Types of Malpositioning
Every patient’s body is different, so malpositioning may present slightly differently. In general, breast implant malposition can be sorted into the following four categories.
Inferior
With inferior malpositioning, the breast implant is placed too low on the chest, creating too much breast volume beneath the nipple and not enough above the nipple. The empty upper breast makes the nipple point up too high, and scarring may rise above the breast crease toward the lower pole of the breast. Because the breast is too low on the torso, the patient’s abdomen can appear more square, throwing off their natural proportions.
Most cases of inferior malpositioning are caused by poor implant placement, but it can also develop due to thin or weak breast tissue, heavy implants, and gravity. At times, inferior malpositioning can cause a “double bubble” breast, where an additional hump appears on the torso below the breast crease. Typically, this is fixed by either reducing the size of the existing implant pocket or creating a new pocket within the breast.
Superior
In a superior malposition, the breast implant is too high on the chest, creating too much volume above the nipple and not enough below it. Superior malpositioning is defined by the following:
- Emptiness along the bottom of the breast
- Downward-pointing nipples
- Upper bulges that can create a shelf-like appearance
- Excessive rounding of the breast
- Visible or palpable breast implant edges
- Overly artificial look
Superior malposition can be caused by a poorly placed implant, capsular contracture, excess fluid around the implant, or overly tight chest muscles. Treatment for superior malposition will depend on the underlying cause. For most patients, a capsulectomy will fix capsular contracture-related malpositioning, while others will need a new implant or a careful release of excess tissue to adjust their implant.
Symmastia
Symmastia, also known as a “uniboob,” occurs when the breast implants are too close together, tenting up the skin over the breastbone. Sometimes the implants are equally malpositioned, whereas in other cases, symmastia is caused by a single misplaced implant. Because too much breast implant volume is located between the nipples with symmastia, the nipples will tip outward and can affect the appearance of the breasts through a bra.
Symmastia can be caused by the following:
- A depressed breastbone (pectus excavatum)
- An improperly dissected breast implant pocket
- Overly large implants
- Thin, weak, or overly flexible breast tissue
Dr. Teitelbaum is an expert in symmastia breast revision surgery and will tailor your procedure to your body’s exact needs. No one technique works for all patients, but most will find success with a capsulorrhaphy, which closes a section of the implant capsule, or a neosubpectoral or neosubglandular pocket, which uses the body’s own tissues to close the implant pocket. Dr. Teitelbaum may also use an acellular dermal matrix (ADM), like AlloDerm® or Strattice, to support the breast.
Lateral
In a lateral malposition, the implants are placed too far out to the sides, creating a wide space between the breasts and a lack of cleavage. Here, the nipples point inwards due to a lack of volume in the inner breasts, and the patient may have irritation along their arms from the increased volume in the outer breasts.
Most often, lateral malposition is caused by a protruding breastbone, heavy or overly large implants with thin tissue, poor placement, or strong pectoralis muscles. Typically, lateral malpositioning is fixed through a neosubpectoral or neosubglandular pocket, a capsular flap, biomesh reinforcements, or acellular dermal matrix supports.
