A 27-year-old woman visited us complaining of contour deformity on the left breast after augmentation mammoplasty. The symptom was found during a physical exam at our clinic, and there was no history of any traumatic event affecting the breast. She had undergone bariatric surgery 2 years ago, and therefore also complained of excessive skin on the trunk and both thighs. She had a 2-year history of polycystic ovarian syndrome that was controlled well with oral contraceptives. The patient had undergone augmentation mammoplasty with round implants (Allergan [Allergan Inc., Irvine, CA, USA], type 110, 270 mL) 1 month previously. In each breast, an inframammary fold incision was made and the prosthesis was placed in the subglandular pocket. There were no immediate complications. Upon physical examination, the implant in the left breast was palpable on the medial side of the breast. There was no bruising, erythema, tenderness, or signs of inflammation on the covering skin (
Fig. 1). We also were not able to observe rippling of the implant. A moderate degree of breast asymmetry was shown. For further evaluation, chest computed tomography with contrast enhancement was carried out. Magnetic resonance imaging has the highest sensitivity and specificity for detecting implant rupture; however, our patient, as a cosmetic surgery patient, declined this imaging modality for financial reasons. Thus, computed tomography was used. There was no abnormal surrounding fluid collection or capsular rupture in the breast parenchyma, but upside-down rotation (along the vertical axis) of the silicone implant was observed on the left side of the breast (
Fig. 2). We planned an implant exchange, in which the rotated implant would be removed and replaced with another implant (same size, same type) via the original incision under local anesthesia. When the breast capsule was opened, the floor surface of the implant faced the breast tissue, not the chest wall, and almost half of the implant was covered by another intact capsule (
Fig. 3). The capsule was intact and adherent on one side of the implant. Since the implant pocket was clean and healthy and the other breast had no problem with the inserted prosthesis, we decided to use the same implant and the same plane for symmetry. The pocket was irrigated and a new implant was inserted in the same pocket. The operation was finished after subcutaneous and cutaneous repair and aseptic compressive dressing without drainage. The patient used the dressing and there was no problem with the contour of her breast at 7 months of follow-up.