I have bottoming out on one of my implants. I have been on multiple consultations trying to find a surgeon to correct this. I am confused because I keep getting different opinions on what I need to do to fix it. I've been told about everything from creating a "hammock" out of cadaver skin to hold my implant up to some light "tuck stitching" to hold it up. One PS told me the only way it will hold for sure is if my skin is stitched and hooked permentently to my ribs. Is this true?
Does a Caspuslorrhaphy Involve Stiching to the Ribs?
Doctor Answers 7
Capsulorrhaphy after breast augmentation
As others have stated, you have experiences bottoming out on your right side. There are various ways to fix this. One of the more commonly used methods includes elevating the pocket by attaching the capsule to the rib periosteum (the outer lining of the rib). There are also products such as Strattice that have been used successfully to re-create a pocket in cases of bottoming out. Make sure you find a surgeon who has experience fixing this problem. Good luck.
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Does a Caspuslorrhaphy Involve Stiching to the Ribs?
Sorry for your issues. There are many opinions/options to try and correct the "bottoming out" issue. Recommendations might include acellular dermal matrixes with deep "rib" sutures. Best to continue to obtain in person opinions.
Capsulorraphy can resolve implant bottoming out
Bottoming out is defined as the middle of the implant being below the nipple/areola complex, with most of the implant below the middle of the breast. For a successful capsulorraphy, we recommend:
- Calculate the appropriate size of implant for the pocket and verify that it is not too large
- Open and widen the upper aspect of the pocket to free the implant to move up
- Weaken the pressure by the Pectoralis muscle
- Double running suture line folding the lower breast pocket on itself in a double or triple layer
The vast majority of successful capsulorraphy at our center do not require the use of synthetic materials or suturing to the rib (very painful).
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Repair for a low breast implant
When an implant pocket is low and the implant is projecting low below the nipple there are options, and solutions, though nothing always works so opinions vary. We favor suture repair of the pocket with a double row of sutures internally in the pocket alone, not the rib. This is called capsulorrhaphy and like a hernia repair for a very few the repair might not hold. The next option is adding support, one of the many 'allografts' to reinforce the lower support under the implant, and we would use this only if the first repair did not work.
Best of luck,
Pocket Options Include...
You definitely have bottoming out. Options to fix include ( in the order that I would perform them)
1. Tighten the lower pocket - the inferior capsulorrhaphy. This basically closes the lower pocket and raises the implant. Success rate is dependent on internal tissue, size of the implants and how much the tissue stretches.
2. Use of Alloderm or Strattice. This uses dermal tissue (from a cadaver or pig) to reinforce the position of the fold and helps keep bottoming out from recurring. The issues are cost of the material and placement of artificial material.
3. The last option would be to advance the skin and create a new fold with your own tissue. I would use this only in a reconstruction or severe malposition.
You will need to have pocket revision
Your condition is due to detachment of the infra-mammary ligaments from the chest wall. This is due to the surgical dissection. The use of the AlloDerm is indicated in the cases that the normal tissue is missing. You need to find a surgeon that has experience with pocket revision . This is seen more in the trans-axillary breast augmentation due to the lack of visualization.
Capsulorrhaphy for breast implant malposition
Thank you for the question and pictures.
One of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall. This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla).
In your case, I would suggest repair of the inferior breast capsule with permanent internal sutures (capsulorrhaphy). This involves removal of a segment of breast implant capsule among the inferior/lower aspect of the left breast implant pocket. The 2 edges of capsule tissue are sutured to one another with permanent suture. This procedure reduces the size of the implant pocket and prevents the descent of the implant on the left side. Suturing to the ribs is not necessary and complication prone. This procedure will improve the symmetry of the breasts and the positioning of the nipple–areola on the left breast mound.
Make sure you're working with a well trained experienced board-certified plastic surgeon. Capsulorrhaphy, even in the best of times, is not always successful and further revisionary surgery including the use of allograft ( I use this material for cases of recurrent implant malposition) may be necessary.
I hope this helps.
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