High-Riding Breast Implants

High-riding implants occur when an implant fails to settle properly after breast augmentation or becomes displaced later.
The issue can be fixed, sometimes without surgery, but the specific fix depends on the reason the implants are high.
Almost all breast implants sit high on the chest immediately after breast augmentation, and it could easily take six months for them to settle into their proper position.
High-riding implants should not be confused with high-profile implants.
Woman with long dark hair falling over her chest, illustrating high-riding breast implants

What Are High-Riding Breast Implants?

As their name suggests, high-riding breast implants are those that sit too high on the chest. The term refers to implant displacement or malposition, and not to the high appearance that breast implants often have immediately after surgery. High-riding implants create excess upper pole fullness and a nipple that appears to be too low on the breast mound. One or both breasts may be affected.

Why Do Breast Implants Ride Too High?

There are several reasons why your breast implants might sit too high. Some can make your breast implants ride high soon after your breast augmentation, while others take time to manifest. This means that high-riding breast implants can occur at any point after breast augmentation — even if you’ve had your implants for several years.

A Tight Lower Implant Pocket

Your breast implants could ride high if the bottom of the implant pocket is too small to allow the implant to properly settle downward. Making adequate room for the implant involves releasing the inframammary fold where the breast meets the chest wall. Inadequate release can cause the implant to remain high, even after it should have settled into the lower pole of the breast.

Tight Pectoral Muscle After Submuscular Placement

Plastic surgeons sometimes place breast implants beneath the pectoral muscles in the chest. Usually, this placement works well and even offers some advantages, but tight pectoral muscles can keep the implant suspended higher than intended. With implants placed partially or completely beneath the pectoralis muscle, muscle tension can initially push the implant upward. This should ease in time, but persistent muscle restriction may not allow for this adjustment.

Capsular Contracture or Scar-Tissue Tightening

The formation of scar tissue around a breast implant is normal, but excessive scarring can create a problem known as capsular contracture. In capsular contracture, the scar becomes so large and firm that it squeezes and pushes on the implant. If the contracture forces the implant upward, a high-riding implant results.

Implant Size and Preexisting Anatomy

An oversized implant has a greater chance of becoming a high-riding one. Sometimes larger implants simply take longer to drop and settle because the skin needs to stretch further to accommodate them. But if the implant is too large for the available breast tissue and chest space, implant displacement is a likely outcome. An implant that is displaced upward becomes a high-riding one.

High-Riding Implant vs. High-Profile Implant

Don’t confuse a high-riding breast implant with a high-profile breast implant. The two are not the same. A high-profile implant is one that intentionally projects out farther from the chest wall. A high-riding implant is an unintentional consequence of implant malposition.

Is My Implant High-Riding or Still Dropping and Fluffing?

Although not a technical term, “drop and fluff” is the common moniker given to the healing process after breast augmentation. Breast implants usually sit quite high on the chest immediately after augmentation but settle into a more natural position as swelling decreases and muscle tension relaxes. This process can easily take six months, and one breast may drop and fluff more quickly than the other.

You may have a high-riding breast implant if your breast augmentation was six to 12 months ago and you are experiencing:

  • Excessive fullness in the upper breast
  • Limited fullness in the lower breast
  • Nipple appears unusually low or pointing downward relative to the implant
  • A breast that looks square, overly round, or unnaturally high
  • One implant sitting noticeably higher than the other
  • Breasts that feel firm or tight

High-Riding Implant and Waterfall Deformity

These two breast implant issues can look quite similar and sometimes occur together, so it’s important to distinguish between the two. A high-riding implant is one that sits too high on the chest. In a waterfall deformity, however, the breast implant position is correct, but the breast tissue around the implant falls and sags below the implant. This can make the implant look like it is too high when really the breast tissue is too low.

It is possible to have a high-riding implant and a waterfall deformity together, or to have one or the other. We will explain the ways that your plastic surgeon can correct a high-riding breast implant in just a minute, but a waterfall deformity correction usually requires a breast lift.

How Are High-Riding Breast Implants Corrected?

We can correct a high-riding breast implant; however, the exact method depends on the timing and specific reason for your implant displacement.

Early Postoperative Management

If you’re concerned that your implants aren’t dropping and fluffing as expected, your plastic surgeon might recommend simply waiting a bit longer while closely monitoring your breast tissue as it heals. They may also recommend a breast band or compression garment designed to help direct your breast implants downward. There are also breast implant massage techniques that may help encourage your implants to drop. These options can help some patients avoid breast implant revision surgery, but never engage in them unless directed to do so by your plastic surgeon.

Breast Implant Revision Surgery

Whether your breast implants remain too high after breast augmentation or start riding high months or years after your surgery, breast implant revision surgery can help. The steps taken during a revision procedure vary depending on the specific reasons your implants are elevated. Simply repositioning the implants or replacing them alone, however, won’t correct the problem. To prevent future issues, it is necessary to identify and correct the underlying reasons for your high-riding implants.

Correcting high-riding implants may require several corrections, including:

  • Releasing or lowering the bottom of the implant pocket
  • Repositioning the inframammary fold (breast crease)
  • Releasing restrictive scar tissue
  • Adjusting the pectoral muscle
  • Repositioning the existing implant
  • Changing implant size, dimensions, or profile
  • Performing a breast lift (corrects waterfall deformity)

When to Talk to Your Plastic Surgeon

We encourage you to reach out to your plastic surgeon whenever you have questions or concerns. But your doctor will likely want to wait six months to a year after your breast augmentation before performing revision surgery. This gives your body ample time to adjust and fully heal before undergoing another procedure.

You might need to wait a bit for revision surgery, but early intervention after your breast augmentation can sometimes help you avoid surgery, so don’t hesitate to contact your surgeon if you think your implants are riding too high. You should also notify them immediately if you experience any of the following after breast augmentation:

  • Increasing firmness
  • Significant or worsening pain
  • Redness, warmth, fever, or drainage
  • Sudden breast-shape change
  • Marked swelling
  • Hematoma
  • Progressive rather than improving asymmetry

Frequently Asked Questions

Yes, it is possible for only one breast implant to ride too high. There may be differences in muscle tightness, pocket dimension, natural breast anatomy, scar formation, and post-op complications that could cause the implants to sit differently in each breast.

A hematoma can cause one implant to stay high. A hematoma is a collection of blood around the implant that can place upward pressure on it. The implant may drop into place when the hematoma resolves. If the hematoma leaves behind excessive scar tissue, however, revision surgery may be necessary to fix the implant position.

They can, yes. Gravity makes this seem counterintuitive, as it would make sense that a heavier implant would fall more quickly. But your breast skin and tissue need time to adjust and stretch around the implant. Your body may need more time to accommodate a larger implant. Implant size isn’t the only relevant factor, however. Muscle tightness, skin elasticity, pocket design, implant plane, and starting anatomy also influence the timeline.

Yes, because breast tissue position and breast implant position are two different variables. A breast lift repositions the breast tissue itself rather than adjusting the position of the implant. The implant can remain high while the lifted or natural tissue settles lower, potentially creating a mismatch or waterfall-type appearance.

Not at all. High-profile refers to an implant’s projection, meaning how far it sticks out from the chest wall. It has nothing to do with the implant’s vertical placement on the chest wall. High-profile implants can ride high, but so can lower-profile implants. High-profile implants do not increase the risk of high-riding implants.

Unfortunately, yes. Breast implants that were previously stable can shift and become high-riding implants. Late implant shifts are often the result of scar tissue changes, breast tissue trauma, breast tissue changes, or other implant complications.

Not necessarily. Oversized implants can contribute to implant displacement, and that could necessitate a smaller implant. But implant size isn’t always the root of the problem. Sometimes correction of the implant pocket or inframammary crease is the correct remedy rather than resizing the implants.

Breast implant position influences breast shape and upper-pole contour, so high-riding implants can change how the breasts appear in clothing and how cleavage looks. However, cleavage also depends heavily on chest width, natural breast spacing, implant width, and medial pocket anatomy. In short, some women with high-riding implants notice cleavage changes while others may not.

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