Medically known as AP malposition (anterior-posterior malposition), a flipped implant happens when a breast implant rotates front-to-back in the breast pocket. In this case, the flatter back of the implant faces forward rather than sitting against the chest wall as intended. A flipped implant can create a dramatic and sudden change in the appearance of your breast, causing it to look much flatter and possibly allowing you to see the edges of the implant beneath your skin. It may affect one or both breasts, and it can be a one-time event or a recurring problem.
Implant flipping is a unique problem and is not the same as implant displacement. It is also not indicative of a ruptured implant or capsular contracture. Flipping means that your implant has turned so that the back of the implant now faces forward. Implant displacement, on the other hand, occurs when the implant changes position on the chest wall, moving either higher, lower, inward, or outward.
A ruptured implant is one whose outer shell has been compromised. This causes rapid breast deflation with saline implants but often goes undetected in cohesive silicone implants. Capsular contracture is a condition in which excess scar tissue forms around the breast implant, applying pressure that can displace or deform the implant.
These issues can overlap, so you could have more than one breast implant issue. A flipped breast implant, however, denotes only a loose implant pocket. It does not mean that your implant has shifted, ruptured, or been subjected to capsular contracture.
There are several different reasons why breast implants flip, but all of them ultimately happen because the implant had room to move inside the breast pocket. The body forms a capsule of scar tissue around breast implants, creating a pocket that holds the implant in place. Ideally, that pocket should be large enough to accommodate the implant while still keeping it in its proper position. If the pocket stretches or becomes oversized, the implant has more room to rotate.
High-profile and/or large implants are more likely to flip. High-profile implants project further from the chest wall. Their geometry makes them more likely to rotate within the breast pocket if they have room to do so. Large, heavy implants may flip because they place pressure on the implant pocket, stretching it over time. The stretch makes the pocket larger and gives the implant room to move.
Highly cohesive silicone implants, such as gummy bear implants or teardrop implants, are known for holding their shape well. This is one of their advantages, but it can cause a very obvious deformity if the implant flips.
Sometimes plastic surgeons place breast implants on top of the chest muscles, and sometimes they place them beneath. Both positions have benefits in the right patients, but repeated pectoral muscle movements can place force on a submuscular implant, stretching the implant pocket over time. Once the pocket becomes loose enough, the implant may have enough room to flip.
Some patients notice that their implant has flipped after sleeping on their side or stomach. This makes sense, as certain positions may temporarily impact the shape of the breast pocket, giving the implant more freedom within a loose pocket. This doesn’t mean you need to change how you sleep after getting breast implants! A healed, stable pocket won’t allow an implant to flip. Sleeping position is only one potential factor that may contribute to an implant flipping if the pocket is already loose.
If your breast implant flips, there may be visual clues as well as odd feelings or sensations. Both tend to be immediately noticeable. Visually, you may notice:
Although every patient is different, some can feel a flipped implant. Not every woman feels a flip, but those who can often report:
Sometimes, you or your plastic surgeon can manually flip a breast implant back into its intended position. Your plastic surgeon may be able to manually reposition the flipped breast implant. After that, some women never experience a flipped breast implant again.
Other women aren’t so lucky and experience repeated breast implant flipping. With the help of their surgeon’s instructions, many manually reposition the implant themselves at home when repeat flips occur. This is bothersome, however, and frequent flips clearly indicate that the implant pocket is too big and surgical correction is necessary. If your implant keeps flipping, it’s time to consult with a plastic surgeon.
The fix for a repeatedly flipping breast implant is revision surgery. The surgery may or may not include replacing your implants. The specifics of your surgical plan will depend on why your implant pockets became oversized. The surgery may include:
Although unlikely, implants can flip again after surgical correction. The risk depends on breast tissue strength, implant dimensions, pocket size, prior surgery, and how the pocket heals after repair. The best plastic surgeons approach repeated implant flipping as a structural problem, focusing on why the implant flipped and repairing the underlying issue. This approach greatly minimizes the risk of future implant flips, although no one can guarantee you that your implant will never flip again.
Each breast implant sits in its own pocket and can behave independently. As such, it is possible for one or both implants to flip. Breast implants can flip at the same time, but it’s common for only one implant to flip.
Breast implant flipping can occur at any time after you’ve healed from your breast augmentation surgery. As soon as swelling eases and the pocket is healed enough to allow movement, a flip is possible, but timing varies. If you experience a sudden change in your breast shape while still recovering from your breast implant surgery, contact your plastic surgeon. A sudden postoperative shape change should be evaluated rather than assumed to be flipping.
Yes, a breast implant can flip even years after surgery. The implant pocket can stretch or change over time, creating more room for an implant to flip. This means your implant could flip even if it has been stable for many years.
Any implant can flip, including saline implants. Online, you will often see discussions focusing on gummy bear or teardrop implants flipping. This is because these implants hold their shape extremely well, making it visually obvious when they flip. Saline implants can flip too, but it may not create as dramatic of a visual change as a flipped silicone implant.
Patients with round breast implants are often surprised to learn they have AP malposition. They assume that because their implants are round, they have no front or back. However, a round implant shape does not imply that the implant is spherical; it simply means the implant looks round from the front rather than teardrop-shaped. Saline implants have a front and back, like their silicone counterparts, and can also flip.
Not necessarily. Implants can suffer damage, and persistent distortion, pain, or questions about implant integrity warrant an evaluation. But a flipped implant is not necessarily a damaged one.
A flipped implant can make your nipple look odd and out of alignment with the breast mound. It’s not that your nipple itself has actually moved. It just looks that way as the implant beneath it has flipped and no longer sits in its correct position under the nipple.
Because breast implants tend to flip at night when patients lie down, some plastic surgeons recommend wearing a bra while sleeping for extra support. This recommendation only applies to patients with known implant mobility issues and is not universally applied. It’s best to ask your plastic surgeon if this may help you and follow their specific advice.
Yes, and a lot of the clinical data we have about flipped breast implants comes from examinations of women who have undergone breast reconstruction. Tissue thickness after a mastectomy, reconstruction of implant pockets, prior radiation treatment, and previous surgery can affect implant mobility differently from cosmetic breast augmentation. Currently, it appears as though flipping may be more common in breast reconstruction cases, but medical science does not have hard head-to-head data on this as of yet.
A flipped implant alone is not a medical emergency, but seek emergency treatment if you experience sudden severe pain, rapidly increasing swelling, fever, drainage, trauma, or other abrupt, unexplained changes.