Breast Implants and Breast Shape – Differences Lying Down Versus Standing Up

This educational writing reviews how breast augmentation can lead to differences in breast shape when a woman is standing up versus lying down. By understanding how the shape may vary, it gives us a better understanding of the results of breast enhancement. The change in breast implants with position does not always imply that something is wrong. Most of the time this is normal. Unattractive shapes can sometimes require surgery. Patients from Media and Delaware Valley, PA prompted this educational writing.

What is the goal of breast surgery?

Honestly, we want our breasts to be perfect! We want them to look great in the standing position and to be natural. This means the breast implant sits in the correct location on the chest. Also, the nipple is naturally located on the breast mound. Finally, the implant is not visible with rippling or edges.

We want this shape in the standing position, but we want the breasts to stay this way in the lying down position. Interestingly, this is not what natural breasts do without implants. Natural breasts tend to flatten out and drop to the side when lying down. This is not what we want after augmentation surgery. We want them to be perky and full in both positions. We want our breasts to be full and natural standing; and when we lie down, we want them to stay that way and not flatten like real breasts.

What is the result when lying down?

Most patients will be very happy with the result of their breast enhancement. They will be happy with the shape of the breast in both positions. The breasts will be perky standing, and they also retain a natural look lying down. The implants should stay in the center of the chest and not flop to the side or move up. The breast should retain a lot of its fullness and not flatten too much when lying down.

Do medical studies study breast shapes?

An extremely good medical study was done to study the appearance of the breast and implants in different positions. These positions included standing and lying down. The implants were round versus tear dropped or anatomic implants. Tear dropped implants are also called shaped or anatomic implants. The study involved placing metal beads at the edges of the implant. These little pieces of metal could be seen on X-rays. This allowed us to see what the implant looked like inside when the woman moved into different positions.

The results showed that standing up the cosmetic appearance between round implants and anatomical (or tear dropped) implants was exactly the same. The interesting finding, however, was when the woman was lying down. In this position, the shape was better and more natural for round implants. Also, the shape was more abnormal for shaped implants.

Of interest too, the tear dropped implants had double the rate of rippling and palpability as compared to round implants. This was believed to be due to the textured surface of the implant. Anatomical breast implants need textured surfaces to stop rotation or spinning of the implant. The textured surface led to a doubling of rippling and feeling of the edge of the implants.

The study concluded that round breast implants gave the most attractive breast shape with lower rates of complications. Both implants gave natural results when standing. When lying down, anatomic or tear-dropped implants gave unnatural results.

What can go wrong?

When breast shape is not correct, surgery can be necessary. This includes suturing the pocket to reposition the implants. This can be called a capsulorrhaphy or a pocket repair. The results can make dramatic improvements in the shape of the implants. Success is not perfect however. Re-operations can be necessary, and a patient must understand this can happen.

I am a board certified plastic surgeon who practices exclusively cosmetic surgery. Please come in for a complimentary consultation. Details of your cosmetic procedure and your surgical plan will be discussed completely.