Implant malposition — when the implant has moved out of place.

What malposition means

An implant in the correct position sits where the surgeon designed it: within an inframammary fold of the right height, with the implant filling the breast mound, neither too medial nor too lateral. Malposition means the implant has moved away from this design — sometimes within weeks of surgery, sometimes years later.

Malposition is not the same as size mismatch. A correctly positioned but oversized implant will look wrong because of size, not position. A correctly sized implant in the wrong position will look wrong because of position. Distinguishing these matters for the surgical plan.

Four types of malposition

Diagnosis & assessment

Visual examination plus measurements:

• Distance from nipple to inframammary fold (target: ~7-8 cm with appropriate implant)
• Distance between medial implant edges (target: ~2-3 cm at sternum)
• Lateral border of implant relative to anterior axillary line
• Symmetry of inframammary fold heights between sides

Comparing pre-primary photos (if available), early post-primary photos, and current photos shows the trajectory — was malposition immediate or progressive? This affects surgical planning.

Surgical technique

The operation depends on type:

For bottoming out

The expanded inferior pocket is reconstructed with internal capsulorrhaphy — permanent sutures placed inside the capsule to recreate the inframammary fold at the proper height. The pocket is reduced from below; the new fold is anchored to chest wall structures.

For lateral displacement

Lateral capsulorrhaphy reduces the pocket from the lateral side. Permanent sutures placed along the lateral capsule wall reduce pocket dimensions and prevent re-displacement.

For symmastia

Most challenging type. Medial capsulorrhaphy plus restoration of the sternal soft-tissue cover. May require ADM (acellular dermal matrix) reinforcement if tissue is very thin. Implant may need to be downsized.

For double bubble

The original adherent IMF must be released and the new fold raised to the proper height. Capsulorrhaphy at the new fold level.

Internal capsulorrhaphy — the "internal bra"

The technical centrepiece of malposition repair. Permanent sutures placed inside the capsule reduce the pocket dimensions and reinforce key boundaries — particularly the inframammary fold. The repair is invisible from outside but holds the implant in the correct position long-term.

Three layers of sutures are typical: deep (capsule to chest wall structures), middle (capsule wall to capsule wall), superficial (subcutaneous reinforcement). Permanent monofilament sutures (typically Prolene) are used.

For complex or recurrent cases, a sheet of ADM or surgical mesh may be added internally to provide additional structural support. This adds cost but improves long-term outcomes in select cases.

Recovery profile

• Day 1-3: Moderate discomfort, especially with arm movement.
• Week 1: Compression bra continuously; restricted upper-body movement.
• Week 2-3: Office work return; arm restrictions continue.
• Week 4-6: Light exercise (no chest or upper-body resistance).
• Week 8-12: Full activity return after the internal repair has healed.

Internal capsulorrhaphy recovery is longer than other revision types — the internal sutures need time to integrate with healing capsule. Resistance training too early can stress the repair.

Frequently asked