What is implant flipping?
Breast implant flipping is a complication where a breast implant rotates inside the tissue pocket created during surgery. It can involve a simple rotation, like a wheel, or a full anterior-posterior (front-to-back) inversion. The issue becomes particularly noticeable with anatomically shaped, or 'teardrop,' implants, which have a specific orientation to provide a more natural slope to the breast. When a teardrop-shaped implant flips, it can cause a significant and visible distortion of the breast's shape. While round implants can also flip, the change in appearance is often less dramatic and may go unnoticed.
Factors influencing the risk of implant flipping
Several factors can contribute to the risk of an implant flipping. Understanding these can help patients and surgeons make informed decisions during the planning phase of breast augmentation or reconstruction.
Implant characteristics
- Implant Shape: Anatomical or teardrop-shaped implants carry a higher risk of aesthetic issues from rotation because of their specific contours.
- Cohesive Gel: Highly cohesive, form-stable implants, often used with anatomical shapes, can make a flip more noticeable due to their ability to retain their shape even when inverted.
- Size and Profile: Larger and higher-profile implants have been associated with a higher risk of flipping, as they may have more leverage to rotate within the pocket.
Surgical and anatomical factors
- Pocket Size: If the surgical pocket created to house the implant is too large, it can give the implant excess room to move and rotate.
- Implant Placement: Research has suggested that prepectoral (above the muscle) placement may carry a higher risk of implant flipping compared to subpectoral (under the muscle) placement.
- ADM Use: The type and technique of acellular dermal matrix (ADM) coverage used, such as wrapping or tenting, has also been associated with an increased risk of flipping in some studies.
- Capsular Contracture: The tightening of the scar tissue capsule around the implant can sometimes cause it to distort or displace.
Signs and symptoms to watch for
Not all instances of implant flipping produce obvious symptoms. Some patients may not even realize it has happened, especially with round implants. However, if you have a form-stable implant, a flip will likely be noticeable. Key indicators include:
- Visible or palpable change in breast shape or asymmetry.
- A sudden flattening of the breast's contour.
- Feeling a ridge or distinct edge of the implant under the skin.
- Visible ripples or wrinkles in the implant surface.
- Discomfort, although many flipped implants are asymptomatic.
Comparison of Implant Surfaces and Rotation Risk
This table outlines the differences in rotation risk and other factors between smooth and textured implants.
| Feature | Smooth Implants | Textured Implants |
|---|---|---|
| Adherence to Tissue | Lower; allows more free movement | Higher; surface 'grips' surrounding tissue |
| Rotation Risk | Slightly higher risk of displacement | Lower risk of rotation, especially for shaped implants |
| Natural Movement | Moves more freely and naturally | Provides more stability; less natural movement |
| Capsular Contracture | Some studies suggest a higher risk | Developed to reduce risk, though evidence varies |
| Aesthetic Appearance | Softer feel, lower rippling risk | Firmer feel, may have higher rippling risk |
| BIA-ALCL Risk | Very low risk | Small, but significant, risk linked to some designs |
How to prevent implant flipping
While not all complications can be prevented, several measures can reduce the risk of implant flipping:
- Careful Surgeon Selection: Choose a board-certified plastic surgeon with extensive experience in breast augmentation and revision surgery.
- Proper Implant Sizing: The surgeon should select an implant size that is appropriate for your anatomy and ensures a snug but not overly tight fit within the pocket.
- Choosing Textured Implants: For anatomical implants where orientation is critical, textured surfaces can significantly reduce the risk of rotation by adhering to the surrounding tissue.
- Submuscular Placement: Placing implants under the pectoral muscle can provide greater stability and reduce the risk of flipping.
- Following Post-Operative Care: Adhering strictly to your surgeon's instructions, including wearing support garments and limiting strenuous activity, is crucial for proper healing and preventing implant displacement.
What to do if you suspect a flipped implant
If you notice a change in your breast's shape, experience discomfort, or feel a ridge indicating a potential flip, it is important to contact your plastic surgeon for an evaluation. While not a medical emergency, addressing a flipped implant is necessary to restore your desired aesthetic result.
Treatment options may include:
- Manual Repositioning: In some cases, a surgeon can manually manipulate the implant back into the correct position. However, this is often a temporary fix with a high risk of recurrence.
- Revisional Surgery: The most definitive solution involves surgical intervention. This could include tightening the implant pocket (capsulorrhaphy), replacing the implant with a different type or size, or altering the implant plane (e.g., from prepectoral to submuscular).
Conclusion: Is implant flipping serious?
While not typically considered a dangerous health issue, a flipped implant is a notable aesthetic and comfort concern for patients. It is a known complication, particularly for anatomical and higher-profile implants, but can be effectively addressed with the right surgical approach. By understanding the risk factors, recognizing the signs, and working closely with an experienced surgeon, patients can achieve their desired outcomes and manage potential complications effectively. For more information on plastic surgery topics, consider consulting an authoritative source like the American Society of Plastic Surgeons.
