Breast Implant Flipping: Prevalence, Clinical Correlation, and Independent Risk Factors in a Consecutive Ultrasound Cohort

Abstract Background Silicone breast implants are designed with an anterior domed surface, and relatively flat posterior surface that contains the cured silicone patch. With implant flipping (an anterior-posterior malposition), the posterior patch rotates to an anterior position. Objectives There are currently no prospective published studies reporting the prevalence of implant flipping and its associated symptoms in aesthetic patients. This prospective study used in-office high-resolution ultrasound (HRUS) to evaluate the prevalence of breast implant flipping, assess associated changes in breast shape, appearance, and symptoms, and identify potential risk factors. Methods Consecutive patients with silicone breast implants presenting for routine follow-up underwent HRUS at 7 study sites in the United States over a 4-month period between April 1st and August 1st, 2026. Demographic data included age and BMI. Implant data included time since surgery, whether a primary of revision procedure, number of revisions, manufacturer, size, style, surface, use of ADM or scaffold, pocket location, capsule grade, flipped or not, and rupture. Results Five hundred and ninety consecutive patients were enrolled over 4 months. Mean age 43 years with range 22-82, mean BMI 23 with range of 16-34.5. Primary augmentations accounted for 64.6% of procedures, while revision augmentations accounted for 35.4%. Device manufacturer distribution, 63.9% Allergan, 12.4% Mentor, 15.9% Motiva, and 7.1% Sientra. Implant flipping was identified in 75 patients (12.7%). Conclusions Implant flipping was identified by HRUS in one in eight patients. Larger implant volume, prepectoral placement, and lack of soft tissue support were independently associated with flipping. HRUS improves detection, patient counseling, and surgical planning.