Prevention and treatment of horizontal malposition of implants (telemastia and synmastia) after breast augmentation

Objective. Implant malposition is a common complication after augmentation mammoplasty and ranks second among the reasons for revision surgery after capsular contracture. Improperly positioned implants are not only aesthetically unattractive but can also negatively affect the psychological state and quality of life of patients.

Purpose of a study: to analyze current trends in the prevention and management of lateral or medial implant displacement following augmentation mammoplasty.

Material and Methods. A literature search was conducted in the PubMed and Google Scholar databases for English-language articles published over the past 10 years on the topic of “Prevention and management of horizontal implant malposition.” Included in the analysis were clinical studies, case reports, and case series specifically addressing this issue. Brief communications, letters to the editor, reviews, meta-analyses, and experimental studies were excluded. The search strategy utilized the terms “lateral displacement” and “symmastia after augmentation mammoplasty,” as well as their synonyms and related combinations.

Results and Discussion. Using the keywords “lateral displacement” and “symmastia after augmentation mammoplasty,” along with relevant synonyms and alternative phrases, a total of 748 articles were initially identified. After removing 72 duplicates during the preliminary screening, titles were reviewed and inclusion and exclusion criteria were applied, resulting in the exclusion of 608 additional publications. Following full-text assessment of the remaining 68 articles, only 6 met the criteria for final analysis.

Horizontal implant malposition is a relatively rare and underexplored complication of breast augmentation surgery. The studies selected for final analysis addressed both lateral and medial implant displacement in the broader context of implant malpositions, including superior and inferior displacement.

Conclusion. The primary strategy for preventing lateral and medial implant displacement is careful surgical planning based on each patient’s individual anatomical characteristics. Other important factors include implant size, preservation of natural folds and fascial structures, adherence to proper surgical technique, and appropriate pocket selection. For the treatment of lateral implant displacement, the reviewed literature recommends capsulorrhaphy and the use of biological or synthetic meshes.

1. Denney B.D., Cohn A.B., Bosworth J.W., et al. Revision breast augmentation. Semin Plast Surg. 2021 May; 35(02): 98-109. https://doi.org/10.1055/s-0041-1729885. PMID: 34121945

2. Kokosis G., Dayan J.H. Correction of nipple-areola complex malposition with conversion from subpectoral to prepectoral plane: proof of concept. Plast Reconstr Surg. 2020 Aug; 146(2): 237e–238e. https://doi.org/10.1097/PRS.0000000000007015. PMID: 32740623.

3. Pacifico M.D., Goddard N.V., Harris P.A. Classification of breast implant malposition. Aesthet Surg J. 2024 Oct; 44(10): 1032-42. https://doi.org/10.1093/asj/sjae084. PMID: 38621023.

4. Komiya T., Ojima Y., Ishikawa T., Matsumura H. Surgical techniques to prevent nipple-areola complex malposition in two-stage implant-based breast reconstruction. Arch Plast Surg. 2022 Sep; 49(5): 580-86. https://doi.org/10.1055/s-0042-1756292. PMID: 36159373. PMCID: PMC9507447

5. Awaida C.J., Paek L., Danino M.A. A new technique for breast pocket adjustment: argon beam thermal capsulorrhaphy. Plast Reconstr Surg Glob Open. 2022 Jul; 10(7): e4437. https://doi.org/10.1097/GOX.0000000000004437. PMID: 35923993. PMCID: PMC9325331.

6. Munhoz A.M., de Azevedo Marques Neto A., Maximiliano J. Reoperative augmentation mammoplasty: an algorithm to optimize soft-tissue support, pocket control, and smooth implant stability with composite reverse inferior muscle sling (CRIMS) and its technical variations. Aesthet Plast Surg. 2022 Jun; 46(3): 1116-32. https://doi.org/10.1007/s00266-021-02726-1. PMID: 35075504.

7. Denney B.D., Cohn A.B., Bosworth J.W., Kumbla P.A. Revision breast augmentation. Semin Plast Surg. 2021 May; 35(2): 98-109. https://doi.org/10.1055/s-0041-1727272

8. Buccheri E.M., Villanucci A., Mallucci P., Bistoni G., de Vita R. Synthetic reabsorbable mesh (GalaFLEX) as soft tissue adjunct in breast augmentation revision surgery. Aesthet Surg J. 2023 May; 43(5): 559-66. https://doi.org/10.1093/asj/sjac326

9. Harris R., Raphael P., Harris S.W. Thermal capsulorrhaphy: a modified technique for breast pocket revision. Aesthet Surg J. 2014 Sep; 34(7): 1041-49. https://doi.org/10.1177/1090820X14542650. PMID: 25028741.

10. Kim Y.J., Kim Y.W., Cheon Y.W. Prevention of implant malposition in inframammary augmentation mammaplasty. Arch Plast Surg. 2014 Jul; 41(4): 407-13. https://doi.org/10.5999/aps.2014.41.4.407. PMID: 25075366; PMCID: PMC4113703.

11. Spear S.L., Sinkin J.C., Al-Attar A. Porcine acellular dermal matrix (Strattice) in primary and revision cosmetic breast surgery. Plast Reconstr Surg. 2013 May; 131(5): 1140. https://doi.org/10.1097/PRS.0b013e3182865d0c. PMID: 23629094

12. Maxwell G.P., Gabriel A. Efficacy of acellular dermal matrices in revisionary aesthetic breast surgery: a 6-year experience. Aesthet Surg J. 2013 May; 33(3): 389-99. https://doi.org/10.1177/1090820X13478967. PMID: 23439064.

13. Pozner J.N., White J.B., Newman M.I. Use of porcine acellular dermal matrix in revisionary cosmetic breast augmentation. Aesthet Surg J. 2013 Sep; 33(5): 681-90. https://doi.org/10.1177/1090820X13491279. PMID: 23813397.

14. Spear S.L., Murphy D.K. Natrelle round silicone breast implants: Core Study results at 10 years. Plast Reconstr Surg. 2014 Jun; 133(6): 1354-61. https://doi.org/10.1097/PRS.0000000000000021. PMID: 24867717. PMCID: PMC4819531.

15. Maxwell G.P., Van Natta B.W., Bengtson B.P., Murphy D.K. Ten-year results from the Natrelle 410 anatomical form-stable silicone breast implant core study. Aesthet Surg J. 2015; 35(2): 145-55. PMID: 25717116 PMCID: PMC4399443 DOI: 10.1093/asj/sju084

16. Kim J.Y.S. (ed.) Managing Common and Uncommon Complications of Aesthetic Breast Surgery. Cham: Springer; 2021. https://doi.org/10.1007/978-3-030-57121-4

17. Lee W.S., Kang S.G. Upside-down rotation of a breast implant with double capsule formation after aesthetic breast augmentation: a case report. Arch Aesthetic Plast Surg. 2018 Apr 24(2): 75-77. https://doi.org/10.14730/aaps.2018.24.2.75

18. Maxwell G.P., Gabriel A. Acellular dermal matrix in aesthetic revisionary breast surgery. Aesthet Surg J. 2011 Dec; 31(Suppl 7): 65S-76S. https://doi.org/10.1177/1090820X11418333. PMID: 21908825.

19. Spear S.L., Bogue D.P., Thomassen J.M. Synmastia after Breast Augmentation. Plast Reconstr Surg. 2006; 18(7S): 1 168S.

20. Spence R.J., Feldman J.J., Ryan J.J. Symmastia: the problem of medial confluence of the breasts. Plast Reconstr Surg. 1984 Feb; 73(2): 261-66. PMID: 6695024.

21. Szemerey I.B., Szemerey A. Treatment of symmastia. In: Mugea T.T., Shiffman M.A. (eds) Aesthetic Surgery of the Breast. Springer, Berlin, Heidelberg. 2015. [chapter pagination not provided]. https://doi.org/10.1007/978-3-662-43407-9_28

22. Spear S.L., Seruya M., Clemens M.W., Teitelbaum S., Nahabedian M.Y. Acellular dermal matrix for the treatment and prevention of implant-associated breast deformities. Plast Aesthet Nurs. 2017; 37(2): 76–87. https://doi.org/10.1097/PRS.0b013e31820436af. PMID: 21088648.

23. Lain A., Garcia L., Gine C., Tiffet O., Lopez M. New methods for imaging evaluation of chest wall deformities. Front Pediatr. 2017 Dec; 5: 257. https://doi.org/10.3389/fped.2017.00257. PMID: 29255700; PMCID: PMC5722795.

24. Glicksman C.A., McGuire P. Guiding principles for congenital chest wall and breast anomalies: avoiding complications. In: Kim J.Y. (ed.). Managing Common and Uncommon Complications of Aesthetic Breast Surgery. Springer, Cham. 2021. P. [pagination not provided]. https://doi.org/10.1007/978-3-030-57121-4_3