Implant Inversion Explained: Just When You Think You’ve Seen It All (Updated 2025)

After 25+ years in practice, it’s not often that something comes up that is totally new and surprising. But this occurred recently when my breast augmentation patients started reporting they were having their breast implants FLIP!  This phenomenon, known as breast implant inversion, is indeed real, and we’re exploring how to address it below.

What in the World? What Does a Flipped Implant Look Like?

The story was similar each time. Women noticed the following abnormalities:

• A strange contour to their breast (a flatter contour on top)
• A noticeable square-like ridge
• A strange “swooshing” sensation while bending over.

All of these patients had implant inversion or a flipped breast implant. In other words, their implant was upside down, with the smaller, rounded top contour on the chest wall side and the flatter, bigger bottom side facing up. 

Recognizing Implant Inversion: A Rare But Real Phenomenon

The first time a patient called with concerns, she wasn’t sure what was happening—and at that point, neither was I. I advised the nurse to have her come in for an evaluation. When she arrived, and I saw the implant had flipped, I could hardly believe my eyes. With a few firm but gentle manipulations, I was able to rotate it back into place. Still, I began to wonder: How do we prevent this from happening again?

Over the following weeks and months, more patients came in with similar symptoms. At first, all of them had undergone breast revision surgery, leading me to suspect a larger implant pocket was the culprit. But soon, even my primary breast augmentation patients began experiencing this inversion.

Now, six months after first encountering this issue, I’ve come to understand that implant inversion is a real—though rare—phenomenon. Early diagnosis, thoughtful surgical planning, and effective prevention strategies are essential to managing this unexpected complication.

Head Over Heels: Implant Malposition  

At first, I was perplexed—how and why was this happening? The issue initially only appeared in revision breast augmentation patients, which led me to believe a larger pocket or a partially intact capsule might be the cause. The capsule’s smooth, slippery inner surface seemed like a logical culprit, increasing the likelihood of implant inversion.

But could it be more than just the pocket? After all, even in standard cases, the capsule is typically larger than the implant. This raised further questions about the role of implant dimensions, tissue integrity, and other surgical factors in causing this unusual malposition.

Are High-Profile Cohesive Gel Implants the Common Denominator?

It’s becoming increasingly clear that implant inversion may be more closely tied to the implant itself than to the patient’s capsule. Specifically, this issue appears most commonly with the newer, high-profile cohesive gel implants.

These implants are designed with a more teardrop-like shape—wider at the base, narrower at the top, and significantly more cohesive and heavy. This structural imbalance can lead to flipping, especially during everyday movements like bending over in the shower. The implant, quite literally, flips “head over heels.”

In contrast, earlier-generation implants were less cohesive, lighter, and had a more rounded profile. While those implants also had a front and back, inversion was far less noticeable and rarely posed an issue..   

Nothing Is Ever New in Plastic Surgery 

Plastic surgeons who have been around for 20 years will remember the first generation of anatomical teardrop-shaped implants. These implants had more projection in the lower pole than the upper pole, thus the term “anatomical.” In the photo below, the anatomical implant is pictured on the right.

These implants were textured to keep them in the correct orientation. The lower pole with the higher projection needed to stay put in the lower pole, so the implants were textured to get them to stick on the inside. As one of the plastic surgeons using this style of implant in the late 1990s, I liked the concept of the teardrop shape.

However, I had a few patients for whom the texture did not promote sticking, and the implant behaved like a smooth implant. This led to breast implant malposition, as previously described. I switched to using only smooth round implants around 2000, since this surface eliminated a variable that I could not always control. More recently, textured implants have been associated with a condition called BIA-ALCL, and have been removed from the market. So a textured surface was not offered on the new highly cohesive implants. (For more information about smooth versus round implants, take a look at my related blog post.)

Achieving the Best of Both Worlds 

Is it possible to enjoy the benefits of cohesive gel and extra high-profile implants without the risk of flipping? The answer lies in thoughtful planning. A tighter pocket can help reduce movement, but creating that level of control is often easier said than done—especially since the capsule is typically larger than the implant.

This becomes more complex in patients with looser skin from pregnancy or weight loss, where extra projection is needed to re-volumize the upper pole. In these cases, another option is to reduce implant profile, though that means sacrificing some of the fullness patients often desire. Achieving the ideal balance between aesthetics and stability requires careful consideration of profile, implant type, and individual anatomy.

Revision or Breast Lift (Mastopexy) Patients: A Delicate Balance

Revision and breast lift (mastopexy) patients already face some of the most complex breast surgeries. In these cases, introducing additional variables—like the risk of implant inversion—can tip the balance, where the potential risks may outweigh the benefits.

Highly cohesive gel implants have been a game changer in reducing concerns about future rupture. After years of removing ruptured implants and dealing with the messy aftermath, I was genuinely relieved when “gummy bear” implants became available. Their structural integrity offers peace of mind for both me and my patients. That said, implant shape and profile matter. While moderate and full-profile implants appear less prone to inversion, extra high-profile implants—especially in lean patients—seem more susceptible. Knowing this, I’m now more cautious about recommending extra high-profile implants, even in cases where I would have previously considered them ideal.

What’s the Best Solution? 

My suggestion for resolving this issue is to add a tab to the extra high-profile implants. This would effectively “tack” the implant in place and limit breast implant flipping. Unfortunately, this implant doesn’t exist (yet). In a world turned upside down, my best solution is to hold off on the extra high-profile implants until the tabs are added to the product. Honestly, the difference in profile is measured in millimeters, so for now, I feel that this is an adequate solution.  

Your Next Step

To summarize, the best course of action is to seek advice from a board-certified plastic surgeon who has the experience and expertise to guide you in your breast augmentation journey. The entire team at Aesthetica is looking forward to helping you reach for your star. You can schedule a consultation with me by calling my Columbus plastic surgery practice at (614) 569-2649 or by using our online form to request a consultation.

Breast Wishes.