When performing breast augmentation, a plastic surgeon creates a space, or pocket, within the breast tissue to hold the implant. They create this pocket under or over the muscle, depending on where your implants are to be placed. As you heal, your body creates a thin capsule of scar tissue around the implant, which becomes part of the implant pocket. A healthy pocket provides enough room for the implant while still controlling its position.
Implant pocket problems develop when the pocket grows too large, is too tight, or shifts in a particular direction. This results in several different types of implant displacement, or malposition. The specific displacement depends on the cause or position of the shift. Patients often describe implant displacement and breast pocket problems as the implant falling out of the pocket, but this is rarely the case. The implant remains in the pocket rather than falling out, but the implant or the entire pocket may shift.
There are a number of indicators that you’re likely having a breast implant pocket problem. Pocket problems can occur in both breasts at once but commonly happen in only one. They can also happen at any time, even if it’s been years since your breast augmentation. You may have a breast implant pocket issue if you experience any of the following:
A breast implant pocket can change slowly over time or develop immediately for many reasons. While you can have an issue at any time, sometimes your implant pocket problem isn’t a change at all but rather a problem with the pocket’s initial creation.
Plastic surgeons must create a pocket for your implant to sit in during your breast augmentation, and this is not simply a matter of choosing your implant and then sizing the pocket accordingly. The surgeon has to anticipate how the implant, muscle, breast tissue, skin, and inframammary fold will behave both during surgery and as the breast heals. A pocket that is too tight can cause issues, but so can one that is too loose. If the pocket is too big or weak, the implants will move in the direction which offers the least resistance:
Even if your breast implant pocket is perfectly done, a large or heavy implant can stretch it over time. Heavier implants place more force on supporting breast tissues. Implant volume can contribute to pressure and stretching, but so can implant projection and width. An implant that is poorly matched to a patient’s chest width or tissue strength increases the risk of a stretched pocket. This is true of all implants, including saline and gummy bear implants. This is a size issue, not a composition one.
Your breasts don’t stay the same throughout your lifetime, and changes in the tissue can lead to changes in the implant pocket. Weakened tissue makes implant movement more likely. The tissue surrounding your implant can change for several reasons, including:
It’s normal for some scar tissue to form around a breast implant and become part of the pocket. This is a natural part of the healing process. Sometimes, however, the body creates too much scar tissue, leading to a capsular contracture. Capsular contracture is when the scar tissue becomes so thick that it shifts or distorts the breast implant. Because the scar capsule becomes part of the pocket, this is considered an implant pocket problem.
Implant revision surgery allows a plastic surgeon to make changes to the implant pocket, but the treatment must address the specific reason for the pocket failure. Popping the implant back into place and calling it a day is not an adequate repair. Treatment must correct the specific pocket failure to be successful.
To that end, surgery may include several different components, based on an individualized assessment of your needs. Although you won’t need everything on this list, repairing breast implant pocket problems may require:
It’s important to understand that your breast implants should have some movement within the breast pocket. Without some freedom of movement, your implants will look fixed and unnatural rather than moving with your body the way natural tissue does. Normal movement includes a gradual settling and softening of new implants in the months following your breast augmentation and implants that move slightly outwards when lying down.
Movement is more concerning when:
It’s not necessarily a problem if your implants move, but you could have a breast implant pocket problem if they move unnaturally far, or, conversely, if they’re so tight that they don’t move.
Exercising too strenuously or too soon while recovering from breast implant augmentation can stretch an implant pocket. Once you’re fully healed, however, normal exercises and movement should not cause a pocket failure.
Some women don’t feel anything at all, noticing only visual changes if they have an implant pocket problem. Those who do feel the issue report that they can feel the implant shifting or sliding when they change body position or feel movement when transitioning between standing up and lying down.
No. Except in the case of capsular contracture squeezing an implant pocket, an implant pocket won’t become smaller on its own. Breast tissue will stabilize and perhaps tighten during initial breast augmentation healing, but a stretched or enlarged implant pocket will not shrink on its own.
Implant pockets can undergo more than one revision surgery, but scar tissue, tissue strength, previous pocket locations, and other factors all influence subsequent repair strategies and can make future revisions more difficult.
Not by itself, no. Switching from saline to silicone does change some implant characteristics, but a stretched pocket will still be enlarged and potentially problematic. When compared by volume, saline and silicone implants have similar weights, so switching from one to the other won’t impact the likelihood of future pocket problems.
Internal bra is not a medical term but rather an informal one that describes using sutures, surgical mesh, or other appropriate materials to create additional breast pocket support. This is done in a number of ways and is not a standard procedure. The type and position of internal support depend on individual patient needs.