I had breast augmentation with over the muscle silicone implants.  My left breast now has a pointy bulge on the top which is the implant poking up (ultrasound showed it is a folded implant).  Is it possible to spin it around without surgery?

One of the reasons for placing breast implants under the muscle is for better coverage of the implant, so any puckers or ripples that the implant might have are better concealed.  Most implants are round in shape so rotating them will not correct the visibility of the fold.  Another factor to consider is capsular contracture, a tightening of the scar layer that naturally forms around implants.  This results in squeezing of the implant which can cause folds or puckers to appear.  Consult with your plastic surgeon on this.

It sounds like you may have a contracture developing as it will push on your implant and cause it to have pointy edges.  You can appreciate this if your breast is changing in its appearance and the breast is not as soft as it was in the past.  Some doctors will tell you about trying to tear the capsule with vigorous manipulations but this could void your warranty on your implant.

With pointing edges, you do need to see your surgeon to have this further evaluated and managed as ignoring it could lead to thinning of the skin over that point and possible exposure or extrusion of your implant which would then require removal. 

The short answer to your question is NO.  Issues of capsular contracture, malposition, etc. should/need to be be addressed.  First, discuss your concerns with your surgeon.  Then, request copies of your operative reports & pre-operative pictures.  This will allow you the opportunity for a second opinion.  Issues like capsular can be difficult and expensive to correct.  Seek out a member of ASAPS for your options.

Best, 

Gary R. Culbertson, MD, FACS

Coverage of the breast implant is one of the many factors to consider when performing a breast augmentation.  By placing the implant partially under the muscle to provide coverage of at least the upper inner implant, the implant is better hidden.  There are alternatives to treat you that include performing a site change procedure where the muscle is lifted up and the implant placed partially under it.  Also, a silicone implant behaves a bit better than a silicone implant in a thin woman so that may be something to consider as well.  You will be best served if you see a plastic surgeon who can examine you and make suggestions for what your options are for treatment.  I wish you well.

Dr. Edwards

Dear Andria,

Usually malposition of the implant or implant distortion is associated with capsular contracture and/or poorly developed implant pocket.  If the implant extrusion is that noticeable, I would make an assumption that you also have a thin amount of breast tissue.  If any of these factors are contributing to your distortion, then nonsurgical manipulation of the implant is not going to improve the appearance.  Consult with your local plastic surgeon.  You may decide to move the implants under the pectoralis muscle for better coverage.  Good luck with your outcome.

Steve Vu, M.D.