In a previous blog, I introduced the topic of implant inversion or flipping. At the time, this was a completely unheard-of complication for me, so I wrote the blog to help explain it to my patients.
Now that a few years have passed, and I have continued to specialize in both primary breast augmentation and breast augmentation revisions, this topic continues to come up. I see implant inversion in my practice with patients I have operated on, as well as when patients come to me from another plastic surgeon with questions about this crazy situation.
I find myself explaining implant inversion all the time now. As this has happened, my implant choice has gradually shifted from the ones that are prone to flipping to another style that does not flip as often, especially in revision cases or when a mastopexy is also done.
In this blog, I will cover my current practice preferences for avoiding and treating implant inversion.
Treatment of Implant Inversion
When a patient with breast implants calls my Columbus, Ohio, plastic surgery office to report that the shape of their breast has changed, we now know that this is an implant that has flipped. The shape they report is flat on the front, instead of the normal rounded breast shape, and there are definite edges that can be seen and felt. The patients sometimes say they did not notice when it happened, but a few can relate the occurrence when they bent over and felt a strange swoosh feeling.
Manual Maneuvers or Positioning
When an implant inverts, the first treatment is to attempt to flip the implant back into the correct orientation with manual maneuvers and positioning. Some patients are able to flip the implant back into the correct orientation with these manual maneuvers, including lying on their side and trying to flip it, and also bending over at the waist. We recommend that the patient try to do this for at least a week. However, if these maneuvers are not successful, it can be very frustrating and upsetting for the patient. At this point, the treatment option changes to a surgical plan.
Surgical Approaches
A few surgical approach plans are quoted in the literature and on social media, including:
- Tightening the pocket, or
- Changing the pocket from above to below the muscle (or vice versa) and adding mesh
However, in my experience, these can be short-lived fixes, and the implant can flip again. This is the worst-case scenario, and leads to extreme frustration for the patient. Because of this, my preferred plan is now a combination of all of these to prevent this dreaded situation from recurring.
‘The Works’
The surgical plan starts with reviewing the factors that have led to this situation. In patients with very lax tissues—also commonly in revision surgery, where the previous implant pocket is intact—the capsule that forms the pocket can be very helpful when it is thin and pliable.
In these cases, the capsule does not need to be removed; it is simply adjusted for the new implant. The capsule can be tightened for a smaller implant or loosened for a larger implant. However, either way, this site has a higher likelihood of implant inversion.
Because of this, when I do not need to change the pocket, I adjust the cohesive level of the implant. It is necessary to lower the cohesiveness to a medium cohesive implant that does not have the more defined front-to-back “edges” that are easier to see and feel with an inversion.
The Perfect Storm
In a patient with lax tissues, such as a weight loss patient who has had a mastopexy in the past with implants, and now is in my office for a revision, I am very cautious with my surgical plan and implant selection. These patients are the perfect storm that can lead to implant inversion. In these cases, careful planning can help lessen the occurrence.
My surgical plan is guided by what they have had in the past, but includes the following:
- Capsule adjustment
- Skin envelope adjustment
- Choosing an implant lower in the cohesivity scale
Implant Selection
Let me start this paragraph by giving you some history. I have been in practice for 30 years and have seen the entire evolution of silicone implants, as well as using saline implants for over a decade when silicone gel implants were off the market. And I can tell you, the first generation of silicone gel-filled implants were not as sturdy as current implants and would break more easily over time.
Removing an old, broken implant is not an easy operation, and when the newer, highly cohesive implants were introduced, I welcomed them. At first, I thought it was like sliced bread—an implant that held its shape, gave better projection, and had a narrow base, all combined. But after a period of time, my patients started calling about the “strange shape to their breast.” The era of implant inversion had arrived. So even now, on a primary augmentation patient with what I classify as tight skin, I am reluctant to use the highest projection and cohesive level of implant.
Putting It All Together
This is a follow-up to my original implant inversion post, as this is a real and frustrating issue for both the patient and me. I have covered the topic of implant inversion or flipping, and clarified its causes and treatment options.
In each patient’s case, there are a multitude of unique factors that must be considered. So, choosing a plastic surgeon with experience and knowledge about these factors is important for the ultimate solution. The good news is that implant inversion can be corrected, and you can move past this stage to fully enjoy your breast augmentation.
If you’re experiencing implant inversion or have concerns about your breast implants, call our office at (614) 569-2649 or use our online form to request a consultation.
Breast Wishes.
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