Breast implant malposition: risk factors, classification, prevention, and surgical treatment

Objective. To summarize current data on causes, risk factors, classification, prevention, and surgical treatment of breast implant malposition; to identify limitations of modern evidence base. Material and methods. A narrative literature review was devoted to breast implant malposition after aesthetic augmentation, revision procedures, and implant-based breast reconstruction. We reviewed the PubMed, Scopus, Web of Science, Google Scholar, and eLibrary.ru databases. The review included studies containing eligible data on etiology, risk factors, classification, corrective methods, complications, recurrences, and long-term outcomes. Qualitative analysis was performed without quantitative synthesis due to heterogeneity of available data. Results. Breast implant malposition should be regarded not as a single complication but as a group of deformities associated with failure of specific implant pocket boundaries, soft-tissue characteristics, implant plane selection, and implant properties. In primary aesthetic augmentation, the incidence of clinically significant malposition is approximately 1.5—8%. In reconstructive practice, the rate of lateral and inferior malposition reaches 9.8%. The most consistent data concern prevention, including precise pocket creation, preservation or reconstruction of inframammary fold, matching implant dimensions to tissue capacity, and consideration of muscular component in subpectoral placement. Data on surgical treatment remains predominantly retrospective and heterogeneous. The most common techniques include capsulorrhaphy, capsular flaps, implant plane change, inframammary fold reconstruction, and internal pocket reinforcement. Conclusion. Durable results after surgical treatment of breast implant malposition are determined by precise identification of deformity mechanism and complete restoration of implant bed support. The most significant data concern prevention, while results of surgical correction indicate the need for further standardization and accumulation of comparable data on complications and recurrences.