I had my BA about a year ago. Just a few weeks later they began to bottom out and double bubble. Now I have to have a revision and don't know the best way to have it done. Some docs just use stitching and use beladerm. Any advice as to whats better and lasts longer? Any advice would be wonderful. I can barely afford to have it done once, I need this to be right. Thanks. Diane.
Is It Better to Use Beladerm or Just Stitching? (photo)
Doctor Answers (9)
Is It Better to Use Beladerm or Just Stitching?
Suturing is usually effective in restoring the breast fold and is reliable for most patients, and is considerably less expensive. The material alone for two sides will run about $4000.
It is best to discuss the pros and cons with your surgeon who has examined you and followed your course. All the best.
Double bubble correction - whether or not to use Dermal Matrix.
A double bubble deformity can be difficult to correct. In mild to moderate cases, pocket revision with capsulorrhaphy sutures can work very well. It also does not incur additional costs. For severe implant malposition cases, the use of an acellular dermal matrix (Strattice for instance) is much more expensive but allows for precise repair of the defect. I recommend seeing a few different Board Certified Plastic Surgeons to get an estimate on price and recommended technique after an exam.
BAM Repair, best technique
Hard to be exact with just those pics.
That said, I would first try with sutures alone as they generally work very well. Plus, they are way less expensive and less likely to get infected. Your pics don't demonstrate a severe deformity, so that is why I make that suggestion.
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Usually this can be fixed with just suturing. Adding mesh or dermal patches increases expense dramatically, and is usually not necessary.
The fact that you have been given both these options implies that neither is surefire solution. The Beladerm has its own set of complications including additional cost. Simple suturing has a certain percentage of failure and, thus, recurrence. The problem is that when you suture capsule to capsule the body does not form the normal fibrous tissue to connect the two surfaces that is seen with all other tissue. For example, when a person sustains a cut to their skin, sutures are placed that are normally taken out a week to two afterwards. This is possible because the normal response of the human bodyis to form fibrous tissue that increases with strength over time. This phenomenon, however, does not occur between the two capsular laters. This is why many surgeons will use permanent sutures to maintain the repair in order to overcome the above problem. Unfortunately, permanent sutures often tear right through the capsular repair and recurrence occurs nonetheless.
In my opinion, what makes the most sense and is born out in my experience is to have normal tissue sutured to normal tissue. This is analagous to the skin laceration I described above. In order to do this, one must remove the capsule in the region of repair and suture the underlying tissues together. I have been extremely successful in adressing problems as you have mentioned using the technique I have described.
Ary Krau MD FACS
Double bubble after breast augmentation
Dear Mommy of Many. Sorrry to hear about your problem. A properly performed capsule repair ("capsulorrhaphy") should be adequate. Some surgeons use dermal patches for re-enforcement, but I have never found them to be necessary. They add significant cost to the procedure and added complications. Hope it goes well.
Different doctors have different opinions about how to address a problem such as yours. Some, like me, get good results simply by using sutures to re-create the fold under the breast. I generally use two or even three layers of stitches so that they reinforce each other in case one row breaks. After awhile, your tissue will regain some strength of its own and it won't really matter if the stitches break or not. In fact, the stitches that I use are designed to break down after awhile. Some doctors like using sheets of material such as Alloderm, Surgimend, etc. for this surgery. This might work well too. My main problem with such material is that it is VERY expensive. Like you said, you want to get this right the first time so you don't want to be cheap at this point. Still, in my hands, sutures alone work just fine.
Dermal Matrix or Capsulorrhaphy for Double Bubble
I have fixed dozens of these double bubble deformities with capsulorrhaphy alone. I have not had a recurrence. However, there is no question that dermal matrix contributed strength to the repair.
Dermal matrix helps in bottoming out
Tough problem. The technique of suturing the capsule is obviously much less expensive and the same implant can usually be used. The larger the implant, the heavier the device and this technique is less predictable. The use of the dermal matrix has revolutionized this. I use Strattice for this. It allows the crease to be reset and the implant pocke controlled. It is very solid. Obviously there are no guarantees, but with a double bubble effect I would be the most confident in using the dermal matrix. Best of Luck!
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