Why Breast Implants End Up in Different Positions and How to Fix It

Anytime you place breast implants, your body walls them off with scar tissue — and that's completely normal. But as your breasts move with gravity, and because muscle strength, handedness, and healing patterns differ side to side, it's decently common for implants to settle unevenly.

The most important first step is having your plastic surgeon diagnose the actual problem. You always want to make sure the issue isn't a capsular contracture — which can happen on one side or both. This matters because the treatment for contracture is completely different from other positioning issues.

With submuscular implants, the pectoralis muscle needs to be properly released on both sides. If it wasn't released enough during surgery, the muscle can hold the implant chronically high. Unfortunately, fixing this requires going back in to release the muscle further.

Sometimes the muscle is just holding everything up too tightly. How you address this depends on your implant type:

• Textured implants — usually require a surgical fix
• Smooth implants — you have a better chance of getting them to drop naturally

For smooth implants, surgeons may recommend:

• Massage — pushing the implant downward regularly
• Compression bands — worn across the top of the breasts
• Muscle relaxant medications — to calm the muscle and let the implant settle
• Botox injections — partially paralyzes the pectoralis muscle so it stops fighting the implant. Once the implant drops and stretches the lower scar tissue, the Botox wears off and things typically stay in place

Some patients — particularly those with tuberous breasts — naturally have a short distance from the nipple to the breast crease. In these cases, the implant may look high, but it's actually in the right position. The issue is limited lower pole tissue.

Time is the best treatment here. The longer you have the implant, the more gravity stretches that lower pole tissue, and the more natural things will look.

Sometimes there's no clear explanation — one side just heals a little higher than the other. In many of these cases, tincture of time is the best medicine. If you wait 12 to 18 months, things often even out on their own without any intervention.

If they don't, revision surgery involves making cuts in the capsule (capsulotomy) to allow it to expand so the implant can fall further down into the breast.

Every human being is asymmetric. No one's implants are perfectly symmetric — if you know what to look for, you can always find slight differences. Major asymmetry after implant surgery is uncommon, but minor asymmetry is very common.

• Rule out contracture first — it changes everything
• Muscle tightness may need surgical release or Botox
• Smooth implants respond better to conservative measures than textured
• Time fixes many positioning issues — wait 12–18 months before revising
• Work with your surgeon to determine if you have a problem that needs fixing or one that just needs patience