Implant Malposition: Bottoming Out, Side Displacement and Symmastia

Sometimes an implant ends up in the wrong place, either at the time of surgery or over time. The cause guides whether correction is straightforward or complex.

Common types

• Bottoming out: the implant drops below the breast fold, with the nipple pointing upward
• High-riding: the implant sits too high, often with capsular contracture
• Lateral displacement: the implant slides toward the armpit
• Symmastia: the implants come together over the breastbone, losing separation between the breasts
• Rotation or tilt: especially with shaped implants

Why it happens

• A pocket made too large or in the wrong place
• Tissue stretching under heavy implants
• Capsular contracture
• Muscle movement or pull
• Weight change, ageing or pregnancy
• Thin or weak tissue

Treatment options

Treatment depends on the type and severity. Surgeons may:

• Tighten or rebuild the pocket with internal stitches (capsulorrhaphy)
• Change the implant size or position
• Use supportive tissue or materials in selected cases
• Treat any contracture

Supportive materials have varying evidence and costs, so ask what is proposed and why.

Can it come back?

Yes. Correction can be less predictable than a first operation, and tissues that have already stretched may stretch again.

Prevention

Careful planning, an appropriate implant size and following aftercare advice can lower the risk, though they cannot remove it.

How position is assessed

The surgeon compares the implant, nipple, breast fold and chest-wall shape, then considers photographs, scar position and any symptoms. What looks like a low implant can sometimes reflect a high breast fold, skin stretch or a change in the breast tissue itself. Imaging may be useful if rupture or another complication is also suspected.

Correction may involve more than moving an implant

A repair can require pocket tightening, changing the implant plane, adjusting the breast fold, exchanging the implant or adding support in selected cases. If skin and breast tissue have stretched, a lift or a staged approach may also be discussed. Each added procedure brings its own scars and recovery.

Recovery after repair

Aftercare often focuses on protecting the repaired pocket while it heals. Ask about sleep position, arm movement, bras, lifting and exercise rather than relying on the timeline from your first augmentation. Early symmetry is not the final assessment.

Questions to ask

• What is causing the problem in my case?
• How will you correct it, and how long might that last?
• What are the alternatives?