{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T08:57:56Z","timestamp":1790672276360,"version":"4.1.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Aesth Plast Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Superior implant malposition (\u201chigh-riding\u201d implants) is commonly attributed to capsular contracture and frequently treated with capsulotomy or capsulectomy. However, clinical experience suggests that superior displacement may occur in the absence of pathologic capsular thickening. Misclassification may lead to unnecessary capsulectomy and increased operative morbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To characterize the clinical presentation, intraoperative findings, and operative management of patients undergoing surgical lowering of high-riding breast implants and to determine whether this entity represents a mechanical rather than inflammatory capsular process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review was performed of 209 consecutive patients who underwent implant lowering for superior malposition between 2001 and 2024 by a single surgeon. All implants were saline. All patients had revision surgery by lower capsulotomy alone or with a limited lower partial capsulectomy. Demographic variables, parity, ptosis status, nipple-to-crease (NTC) distance, implant characteristics, time from augmentation to revision, and operative times were analyzed. Intraoperative capsular characteristics were documented in all cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Two hundred and nine patients underwent lowering procedures (82 right [39.2%], 54 left [25.8%], 73 bilateral [34.9%]). Mean age was 39.8 years. Mean implant size was 429\u00a0cc (range 275\u2013600\u00a0cc). Ninety-six patients (46%) demonstrated ptosis (mean NTC 8.0\u00a0cm) compared with 6.11\u00a0cm in non-ptotic patients (n=113). One hundred twenty-six patients (60%) had children. Mean time to revision was 13.3 months (range 6\u201366 months). Mean operative time was 43.7\u00a0min for unilateral and 70.8\u00a0min for bilateral lowering. All cases demonstrated a normal fibrous capsule intraoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Superior implant malposition requiring surgical lowering occurs predominantly within the first postoperative year and, in this saline cohort, was uniformly associated with a normal capsule. These findings support the hypothesis that, within this saline implant cohort, superior implant malposition is predominantly mechanical rather than inflammatory in origin. Recognition of this distinction may refine operative decision-making and reduce unnecessary capsulectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence IV<\/jats:title>\n                    <jats:p>\n                      This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors \u00a0\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.springer.com\/00266\" ext-link-type=\"uri\">www.springer.com\/00266<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key message<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Superior implant malposition does not necessarily indicate pathologic capsular contracture.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>In this 23-year saline cohort, all high-riding implants demonstrated a normal fibrous capsule intraoperatively.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Mechanical factors\u2014rather than inflammatory contracture\u2014may underlie many cases of Baker Grade III distortion.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Recognition of this distinction supports targeted pocket modification and capsulotomy rather than routine capsulectomy.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00266-026-06276-2","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T19:25:26Z","timestamp":1790623526000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["High-Riding Saline Breast Implants: Mechanical Malposition Rather Than Capsular Contracture? A 23-Year Single-Surgeon Experience and Proposed Refinement of Baker Grade III"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2992-2661","authenticated-orcid":false,"given":"Ted S.","family":"Eisenberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"6276_CR1","unstructured":"International Society of Aesthetic Plastic Surgery. ISAPS global survey 2022: full report and press releases. 2023. ISAPS, Hanover. Accessed 22 Feb 2026"},{"key":"6276_CR2","doi-asserted-by":"publisher","first-page":"567e","DOI":"10.1097\/PRS.0000000000000033","volume":"133","author":"DA Hidalgo","year":"2014","unstructured":"Hidalgo DA, Spector JA. Breast augmentation. 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