Breast Implant Pocket Problems
Overview
- Breast implant pocket problems include a variety of more specific issues, all of which occur because the implant pocket is too large or small.
- Patients often fear that their breast implant has fallen or slipped out of the implant pocket, but this is very rarely the case. A displaced implant is far more likely to simply be moving around within a pocket that is too loose.
- Implant pocket issues can occur at any time after breast augmentation, often appearing years after breast augmentation surgery.
- Plastic surgeons can fix breast implant pocket problems with revision surgery, but the techniques they use vary based on the unique issue with your implant pocket.
What is a Breast Implant Pocket and What Can Go Wrong with It?
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.
Signs of Breast Implant Pocket Problems
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:
- One implant moves much more than the other
- New or progressive breast asymmetry
- An implant dropping unusually low (bottoming-out)
- An implant shifting toward the armpit when standing or lying down (lateral displacement)
- Implants moving too close together toward the middle of the chest (symmastia)
- An implant sitting unusually high on the chest (high-riding implant)
- Sudden or recurrent change in implant orientation (implant flipping)
- The appearance of two breast creases (double bubble deformity)
- Nipples appearing unusually high, low, or off-center relative to the breast mound
- Loss of upper-pole fullness
- Breast looking wider, flatter, elongated, or distorted
- A visible implant edge or increased implant palpability
- Discomfort, pulling, heaviness, or excessive movement
Why Do Breast Implant Pockets Stretch or Change?
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.
The Original Pocket Design
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:
- Excessive medial dissection can increase symmastia risk.
- Excessive lateral dissection can allow outward or lateral displacement.
- An inadequately supported lower pocket can contribute to bottoming out.
Implant Size, Weight, and Dimensions
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.
Tissue Quality and Changes Over Time
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:
- Naturally thin or weak breast tissue
- Pregnancy and breastfeeding
- Significant weight fluctuations
- Aging and gravity
- Previous breast augmentation and surgery
- Breast lift with implants
- Repeated revision surgery
- Smoking
The Scar Capsule Around the Implant
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.
How Are Breast Implant Pocket Problems Repaired?
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:
- Tightening the implant pocket with internal sutures (capsulorrhaphy)
- Closing part of the implant pocket
- Creating a new implant pocket
- Moving the pocket to another plane (moving an implant above or below the muscle)
- Reconstructing the inframammary fold (breast crease)
- Reattaching and reinforcing pocket boundaries
- Creating a stronger internal support (internal bra)
- Changing the implant size or shape
How Do You Know If Implant Movement is Normal or a Pocket Problem?
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:
- Breast changes progressively get worse
- One implant moves much farther than the other
- The breast crease moves or looks odd
- The implants take up residence too close to your underarms or each other
- Implant dips below the natural breast crease
- Breast shape or nipple position meaningfully change
- Implant can be moved unusually far inside the pocket
- New pain, firmness, or significant asymmetry develops
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.
Frequently Asked Questions
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.