Poor Implant Positioning

The positioning of your implants in the breast pockets plays a large role in the appearance of your breast augmentation results. The breast pocket, which is created below your breast tissue, is designed to hold the breast implants in an aesthetically pleasing position. When the breast pocket fails, the implants can shift their position, leading to a poor appearance or complications.

Reasons for Poor Implant Positioning

Poor Placement Choice

Implants can be placed above the pectoral muscle or under the pectoral muscle. Your implant placement is determined during your breast augmentation consultation. Factors such as tissue laxity, desired breast slope, and needed range of motion will all affect the location chosen for your implant placement. However, your body’s frame will also affect whether a particular implant location will work for you. For some patients, the shape of their breast pocket may change over time, prompting the need for a different implant placement.

Gravity and Implant Size

Choosing the proper implant size requires a careful balance. Large or heavy implants are more likely to succumb to the effects of gravity. The pull of gravity and the weight of your implants can weaken your breast tissue over time. Eventually, your implants may begin to slip out of their created pocket, usually falling down and out.

Capsule Thickness

A scar tissue capsule develops around the breast implant as the body’s natural response to a foreign object. It is this capsule that helps hold the implant in place. Some patients develop thin capsules that aren’t strong enough to support the weight of their implants. Other women develop extremely thick capsules that may contract and squeeze the breast implants. This can lead to capsular contracture and often to implants sitting high and tight on your chest.

Implant Shell Texture

The texture of your implant shell (smooth or textured) doesn’t play a role in and of itself in poor implant positioning. However, smooth implants, when combined with other complications, have a higher rate of shifting out of the breast pocket. Smooth implants also place you at an increased risk of developing capsular contracture.

Types of Poor Implant Positioning

Bottoming Out

Bottoming out occurs when the implant slips out of the breast pocket downwards and outwards on the chest. A visible edge of the breast implant can be seen below the inframammary line. Bottoming out is typically the result of a weakened breast pocket.


Symmastia is the medial movement of implants out of the breast pocket. Your implants migrate towards the center of the chest, and their edges will often begin to touch each other, creating the appearance of a single breast.


Asymmetries are the result of multiple factors including placement choice, asymmetrical healing and capsule formation, gravity, implant size, and differential capsular type and formation. The end result is an unwanted, unbalanced, asymmetrical appearance in and out of clothing.

Solutions to Poor Implant Positioning

Implant positioning is complex, and for many patients, there isn’t a single, straightforward solution to correct their issues. Dr. Strawn uses a combination of multiple techniques to treat your specific need. The following are possible solutions that may be used to improve your poor implant positioning:
  • A breast lift can be performed to move the nipple and areola into a more favorable position
  • Dermal Matrices may be used to reconstruct and reinforce the inframammary fold
  • Capsule work can be done to create an implant shelf and improve the shape and strength of the implant pocket
  • Implant exchange is used to increase or decrease the size of the implants, change from round to shaped implants, and/or change the texture of the implants
  • Fat grafting is performed as a final shaping tool to smooth out the edges and make the breasts appear natural

Your Breast Revision

At Scultura Plastic Surgery, we focus on providing hands-on care and customized treatment plans. Dr. Strawn is a leading expert in revision surgery and believes that a combination of tools must be used to create your ideal breast appearance. Dr. Strawn spends over an hour in consultation with his patients to develop a detailed, customized treatment plan. Patients often present with more than one issue that is cause their poor breast appearance. For this reason, multiple treatments are often required to get the most natural, flawless results possible.
If you are unhappy with the results of your breast augmentation, schedule your consultation with Dr. Strawn today. Contact our office at 949-612-7231 or fill out our online contact form for additional information.

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361 Hospital Rd Ste 221
Newport Beach, CA 92663
Phone: 949-612-7231
Fax: 949-612-7361
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