Rotation of anatomical implants at a glance
- Frequency6.2% (thesis, macrotextured implants)
- ConsequenceDistorted breast
- Main factorPocket too large
- PreventionMade-to-measure pocket, rest
- Definitive treatmentRound implant
- PriceOn quotation
An anatomical implant, shaped like a teardrop, is not symmetrical: if it turns in its pocket, the shape of the breast changes. This is its main drawback. In the series in Dr Médard de Chardon’s thesis, 6.2% of macrotextured anatomical implants had rotated. Micro-textured, nano-textured or smooth anatomical implants, used since macrotextured surfaces were banned, rotate much more often: Dr Médard de Chardon therefore no longer recommends them. The risk increases with a pocket that is too large, a haematoma, exertion too soon after surgery or capsular contracture. It is prevented by a made-to-measure pocket and a period of rest. An implant that has rotated often rotates again: the definitive treatment is to replace it with a round implant.
Price: implant replacement on a written quote after consultation (€100).
Why is rotation of an anatomical implant a problem?
Anatomical implants bring a real improvement to the shape of certain breasts. But their fullness is at the bottom: if the implant turns, this fullness moves to the side and the breast becomes distorted. A round implant, being symmetrical, can turn without any consequence.
In position: the anatomical implant, fuller at the bottom, sits snugly in a made-to-measure pocket (dotted line), only slightly larger than the implant. (default state).
Is rotation common?
In the series in Dr Médard de Chardon’s thesis (cosmetic breast augmentations), the rotation rate of macrotextured anatomical implants is 6.2%. Baeke reports 14% and considers this figure an underestimate, as rotation often goes unnoticed by patients. Panettiere reports 9.4%, mainly in breast reconstruction. These figures concern macrotextured implants: rotation rates for non-macrotextured anatomical implants (micro-textured, nano-textured or smooth) are very much higher.
What are the risk factors?
| Factor | Why |
|---|---|
| Pocket too large | The implant is entirely free to turn |
| Haematoma or fluid after the operation | Prevents the implant from adhering to the tissues and enlarges the pocket; a haematoma reportedly increases the risk by 23 to 80% |
| Implant characteristics | Smooth implants, wider than they are tall; in Dr Médard de Chardon’s experience, low-projection implants too |
| Exertion too soon | Before the capsule has stabilised the implant |
| Capsular contracture | The tightening of the capsule puts stress on the implant (see capsular contracture) |
How can rotation be prevented?
- A made-to-measure pocket: do not create a pocket that is too large. For an implant taller than it is wide, dissection on the sides is limited to hold it in place (the “cam effect”); and the reverse for an implant wider than it is tall.
- A period of rest after the operation, so as not to create stresses before the capsule forms.
- A support bra, reinforced over the upper breast for 15 days, offered by some surgeons; to be used with caution, or even avoided, in secondary (revision) surgery, where it can make the implant turn in a poorly fitting pocket.
Choosing a qualified, experienced and reputable surgeon reduces these risks, and can even eliminate some of them.
What about macrotextured or polyurethane implants?
To grip the tissues, anatomical implants were for a long time macrotextured; polyurethane-coated implants, which Dr Médard de Chardon used in certain cases, did not rotate and gave very little capsular contracture. Since April 2019, the ANSM (French National Agency for Medicines and Health Products Safety) has banned both these types of implant in France, because of a rare risk of lymphoma (BIA-ALCL, breast implant-associated anaplastic large cell lymphoma). The anatomical implants still available, micro-textured, nano-textured or smooth, rotate much more often than the former macrotextured implants: Dr Médard de Chardon therefore no longer recommends them.
How is rotation treated?
- Manual repositioning: possible, but an implant that has rotated once usually rotates again.
- Definitive treatment: replacing the anatomical implants with round implants, which can turn without distorting the breast.
The operation takes place at Clinique Oxford in Cannes, after a consultation (€100), a written quote and the statutory 15-day cooling-off period.
Dr Médard de Chardon’s experience
- MD thesis on breast augmentation with implants (Nice Faculty of Medicine, 2008): this page is drawn from it.
- More than 3,000 breast implants placed; practising in Cannes since 2011.
- Qualified plastic surgeon in plastic, reconstructive and aesthetic surgery, former Chef de Clinique (university hospital senior registrar), Nice Faculty of Medicine; member of SOFCEP (French Society of Aesthetic Plastic Surgery), SOFCPRE (French Society of Plastic, Reconstructive and Aesthetic Surgery) and ISAPS (International Society of Aesthetic Plastic Surgery).
See breast augmentation before and after photos
Frequently asked questions about rotation of anatomical implants
How can I tell if my breast implant has rotated?
The shape of the breast changes: the fullness of the implant, normally at the bottom, moves to the side or to the top. Rotation often goes unnoticed; an examination by the surgeon can confirm it.
Can a round breast implant rotate?
It can turn, but because it is symmetrical, the shape of the breast does not change.
Why does an anatomical breast implant rotate?
Mainly because its pocket is too large, or because of a haematoma, exertion too soon after surgery or capsular contracture.
Can a breast implant that has rotated be put back in place?
Manual repositioning is sometimes possible, but the implant usually rotates again. The definitive treatment is to replace it with a round implant.
How can rotation of a breast implant be avoided?
With a made-to-measure pocket that holds the implant in place, and a period of rest after the operation. A round implant avoids this risk: since micro-textured, nano-textured or smooth anatomical implants rotate much more often, Dr Médard de Chardon no longer recommends them.
References
- Médard de Chardon V. MD thesis on breast augmentation with implants. Nice Faculty of Medicine, 2008.
- Baeke JL. Breast deformity caused by anatomical or teardrop implant rotation. Plast Reconstr Surg 2002; 109: 2555-2564.
- Panettiere P, Marchetti L, Accorsi D. Rotation of anatomic prostheses: a possible cause of breast deformity. Aesthetic Plast Surg 2004; 28: 348-353.
- Tebbetts J. Use of anatomic breast implants: ten essentials. Aesthetic Surgery Journal 1998; 18: 377-384.
- Spear SL, Bulan EJ, Venturi ML. Breast augmentation. Plast Reconstr Surg 2004; 114: 73E-81E.
- Tebbetts JB. Breast augmentation with full-height anatomic saline implants: the pros and cons. Clin Plast Surg 2001; 28: 567-577.
- Wilkinson TS. Rotation of anatomic breast implants. Plast Reconstr Surg 2003; 112: 919-920.
- ANSM. Decision of 2 April 2019: withdrawal from the market of macrotextured breast implants and polyurethane-coated breast implants.