Advice on Making Capsulorrahphy a Success?

I am having a capsulorrahphy done in two weeks for a bottomed out implant on the right side. Any advice on things I can do to make the surgery a success? If the surgery fails does the implant just drop back to the position it originally started from before the capsulorrahphy?

Doctor Answers (8)

Capsulorraphy success and recovery

+1

I perform a lot of capsulorraphy procedures and feel that the success depends on the type of suture used, technique, and postoperative strain.  I would place reinforcing foam tape in the area and try not to strain the muscles.


Los Angeles Plastic Surgeon
5.0 out of 5 stars 47 reviews

How can I make my capsular repair a success?

+1

The success of a capsular repair can be influenced by several factors including the following:

  • strength of the local tissues
  • strength of the local capsule itself
  • size of the implant
  • use of a supporting graft (e.g.:  Strattice)

Given these variables, there are a few things that we can do to help improve the chance for success.  First, I generally recommend either downsizing slightly or at least maintaining the same size.  I would not recommend increasing the size of your implant since this simply puts even greater strain on tissue that is already compromised.

Next, considering that the tissue is probably somewhat compromised (which may be why it bottomed out in the first place), the strength of the capsule is going to be extremely important as is what is supporting it.  To improve the strength of the capsule, I generally suggest reinforcing this repair with a piece of Strattice.  This graft acts as a sling that can support and reinforce the local capsule and hopefully improve the odds for success.  

 

Finally, I recommend that my patients wear a supportive underwire bra for at least 2-3 months continually following an IMF repair.  In addition, I usually tape their folds weekly and continue this for about 2 months to allow for additional support to this area. 

 

I hope this helps!

Gregory A. Buford, MD, FACS
Denver Plastic Surgeon
5.0 out of 5 stars 2 reviews

Bottoming out

+1

When an implant has bottomed out, a capsulorrhaphy has to be performed.  Often I will place a conforming dressing along the lower pole and a form fitting bra to hold the repaired fold.  Best to ask your surgeon.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

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Capsulorrhaphy for bottoming out.

+1

Success in this situation is two fold.  First, an appropriated size implant must be utilized.  Larger implants, are of course heavier and the pectoralis muscle can have a much greater effect on implant position. Second, it is important to reinforce the repair of the capsule with Acellular Dermis, especially if you have thin tissues.  I will often have the patients limit activity and wear a supportive underwire bra for a period of 6 to 8 weeks as well.  Good luck with your surgery.  

Joseph C. Berardi, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 1 review

Capsulorrhaphy Success in Breast Implant Revision

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   Capsulorrhaphy is dependent to some extent on patient tissue strength but mostly on the surgical technique and precision.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 194 reviews

Success depends upon the surgeon and the patient both

+1

A bottomed out implant can be very frustrating.  The reasons for this can be related to your surgery, your tissues or events after your original surgery that made this more likely.  Similarly, these are the things that will help determine the success of your revision.  The keys to a good capsulorrhaphy are centered in surgeon patience and attention to detail.  This includes the size of the implant chosen as there is no doubt a heavy, larger implant puts more pressure on the tissue below it.  If your tissue quality is inadequate, a commonly used solution is the implantation of a biologic material to provide strength.  Strattice (made from pig skin) is commonly used for this because it is less expensive and fairly effective.  Finally, you will have a say in your outcome after surgery.  Following a good set of directions to the letter, minimizing activation of your pec muscle and providing good support can all help your outcome.

Jeremy Pyle, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 23 reviews

Successful Capsulorraphy for Breast Implant Displacement?

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Although I'm not able to provide you with specific advice, some general thoughts about successful capsulorrhaphy surgery may be helpful to you.

 Surgeon selection may be the most important decision you make;  like any other type of operation, there is a “learning curve” and success rates improve with experience. Ask your surgeon to show you lots of examples of patients he/she has helped in your situation.

 Otherwise, from the technical standpoint, different surgeons may do things differently and still end up with successful results. For example, I know of good surgeons who perform the operation with permanent suture and others who performed the operation with temporary sutures;  the success of the operation seems to be more dependent on the surgeon, not the specific sutures etc.  In my practice, I use a 2 layered permanent suture repair after performing a limited capsulectomy  of the involved area of the breast implant capsule.

Appropriate breast implant selection ( size/profile)  and/or the use of  acellular dermal matrix ( if necessary)  are also considerations.

 In my opinion, postoperative activity plays an important role in the success of this operation. Depending on  what part of the breast the capsulorrhaphy procedure is performed,  postoperative activity should be tailored appropriately. For example,  heavy lifting and/or reaching above the head may cause stress along the suture line used to correct “bottoming out” of breast implants.

 I also find the use of both "bolster dressings" and/or snug sitting bras  helpful during the postoperative management of patients who have undergone this type of surgery.  I will often use tape to apply pressure to previously elevated skin that I hope will readhere  after the breast implant opposition has been corrected.

 Of course, your plastic surgeon will have his/her preferences and/or recommendations.

 Best wishes for a successful outcome.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 710 reviews

Advice on Making Capsulorrahphy a Success

+1

Hard to answer without photos and a bit more history. 

Success depends on a good reinforcement of the breast fold. Sometimes sutures are enough, sometimes it is better to use Strattice to support the implant and the fold. If the implants are very large, switching to smaller ones will increase the chances of long term success.

Discuss with your surgeons all the options. Best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 31 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.