Most breast augmentation results settle beautifully into place and stay that way for years. But sometimes an implant shifts from where it was originally positioned – sitting too low, too far to one side, too high, or even migrating toward the center of the chest. This is called implant malposition, and it’s one of the more common reasons patients seek revision surgery.

Malposition isn’t a sign that something was necessarily done wrong at your original surgery – though technique matters, tissue behavior over time plays a significant role too. Here’s what causes it, what the different types look like, and how it’s corrected.

What Is Breast Implant Malposition?

Implant malposition refers to an implant sitting in a location different from where it was originally and intentionally placed. It’s not a single condition – it describes several distinct patterns, each with its own cause and correction approach.

Bottoming Out

The implant drops below the natural inframammary fold (the crease under the breast), causing the nipple to appear too high relative to the breast mound and creating a lower pole that looks overly full or “bottom-heavy.”

Lateral Displacement

The implant shifts toward the side of the chest, sometimes settling near the armpit, especially when the patient lies down. This often results in breasts that appear to sit too far apart when standing.

Symmastia (“Uniboob”)

The implant pockets merge across the midline of the chest, causing the inner edges of both breasts to appear connected rather than separated by a natural cleavage line. This is one of the more difficult malposition patterns to correct.

Superior Malposition (High Riding)

The implant sits too high on the chest, often because the pocket wasn’t fully released during the original surgery or because scar tissue has tightened around the upper portion of the pocket.

What Causes Implant Malposition?

Inadequate pocket support. If the tissue pocket created during surgery is too large relative to the implant, or if it’s positioned imprecisely, the implant has room to shift over time – most commonly downward or to the side, following gravity.

Capsular changes. Scar tissue (the capsule) around the implant can tighten unevenly, pulling the implant in one direction, or can weaken in one area, allowing the implant to shift into it.

Implant weight and size relative to tissue support. Larger, heavier implants place more downward stress on the supporting tissue over time. If the native tissue and internal support structures aren’t strong enough to bear that weight indefinitely, gradual bottoming out can occur, sometimes years after the original surgery.

Tissue stretching over time. Skin and internal breast tissue naturally stretch somewhat under sustained weight, particularly with pregnancy, significant weight changes, or simply the passage of time. This can allow an implant that started in the correct position to gradually shift.

Original surgical technique. The precision of the initial pocket dissection matters. A pocket that’s dissected too widely, too low, or asymmetrically increases the likelihood of later malposition.

Trauma or significant physical impact. A direct injury to the chest can, in some cases, disrupt the implant pocket and cause a shift.

Breast Implant Malposition Symptoms

Beyond the visible shift in implant position, patients may notice:

• Breasts that look asymmetric in a way that’s new, rather than present from the original surgery
• A change in the position of the nipple relative to the breast mound
• Visible or palpable implant edges, especially at the sides or bottom of the breast
• Discomfort or a pulling sensation, particularly with certain movements or positions
• A “double bubble” appearance, where the natural breast fold and the implant’s edge create two distinct visible creases
• In symmastia, a loss of the natural separation between the breasts

How Implant Malposition Is Corrected

Correction depends entirely on which type of malposition is present and how significant it is.

Capsulorrhaphy. This procedure involves surgically repairing or reinforcing the internal pocket – essentially suturing the capsule to reshape and stabilize the space the implant sits in. It’s commonly used to correct bottoming out or lateral displacement by rebuilding support where the pocket has stretched.

Internal support with mesh or acellular dermal matrix (ADM). For more significant support needs, internal support material can reinforce the lower pole or other weakened areas of the pocket, providing structural support beyond what capsulorrhaphy alone can offer.

Pocket conversion. In some cases, converting the implant to a different pocket plane can resolve chronic malposition issues, particularly when the original pocket has been compromised.

Capsulectomy. In cases involving scar tissue tightening or symmastia, removing the abnormal capsule tissue is often necessary before the pocket can be properly reconstructed.

Implant downsizing. If the original implant size is placing more demand on the supporting tissue than it can reasonably maintain, choosing a smaller or lighter implant at the time of correction reduces the likelihood of recurrence.

These corrections are typically performed as part of a breast implant exchange procedure, since addressing malposition almost always involves some degree of implant removal, pocket revision, and replacement.

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Can Implant Malposition Be Prevented?

While not every case is preventable, several factors reduce the risk:

• Precise, individualized pocket dissection at the time of original surgery, sized appropriately to the implant rather than larger than necessary
• Thoughtful implant size selection relative to the patient’s existing tissue support, rather than choosing size based on preference alone
• Following activity restrictions during the early recovery period, which allows the pocket to heal and stabilize properly
• Wearing recommended post-surgical support garments as directed
• Regular follow-up so early shifts can be identified and addressed before they become more pronounced

Our On Top® Rapid Recovery technique places implants above the muscle through a precise inframammary approach, which allows for accurate pocket creation and reduces certain mechanical stresses associated with submuscular placement – though bottoming out and lateral displacement remain possible with any implant placement technique if the supporting tissue is under strain.

Frequently Asked Questions

Notice a Change in Your Results?

If your implants seem to have shifted from where they originally sat, an evaluation can clarify what’s happening and what correction options make sense for you.

Schedule a consultation to discuss your options →

Learn more about our breast implant exchange process for correcting malposition and other implant concerns.

References

1. American Society of Plastic Surgeons. “Breast Implant Revision Surgery.” PlasticSurgery.org
2. Spear SL, Little JW 3rd, Lippman ME. “Repair of symmastia and pseudosymmastia.” Plastic and Reconstructive Surgery. 1993;92(5):882-887. PubMed
3. Maxwell GP, Gabriel A. “Breast implant design.” Gland Surgery. 2017;6(2):148-153. PubMed
4. U.S. Food & Drug Administration. “Risks and Complications of Breast Implants.” FDA.gov

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