Breast Implant Revision Surgery
What is Appropriate for You?

Michael C. Edwards, MD, FACS

Capsular contracture

It is not known precisely what causes the capsule or scar that surrounds an implant to tighten. Trauma or bleeding around the implant, an infection either of the breast or even elsewhere on the body or just plain idiopathic (unknown cause) are the reasons felt to be causative in nature. Once a capsular contracture has declared itself it will most likely require surgery to repair. Other more conservative modalities tried include aggressive massage, Vitamin E, Accolate or Singulair (prostaglandin inhibitors) and even therapeutic ultrasound. There are mixed reports of success, most of which are anecdotal in nature. Surgical treatment involves either removing the entire capsule (capsulectomy) or opening the capsule by making cuts in it (open capsulotomy). The decision will depend on a number of factors including the type of implant, how old they are, etc.

This patient was offered a full mastopexy but wanted only a capsule release with peri-areolar breast lift.

Implant Malposition

The capsule that surrounds the implant ideally allows enough room for a soft and supple/natural feeling breast but it is too large it will allow the implant to move farther than is desired leading to implant malposition, aka “implant drop out or armpit breast”. Treatment revolves around properly diagnosing the problem and repairing it with either internal sutures alone or what ever other external technique is required, such as a breast lift. There is more information being published about using materials to support the reinforced folds such as collagen products like Alloderm, Strattice or synthetic mesh.

This patient was unhappy with the shape and position of her left breast inferiorly and to the side which were repaired with internal suturing.

Synmastia occurs when the pockets that the implants are in communicate with each other. The best solution is to avoid by proper technique and not using implants that are too large. Operative repair can be accomplished with internal suturing with or without the products listed above. This is a difficult problem to correct but with proper planning can be corrected. Other descriptions in the public are “uni-boob, bread-loafing, etc.

This patient underwent larger volume breast augmentation in the past and over time developed a communication between the pockets.