Breast implant malposition is an increasingly recognized complication of breast augmentation and implant-based breast reconstruction. Etiologic factors include technical imprecision during surgery with overdissection or inadequate dissection of the pocket, inappropriately large implant selection, and the compromise of the local breast tissues, which produces an inability of a patient's natural tissues to support an implant in the placed position. In this article, the author describes a series of 19 patients with significant breast implant malposition following staged implant breast reconstruction in the setting of locally compromised tissues. Given the results, the author believes that an effective technique in the correction of severe implant malposition is reconfiguration and reconstruction of the periprosthetic capsular space, with a combination of focal "mirror image" capsule excision and permanent suture repair to restore breast folds, along with an acellular dermal matrix inlay technique designed to confer structural support to this repair. This strategy merits consideration in patients who have significant implant malposition in the face of severely compromised local breast tissues.
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