I have read that it's necessary to use permanent sutures to repair an over-dissected pocket and raise the fold. I've also read that there's a high risk of infection with permanent sutures. What are the odds of a successful long-lasting outcome using absorbable sutures? If that's not a good option, then what about the sutures that dissolve in 6 months? Thank you.
Lateral and Inferior Displacement of Implants - Capsulorraphy
Doctor Answers (10)
Suture type for capsule repair for implant malposition not important
There are different causes to implant malposition, only one of which is overdissection. Whatever the cause, the repair relies on healthy tissue for support. Permanent sutures will not be successful if the tissues into which they are placed are weak, which is often the case. I don't think there is muscjh in the way of infection risk with permanent sutures in the capsule, but ensuring good support is more important. One way to do this is with a material called Strattice, which forms sort of living internal bra. Whatever you decide, it is really important to get the first repair done right since it only gets more difficult if it fails.
Treatment options for implant malposition
Depending on the severity of your malposition and the quality of your tissues, a capsulorraphy with permanent sutures could be a great option. Another advanced alternative is to utilize a special FDA approved collagen sheet such as Strattice to treat implant malposition. I've used Strattice in revisional breast implant surgery cases with outstanding success to correct the problem of implant bottoming out & malposition. Please visit with a board certified plastic surgeon experienced in revisional breast implant surgery to learn more about your options.
Capsulorhaphy for Malpositioned Implants
I have used both types of sutures for capsulorhaphies and have not seen an infection with either type. I think the technique is very important in performing the procedure not just the suture. There are other options as well such as changing the pocket location (subglandular to submuscular) and using products such as alloderm for added support and coverage.
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I use permanent sutures for my capsulorrhaphy, but it has become more common to use absorbable suture for repair of fascia for capsules,fascia,etc.
The risk of infection is very low, no matter which suture is used. I usually only use the resorbable type (0, or 2.0 PDS), but occasionally will also use a heavy monofiliment non-absorbable (2.0 Prolene). I have had success and failures both ways.
I think it is important for you find a surgeon who is comfortable with the repair and don't sweat the small technical details like suture type.
Repair of malpositioned implants
You seem to be focusing on the suture chosen to "Keep" your post op result. Perhaps the weight of the implant itself and the inevitable attenuation of your soft tissue envelope with larger volume implants will play a greater role in relapse of your present situation. PDS would be my preferred suture for capsulorraphies.
Sutures Used in Capsulorraphy
Your question is a good one. Thankfully capsulorraphy is not a procedure which I need to do very often. When I do, I usually use a PDS suture which does dissolve with time but typically takes a few months to dissolve.
Sutures for displaced implant?
The "down and out" implant position may have been cause by an overdissected pocket, but it could also have been a result of using a large, heavy saline implant in a patient with poor tissue elasticity. It could also be a result of pectoralis muscle contraction.
For capsulorraphy I've had success using a barbed suture but a nonpermanet longer lasting suture in a multilayer repair should work.
Suture type for breast capsule repair
Permanent sutures do not assure a successful repair - the body has to heal otherwise the sutures will pull through the tissue over time. A long lasting absorbable suture is acceptable.