I’m almost two years post op 450 cc HP bilateral placement. 5’5” 1/2 and 117 lbs, very lean and athletic. The left breast is great. It doesn’t move and stays in place. The right side has always moved to the side since the beginning but now slides over into my side when laying flat or even just reclining back some. It also always feels as if it’s being pulled or tugged on and I have to wear my sports tops a size too small to keep it in place. Do you have to replace the implant to revise it?
Yes, it is possible to revise your pocket with capsulorraphy sutures or mesh material to help position your implants more optimally.
It is not at all uncommon for larger implants to stretch the pocket downward and/or to the side resulting in your situation typically by six months to one year post-op.
There are a few types of revision options, but it is not generally necessary to replace the implants unless there is a specific problem with them, or if you wanted to change the size.
Published on Jul 11, 2012
It is very difficult if not impossible to suture an enlarged cavity, for it will usually break apart. I prefer creating a brand new space which I can design like the other one, as I have seen much better improvement doing it this way.
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Published on Jul 11, 2012
The short answer is no. The same implant can be used if you need a pocket modification.
The old implant is removed and placed in an antibiotic bath. If the implant has any issue, I make it my practice to always have the same style and size implant as a backup in case I find something wrong with it at the time of surgery.
I will however tell you that using Strattice (porcine acellular matrix) is a marvelous way to reinforce your pocket. I would not simply suture the capsule and hope for the best. Your physique, anatomy, and mechanical failure already demonstrate that the pocket is larger than you want it to be.
That being said, the pocket needs to be reduced to centralize your implant, and your tissues need reinforcement to hold your implant in place.
Published on Jul 11, 2012
Hi,
Unfortunately yes. In order to suture the capsule, we need to remove the implant. Once we remove the implant, we need to insert a new one since the risk of infection increases if we reinsert it. The better practice is to remove the implant, suture the capsule and insert a new implant.
Best of luck!
Published on Jul 11, 2012
If the implant is intact after two years, it can be saved. Looks like the pocket is too large for the implant and needs to be reduced.
That being said, if during the surgery there is any sign of implant damage, it will need to be replaced.
Published on Jul 11, 2012
This problem is common in slim patients like yourself particularly when they have large implants. The weight of the implant tends to push against the lateral chest and can cause the implant to shift. I reconstruct the pocket by reinforcing the lateral chest wall and lower portion of the breast with cadaver skin grafts processed by a company called MTF. This has given excellent results in my 10 years of using their grafts. You don't have to replace the implant unless there's a problem with it.
Published on Jul 11, 2012
Pocket revisions do not necessarily require implant replacement. However it is important to remember that despite revision, the anatomic conditions which predisposed you for lateral displacement will likely persist (chest wall asymmetry > sloping laterally). Irrespective of revision, you are at risk for recurrence.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).
Published on Jul 11, 2012