I received an email over the weekend from a woman that has undergone a breast augmentation approximately 5 months ago by another surgeon.  She noted that her implants were placed through the axillary (arm pit) approach and that her implants have fallen too low on her chest.  She writes, “My breast implants have dropped, what can I do?”

Implant malposition following breast augmentation is probably a more frequent problem than is identified in the literature.  It can be seen with any of the surgical approaches.  Malposition can be due to a technical error or it can be the result of the weight of an implant and it’s effect of stretching or dissecting the breast tissues.  It is clear that larger implants are more prone to malposition than smaller ones.  We would describe this woman’s problem with implants that are too low as “bottoming out.”  Malposition can occur in any direction, that is, implants can be positioned too high, too low, too far towards the center of the chest, or to far towards the arm.  

If conservative measures fail to improve implant malposition, there are several surgical techniques that can be used to correct the problem.  These involve using suture lines to close down a portion of the implant pocket and correct the implant’s malposition.  In the technique that I use, I also perform capsulotomies (incisions in the breast capsule) opposite the location of the suture lines  to take some of the tension off of the repair.  Patients are required to tape the breasts and to wear underwire bras for several weeks after surgery to support the repairs while they are healing. 

Here is an example of a patient that experienced implant malposition following a transaxillary breast augmentation.  She was an A cup before her initial procedure and had very short nipple to inframammary fold distances.  She had selected a sizable implant for her initial procedure.  If you consider the history of this patient, she was a set up for problems with implant malposition.  When she presented to my clinic she had “bottoming out” of her implants; that is, they were positioned too low on her chest wall.  Here is the preoperative photograph:

During our consultation she expressed a desire to use the same size implants as her initial surgery.  Her goal was to correct the low position of the implants on her chest.  I performed capsulorraphies (suture closure of the breast pocket) at the lower aspect of the breast on both sides to reconstruct the breast fold and move the implants to a higher position on the chest.  During the procedure I also performed capsulotomies opposite the suture lines at the upper aspect of the breast to take some of the tension off of the repair.  Here is the postoperative result:

The operation achieved her goal of correcting the low position of her implants through reconstructing the breast folds on both sides.  She is now very pleased with her results. 

Our websites www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of breast augmentation for review.  I invite you to schedule a consultation with me if you would like to learn more about breast augmentation or reconstructing implant malposition.  Please feel free to contact our office at (713) 661-5255 if you have any questions.

-Brice W. McKane, M.D.

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