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What Pocket to Place New Implant - Existing or New?

asked 1 year ago by Sydney4945 in Sydney, 02
Latest answer by Thomas B. Lintner, MD
Question viewed 518 times
Tags: capsular contracture, pocket, revision

I had breast augmentation about 6 years ago and have capsular contraction in my left breast with noticable implant outline. The implants were placed above the muscle. I have just had 2 consultations with different surgeons about replacing both implants - one says to definitely go under the muscle this time, the other says to put the new implant in the same pocket above the muscle or it will look terrible (something about banding?). I am very confused?

14 answers to What Pocket to Place New Implant - Existing or New?

Implant placement

I generally reccomend behind the muscle placement if possible especially in patients with history of capsular contracture. You can leave the subglandular pocket unless its calcified and just proceed with submuscular placement. Best of luck to you!

Thomas B. Lintner, MD
Atlanta Plastic Surgeon

Revision implant surgery for capsular contracture

For a treatment plan, I would recommend a total capsulectomy and implant removal and placement of a new implant in a new pocket.. In your case, I would do whats called a site change surgery and transition the implant from the subglandular position to the submuscle or dual plane position. Why? I'd like to place the implant in a new vrigin pocket - a pocket with no history of scar tissue formation. I would also place some sutures to obliterate the empty... more

C. Bob Basu, MD
Houston Plastic Surgeon

Subglandular implant with capsular contracture: placing implant into new pocket

IF you see 3 surgeons, you will likley have 3 different opinions. and so I will toss my recommendations in here for further confusion. I have been realatively pleased with the use of a neo-pecotral pocket. This means that the implant is removed and the capsule is preserved but the implant is placed into a new pocket beneath the existng capsulel. Rates of recurrent capsules have been low. This avoid the possiblity of detaching and having to secure the released pectoralis major muscle when... more

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Where do we put the implant?

Hello Sydney, As others have said, traditionally a new pocket is created to treat capsular contracture. If it was below the muscle, we put it above; If it was above the muscle, we put it below. This is old dictum based on good experience: Capsular contracture tends to come back if the pocket the implant was in is not removed. This is probably because there is a bacterial component to most contractures that requires erradication to prevent recurrance.... more

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon

Breast Implant ReDo- Which Pocket after Capsular Contracture?

The standard textbook advice for capsular contracture is capsulectomy followed by site change and device exchange. That means taking out the old implant, as well as the surrounding scar, closing the pocket, followed by making an entirely new pocket opposite to the original (under the muscle if the original was over the muscle) and using a new implant. That said, there are many variations and options available. For example, some surgeons create a... more

Claudio DeLorenzi, MD
Toronto Plastic Surgeon

Implant Site Change and Capsular Contracture

Unfortunately, capsular contracture is a real complication associated with breast augmentation, and I tend to see this more frequently in implants placed above the muscle. Also, implant visibility is clearly more common in this setting. Two problems you seem to be suffering from. The solution, although not simple, would be to remove the implant and capsule and place the new implants beneath the muscle - this should help in both of the above scenarios. However, the... more

Vincent P. Marin, MD
San Diego Plastic Surgeon

www.marinaesthetics.com

Capsular contracture and implant pocket

The most prudent option would be to place silicone breast implants in the submuscular plane to minimize recurrent advancement of capsular contracture and rippling.

Raffy Karamanoukian, MD
Los Angeles Plastic Surgeon

A new implant should be placed in a new pocket in most cases

The vast majority of time when removing prosthesis for capsular contracture in the subglandular position, new prosthesis should be placed in a submuscular one. If there is a question of banding, then a partial capsulectomy can be performed in that area. What is of greater concern is on switching from a subglandular to a submuscular plane there may be some redundant tissue that needs to be addressed so that you do not have the appearance of glandular ptosis. What can be difficult are those... more

William F. DeLuca Jr, MD
Albany Plastic Surgeon

www.delucaplasticsurgery.com

Pocket location after capsular contraction

If you have them in the subglandular pocket, first you would like to remove as much of the capsule as possible. In addition, placing them in a submuscular( biplanar) approach may offer better superior coverage but it is not mandatory to do so.

Steven Wallach, MD
Manhattan Plastic Surgeon

Revision breast augmentation can remain above the muscle.

As you can see, this is as much an art as a science. Of course it depends on the individual anatomy. Creating a new pocket under the muscle can create a new deformity and so should be approached cautiously. There are studies that show that using Alloderm in revisions (over the muscle) helps prevent recurrence of capsular contracture. Over the muscle and under the muscle can both work well. The most important thing is the skill of the surgeon. see video

George J. Beraka, MD
Manhattan Plastic Surgeon

Breast implants above vs. below the muscle

Given your current situation below the muscle is preferable and usually possible. In some cases the capsule cannot be completely or almost completely removed and the skin envelope shape has contoured to an above the muscle implant. In those cases if you put the implant under the muscle the tissue above it deflates and droops downward away from the implant. I have only seen that once in 27 years.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Implant positioning for revisions

To minimize the risk of capsular contracture recurring, the general consensus is that the new implant should be placed in a new pocket. Thus going under the muscle is the way to go. If there is an issue with 'banding', then that can be addressed at the time of surgery.... likely your surgeon is concerned that the existing capsule is going to prevent the breast tissue from properly re-draping over the implant. In such a case the capsule can be removed. However... more

Martin Jugenburg, MD
Toronto Plastic Surgeon

www.torontosurgery.ca

New Pocket Usually Indicated in Treating Capsular Contracture

I agree with the surgeon who offered the opinion to move your implants to a submuscular pocket. In any case of capsular contracture it is best to place the implants into a virgin pocket. I also feel that there is generally a lesser incidence of contracture with implants in a submuscular location.

John Whitt, MD
Louisville Plastic Surgeon

Submuscular implant conversion

If you made a cc above the muscle, the conventional wisdom is to convert to below the muscle. There might be rare occasions where this is not done but they are rare.