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    Correction of Implant Malposition

    Breast implant malposition can cause many different deformities and/or patient complaints depending on how the breast implant pocket was created during a prior breast augmentation surgery. Common complaints related to breast implant malposition inside the breast include connection of the breasts in the middle of the chest (symmastia), bottom heavy or bottomed out breasts, double bubble appearance of the lower breast fold, high ridding implants and/or “snoopy dog” deformity, lateral breasts or wide cleavage, asymmetry of the nipples due to asymmetric implant malposition.

    These types of deformities can be seen in one breast, both breasts, in isolation or in combination with one another. Once the actual deformity is identified the proper procedure and surgical plan can be developed and implemented in order to correct the implant malposition. There are no “non-surgical” methods of correcting implant malposition.

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    Breast implant malposition is generally caused by the breast implant pocket being too large for a given implant which will cause the breast implant to not be centered inside the breast. Sometimes the pockets are created too large towards the midline causing the breasts to connect in the middle of the chest; this is called symmastia. Other times the breast pocket is created too large inferiorly causing the implants to sink too low in the breast pocket causing “bottoming out” of the breasts, the nipples to point too high and/or creation of a double bubble deformity. If the breast implants are placed too high within the breast pocket due to tight inframammary folds, improper pocket creation or unrecognized droopiness of the breasts pre-operatively, a “snoopy dog” appearance of the breast can be created. Lastly, if the pockets are created too wide laterally, the implants will tend to “fall off” the chest towards the armpits which will also result in “wide cleavage”.

    For all of these implant malposition cases, the corrective procedures involve precise suturing of the pockets from the inside of the breasts in order to make the pockets smaller (called a capsulorraphy), possible switching of implant pocket location (under/over the muscle) and/or possible addition of a lifting procedure. In the case of a symmastia deformity, the implant pocket is suture closed toward the midline in order to separate the breasts and created the appearance of normal cleavage. Switching the plane of the implant from above or under the muscle to a clean pocket can also help prevent recurrence of the deformity.  When the breasts have bottomed out or a double bubble deformity is present, the proper procedure involves suturing of the breast fold (inframammary fold) in order to raise the position of the implant within the breast pocket, correct the double bubble deformity and center the nipple on the breast mound. The corrective procedure may also include closing a poorly created pocket and switching the breast implant to a “fresh” clean pocket that has yet to be disturbed by prior surgery as well as the addition of a lifting procedure in cases where the lower breast skin has been overly stretched-out due to the low riding implants. If a “snoopy dog” deformity is present, the corrective procedure can involve switching the augmentation to a dual plane approach, breast pocket reconstruction with implant repositioning and/or addition of a lifting procedure. If the implants are “sliding” laterally towards the armpits creating “wide” cleavage, the proper procedure involves suturing the outside breast pockets closed near the armpits in order to shift the implants towards the center of the chest which simultaneously improves the appearance of the cleavage.

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    Dr Motykie enjoys being able to perform revision breast surgery for implant malposition even though it can be quite challenging to fix with either internal capsulorraphy, plicating the inferior capsule and/or the addition of a formal breast lift. These procedures can restore a normal shape to the breast, bring the nipple back into the center of the breast mound and possibly lift the breast mound and/or nipples when necessary.  Having said that, the best way to correct these types of deformities is always though prevention such as by having an experienced plastic surgeon perform your initial surgery. Dr Motykie is an experienced expert in performing the dual plane breast augmentation technique wherein he utilizes a peri-areolar technique to accurately create the implant pocket so that the implants sit in the most precise, natural anatomic position within the breast with protection of the inframammary fold and prevention of implant malposition deformities.  Patients who arrive from elsewhere that have had a transaxillary or transumbilical approach often have a complaint of one or more implant malposition deformities requiring dual plane corrective breast re-shaping surgery.

    To find out more about breast surgery please contact us at 310-246-2355

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