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Better to Suture Pocket or Create a New One to Treat Bottomed out Implants?

asked 2 years ago by blackviolet in Lancaster, CA
Latest answer by W. Tracy Hankins, MD
Question viewed 741 times
Tags: bottom out

BA 4-12-08 400cc's mod+ I had thin skin, little tissue, and no sag. I asked to look natural and have a nice slope. I have bottomed out or was over-dissected. It's an inch+ lower. I have sils and unders, and still have rippling.

Two PS's gave two ways of doing revisions. One was to suture the pocket (are temporary or permanent sutures recommened?), the other was to close my current pocket and create a new pocket over it, still below the muscle. Will I still have a nice slope? Should we use Alloderm (or Strattice)? What's the extra cost per sheet?

13 answers to Better to Suture Pocket or Create a New One to Treat Bottomed out Implants?

Capsullorhaphy sutures can correct bottming out

“bottoming out” is the term used to describe the condition which occurs when the breast tends to look as if it has descended on the chest wall after previous surgery, whether the surgery involved implants, a lift, or a reduction. In the case of “bottomed out” implants, sutures can often be placed in the lower pole of the breast to re-elevate the breast on the chest wall. This is called a capsullorraphy and can achieve excellt results in... more

W. Tracy Hankins, MD
Las Vegas Plastic Surgeon

Better to Suture Pocket or Create a New One to Treat Bottomed out Implants?

Depending on the weight of the implant and the quality of the tissues, I tend to favor resorbable sutures with a capsulorrhapy. I will occasionally use permanent sutures.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Bottoming out

For bottoming out, the fold needs to be resuspended. The two ways mentioend are okay to do, go with the surgeon you felt more comfortable with and had good results.

Steven Wallach, MD
Manhattan Plastic Surgeon

Correcting implant malposition with sutures vs. new pocket

Implants which have "bottomed out", or are too low, can be corrected by suturing the lower pocket closed. My practice in doing this is to use permanent suture, but what is more critical are the quality of the tissues being sutured and post-operative care. There is a significant failure rate to this method, however, and I have recently favored creation of a completely new pocket. I agree with going with a little smaller implant, and if there is any... more

Marc Klein, MD
Atlanta Plastic Surgeon

Several techniques are options for bottomed out breast implants

All of the techniques you mentioned are options. For Bottomed out implants, I usually recommend resecting the excess capsule of the lower portion of your breast implant pocket and suturing the free edges together. This works great providing that you have a strong capsule, and that the capsule/pocket is opened up or resected superiorly as well and the implant is repositioned more superiorly to remove any pressure from the inferior tightening. If this fails, then I would consider either a new... more

Daniel P. Markmann, MD
Baltimore Plastic Surgeon

DiscoverTheBeauty.com

Treating bottomed out implants

As stated expertly by Drs. Rand, Aldea, Beraka, & Edwards; SUTURE THE POCKET FIRST! If that fails than you can dissect a new pocket. From MIAMI Dr. B

Darryl J. Blinski, MD
Miami Plastic Surgeon

Treatment of Bottomed Out Breast Implants with Rippling and Breast Thinning

I largely agree with the comments made by Drs. Rand, Beraka and Edwards. First, you must recognize that the reason your breasts bottomed out was because your implants were too large and the breasts could not hold them. The reason why the breasts ripple is because your breasts did not provide enough soft tissue cover to mask the normal rippling of the implants. It would be safer long term to go with smaller breast implants. If you insist on keeping these implants I would suggest you use... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Correcting bopttomed out breast implants

The most important thing is to have a very experienced surgeon taking care of you here. Secondly, without examining you it isn't possible to say for sure but usually I can correct bottomed out implants without changing pockets using absorbable sutures. External underwire support 24/7 for 8 weeks, going smaller with the implant, and avoiding any exercises that involve running, jumpingand excess pec activity complete the plan.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

New pocket will be predictable

The best choice depends on the amount of thinning and also quality of the tissue. I would suggest new pocket if possible and smaller implants. I would not use alloderm or any other product because of increase risk of seroma.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon

Bottomed out implant correction

Strattice etc. is one way to fix the problem, The material is costly and depends on the size of the material purchased. On the other hand, I have had a ot of success with surturing the pocket. Personally, I remove a bit of the capsule and close that with dissolivng surtues. I don't see how creating another pocket will help with this.

Scott E. Kasden, MD
Dallas Plastic Surgeon

Treatment option for bottoming out after breast implants

I have tried suturing a pocket closed to fix bottoming out with varied success. I think it is better to create a new pocket on top of the old one (neopectoral pocket) to get a fresh start. The use of Strattice will help reinforce your tissues, but it is very expensive.

Bruce Genter, MD
Abington Plastic Surgeon

Alloderm good to correct bottoming out after breast implants.

Hi. The first thing I would recommend is smaller breast implants, if you want a natural result. Very hard to give you a plan without examining you. It really has to be individualized. The skill of the surgeon is the important factor.

George J. Beraka, MD
Manhattan Plastic Surgeon

Treatment of bottoming out

The treatment of inferior malposition of the implant, called dropping out, can be accomplished a few ways as you mention in your question. If you have adequate tissue your plastic surgeon may recommend closing up the bottom of the pocket with sutures (i use permanent but others use sutures that dissolve after a few months). If there is sever rippling that bothers you you may consider seeing a plastic surgeon who can discuss the use of Strattice (or some other acellular dermal matrix they are... more