strengthen the surrounding muscle or connective tissue for durable results. They are often recommended for revision patients who have failed prior surgeries.
Should implants be changed when correcting malposition?
If the existing breast implants remain in satisfactory condition without rupture, leaks or deformities, they may be able to be reused when correcting the malposition. However, the surgeon will thoroughly inspect them for any signs of compromise.
It is generally recommended to use new implants in the following cases:
- The previous implants have been in place for over 10 years
- Silicone gel implants show any ripples, folds or creases
- Saline implants reveal any visible wrinkles in the fill valve
- Implants exhibit shell damage, leakage or deflation
- Capsular contracture has caused implant distortion
- There is infection or capsular hardening
New devices that better match the updated breast dimensions and anatomy may be suggested. Ideal implant sizing and style can change over the years along with the tissues.
Can malposition be prevented at the initial surgery?
Careful surgical technique helps minimize risks of future implant displacement:
- Precise pocket dissection following anatomic planes
- Avoiding excess pocket dimensions wider or taller than the implant base
- Meticulous suture technique closing the pocket walls
- Ensuring the lower pole has adequate muscular support
- Selecting an appropriate implant type, fill and shape for the tissues
However, patient factors like capsular contracture, weight fluctuations, aging changes and trauma can still allow implant movement over the long term.
Does malposition surgery have risks?
All surgeries involve potential risks, including secondary procedures to correct breast implant malposition. Possible complications include:
- Bleeding, fluid buildup
- Infection
- Poor wound healing
- Loss of nipple sensation
- Adverse reaction to anesthesia
- Recurrence of capsular contracture
- Need for additional revisions
Selecting an experienced plastic surgeon helps reduce these risks. Following all post-operative instructions can also optimize healing.
Conclusion
While breast implant pockets are designed to securely contain the implants, a variety of factors can allow the devices to shift out of position over time. Malposition may involve rotation, sinking, or rarely, full extrusion from the tissues. Intact implants can move, but ruptured ones are at higher risk of displacement.
Revision surgery can relocate and reinforce the implants. Breast lifts, sutures, mesh and tissue grafting may support the newly created pocket. Replacing aged implants with new ones may also be recommended.
Proper implant selection and pocket dissection technique can help avoid these issues. But some implant movement and settling remains possible years later due to the influences of gravity, aging, weight changes and trauma. Close follow-up and prompt revision when malposition is detected allows for the best surgical outcomes.