Can you suture a pocket to close it off without having to replace the implant with a new one since the implants are fine and it’s only one side?

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?

Answers from doctors (7)


More About Doctor David J. Levens, MD

Published on Feb 12, 2018

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.

Answered by David J. Levens, MD (View Profile)

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


Edward Domanskis M.D.

Published on Feb 06, 2018

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.

Dr. Edward Jonas Domanskis is Certified by the American Board of Plastic Surgery
Newport Beach, San Francisco,Miami, Italy, Anguilla
949.640-6324/1.888.234-5080(Ca)
FAX- 949.640-7347
Website: http://www.surgery-plastic.com
Assistant Clinical Professor of SurgeryWOS-Plastic,University of California (Irvine)
Orange County’s Physician of Excellence/America’s Top Physicians/Top Doctors
Plastic Surgery- 2005-2017
President,American Society of Bariatric Plastic Surgeons
www.ASBPS.org
Organoderm Skin care/ScaRxTape

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Answered by Edward Domanskis M.D.

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.

Dr. Edward Jonas Domanskis is Certified by the American Board of Plastic Surgery
Newport Beach, San Francisco,Miami, Italy, Anguilla
949.640-6324/1.888.234-5080(Ca)
FAX- 949.640-7347
Website: http://www.surgery-plastic.com
Assistant Clinical Professor of SurgeryWOS-Plastic,University of California (Irvine)
Orange County’s Physician of Excellence/America’s Top Physicians/Top Doctors
Plastic Surgery- 2005-2017
President,American Society of Bariatric Plastic Surgeons
www.ASBPS.org
Organoderm Skin care/ScaRxTape

Published on Jul 11, 2012


More About Doctor Vanek Plastic Surgery

Published on Jan 31, 2018

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.

Answered by Vanek Plastic Surgery (View Profile)

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


Dr. Pablo Rivera

Published on Jan 29, 2018

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!

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Answered by Dr. Pablo Rivera

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


Dr. Azita Madjidi

Published on Jan 29, 2018

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.

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Answered by Dr. Azita Madjidi

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


Joseph M. Perlman, M.D.

Published on Jan 29, 2018

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.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/6264_1431012455.jpg
Answered by Joseph M. Perlman, M.D.

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).

Answered by The Institute of Aesthetic Surgery (View Profile)

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


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