“Dr. Polo, I noticed this morning that the shape of my implant suddenly looks different. I too have a slight annoyance. Could my implant break?’
Recently a patient came to my practice with the above complaint. She had undergone buttock augmentation with silicone implants about 15 years ago. Buttock silicone implants are made of solid silicone, not a silicone shell containing silicone gel, which is the design for breast implants. Solid silicone implants do not break or leak their contents. In rare cases, however, a solid silicone implant can break. I changed my patient and when I examined her, my suspicions were confirmed. Her implant had not ruptured or ruptured, but had flipped over.
Implant tipping is not a common complication, but we do see it from time to time. There are several factors related to both the individual and the implant that may contribute to this occurrence. And with breast and buttock implants, the implant pockets can stretch over time and develop some redundancy. When this happens, there is more room for forces acting on an implant that result in tipping or inversion of the implant. Larger, heavier implants, high-impact physical activities, lack of regular use of supportive garments, wide fluctuations in body weight, and simple aging of the body’s tissues are all factors that may contribute to the development of an excess pouch.
A person resting his two hands, with visible signs of aging, on a wooden table.
Once pocket redundancy occurs, some implants are likely to be reversed. With silicone or saline breast implants, there are options for different degrees of projection or profile. Low profile implants are disc shaped and their anterior and posterior surfaces are very similar. This type of implant is less likely to tip over, and even if it does, it is unlikely to be noticed. We often find lower profile implants inverted at the time of surgery for some other indication and neither the patient nor the surgeon had any reason to suspect it.
On the other hand, higher profile implants have more of a dome shape. Their front surface is convex and rounded and their back is flat. When a high-profile implant inverts or inverts, there is much more likely to be a noticeable change in shape, where the contour of the breast becomes less rounded and flatter. The sharper edge of the posterior surface of the implant is now palpable and may cause some tenderness or discomfort.
Another property of silicone gel breast implants that affects the risk of tipping is their degree of cohesion. High-cohesive or “gingival” implants contain silicone gel that is firmer and more rigid than standard silicone implants. This makes the “gum” implants heavier and increases the risk of tipping. Solid silicone buttock implants have the ultimate consistency, making them prone to tipping when there is pocket redundancy.
Three doctors working on a patient in an operating room.
As with my patient above, again, signs and symptoms of an inverted implant may be a sudden change in the visible or palpable shape of the breast or buttocks, a more palpable edge of the implant, and mild discomfort or tenderness. These changes may follow unusually vigorous physical activity or sleeping in an unusual position. The diagnosis can often be made through a simple examination by your plastic surgeon. Imaging studies may also be indicated to rule out any rupture of the implant.
In the case discussed here, I could quite easily manipulate this patient’s implant in the office and return it to its proper position. I instructed her to avoid sleeping or lying on the affected side. If the inversion of the implant recurred repeatedly, then surgery could be indicated to correct the excess pocket.
If you notice a sudden change in the appearance or feel of a breast or buttock implant, consult a plastic surgeon certified by the American Board of Plastic Surgery. If your implant has flipped, there may be a simple solution.
Dr. Max Polo.
Dr. Polo is a graduate of University of Miami, Miller School of Medicine. He is a certified Plastic Surgeon and a partner in Miami Plastic Surgery. He has been in practice for over 20 years during which he has remained an active member of his medical staff Baptist Hospital and South Miami Hospital. Dr. Polo is dedicated to patient safety and Plastic Surgery education and has been recognized by his peers by being elected to leadership positions such as past president of the Miami Society of Plastic Surgeons and president-elect of the Florida Society of Plastic Surgeons . Dr. Polo is a specialist in Cosmetic Surgery of the face, neck, breast and body. His greatest expertise is in breast augmentation and moms. His practice also includes the full range of non-invasive treatments such as Botox, fillers, CoolSculpting, ultrasound, lasers and radio frequencies.
Favorite points of Dr. Polo on the island include Crandon Park Golf Course, the beach at Cape Florida Light and The Spa and Rum Bar at the Ritz Carlton.
You can email him questions at mpolo@miamiplasticsurgery.com.
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