Do implants have to be removed when doing plication, closing the lateral pockets to bring implants closer together?

Hi.  Yes, the implant is removed.  Pocket adjustments are then made doing the plication or what may be referred to as capsulorrhaphy to adjusting close off the pocket.  The implant is replaced and the breast is evaluated.  Adjustments may or may not need to be made.  When the surgeon is satisfied that the result was achieved and things are closed.  That is the typical way that I would do that type of procedure, and probably most other surgeons.  Good luck and take care, Dr. Howell

For my patients, we tell them that the implants have to be removed, otherwise the risk of a sharp needle puncturing the implant would be high. Another word for the plication or repairing the side breast tissue is called a capsulorrhaphy. This means that the internal capsule or scar rind that formed around the implant, will be sewn together to make a tighter pocket. We often like to also use a temporary implant called a sizer to put into the repaired pocket to make sure that it is just right. Then the sizer is removed and the final implant can be placed. Advanced experience is important for precision with this plastic surgery procedure. 

Thank you for sharing your question.  In most cases the implants are temporarily removed to do the suturing but if only a small amount is needed, one or two stitches can be placed without removing the implant.  Hope this helps.

Most breast pocket revision surgeries including capsulorrhaphies in which sutures are used to tighten the capsule of the pocket involve removing the implant, completing the pocket revision, and replacing the existing or a new implant. Trying to complete any significant pocket revision that requires tightening or suturing should be done with the implant removed for appropriate visibility and to minimize the risk of causing damage to the implant. There is one technique that I know of that involves simply touching the inner wall of the capsule with a cautery pencil that does not involve using sutures. This theoretically could be completed with the implant still in place, but it would still be preferable to remove and replace the implant in order to optimize symmetry and an effective result. 

Dear jennaloveatl,
I understand your concern. However, without a proper assessment it would be difficult to determine what is wrong and what needs to be done. It is best that you visit your plastic surgeon for further assessment. Only after thorough examination you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Dear Jenna,Breast implants are usually removed for internal breast implant pocket work to be performed.  Full exposure and visualization of the pocket makes for a more precise plication and modification.  Good luck!

Thanks for your question.  In most implant revision cases to tighten and control the pocket the implant does need to be removed in order to allow full correction and visualization of the pocket.Best Wishes

It would be impossible to tighten the lateral capsule (usually done to prevent the implants from shifting too far laterally, towards the axilla, when you are lying down) with the implants in place. You simply cannot see what you are doing with the implants in place.david berman md