What malposition means
Malposition means an implant is not sitting where it was meant to. The pocket around the implant has stretched, tightened or shifted, so the implant moves with it. It can appear soon after surgery or years later.
- Bottoming out: the implant drops below the fold and the nipple points up
- Lateral displacement: the implants slide toward the armpits
- Symmastia: the implants meet or nearly meet over the breastbone
- High-riding: the implant sits high, often because of a tight capsule
Why it happens
Common reasons include an implant that is too large or heavy for the tissue holding it, thin or stretched soft tissue, a pocket that was made too big, the effect of weight change and pregnancy, and capsular contracture. Gravity and time play a part for everyone.
How it is corrected
Correction aims to rebuild the pocket in the right place and give it lasting support. That may involve tightening the loose side of the pocket with sutures, using the existing capsule as a support layer, or adding a supporting mesh or matrix in selected cases. Tight areas are released so the implant can settle where it should.
The implant itself is reconsidered. A smaller, lighter implant puts less load on the tissue and holds a position more reliably. Downsizing is a growing and thoughtful choice, and many people are happy with a proportionate, natural result.
The role of fat grafting
Fat grafting can thicken thin tissue, refine the cleavage, fill hollow areas and camouflage edges after the pocket is corrected. It is increasingly used to improve the result with a smaller implant, because the final shape is built from implant plus your own soft tissue.
Setting expectations
Revision surgery for malposition is generally more complex than first-time surgery. Recurrence is possible, and the scar and tissue quality limit what can be achieved. A realistic plan, sometimes done in stages, is part of a good consultation. Your result will be individual.