Second Time I Need Pocket Adjustment. What Causes This?
- Asked by rhann in CT
- 2 years ago
I had bi-lat mastectomy 12/2009. I am small frame and was 38D. I have high profile silicone breast implants (550cc)which fit into my 38D bras. I had right pocket adjustment this past April due to sliding. It's now October and the right implant is sliding again. I am having my third round of fat grafts next week, but I haven't told my PS about my pocket.It is uncomfortable with the pulling. What causes the pocket to stretch? Is it common?
Problem with Displaced Breast Implant After Breast Reconstruction
Breast implant displacement following breast reconstruction can occur. The reasons for the displacement are that in doing a mastectomy some anatomic structures including the disruption of the infra-mammary fold which is the attachment point of the lower breast skin to the chest . This along with the occasional lack of strength of the thin mastectomy flaps can lead to movement of the implant due to loss of support normally provided from these tissues.
Breast preserving procedure don't have as much disruption of the support structures and therefore breast implant displacement is less likely.
AlloDerm, a preparation made from the dermis can be used to reinforce the skin flap's integrity, along with the recreation of the the infra-mammary fold, can reduce implant displacement problems.
While not for everyone, breast reconstruction with your own skin and fat tissues using flaps from the abdomen such as the TRAM flap, DIEP flap, or other perforator flap may address your concerns and provide a warm, soft breast that is your own natural tissue. See nybreastreconstruction.com for information.
I would recommend another opinion about your breast reconstruction.
1) These are technical issues which can be corrected and which should not recur.
2) Alloderm is a collagen matrix which can be used as reinforcement for the implant pockets.
Implant displacement is more seen with mastectomy patients because of the wide dissection the general surgeon does. This will destroy certain fixation points like the inframamamry line or over the chest bone then the implant will get displaced . Add to that the weight of the implant.
Repair can be done and reinforced with acellulart matrix to support the implant
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The cancer surgeon who removes the breast has a difficult task depending on where the tumor or tumor are located. In many instances the natural borders of the breast at the fold between the chat and abdomen and the outside of the breast towards the armpit are removed with the specimen to ensure the cancer was removed. Even when the plastic surgeon performs suturing to recreate these areas the tissue is not able to heal properly. The placment of expanders and the process of expansion can have effects on these areas as well. Each time the area is reoperated it is more difficult to creat the pocket size and shape. Typically there is scarring and tissue that no longer has blood supply to ensure adequate wound healing. In many instances I have had to remove implants and use a patients own tissue because of the stress caused by the constant need for revision of the breast pockets.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.