I have lateral displacement more on my right breast. It’s been bothering me so I was seen by my ps. She was pretty vague, but had mentioned using stitches to fix my stretched pocket. I was then told by an outside party that my ps should have mentioned using mesh, because stitches almost always don’t stay. Can someone please shed light on what I should do. Thanks in advance.
Answer: Implant Malposition About 25% of my breast patients are revision patients.I have also done a great deal of research and writing on malposition. I personally believe that just suturing the capsule to itself (Capsulorraphy) does not hold up long term.I prefer with significant malpositions to use a patients own capsule as a flap to support the implant and also to reinforce the capsule with Galaflex which is an absorbable but longstanding mesh support---kindof like an internal bra. It is very rare to have recurrent stretch with this technique where capsulorraphy alone recurrences are very common. I would recommend you see a plastic surgeon with the most revision experience in your area as a second opinion and review with your current surgeon as well.All my Best!Dr B
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Answer: Implant Malposition About 25% of my breast patients are revision patients.I have also done a great deal of research and writing on malposition. I personally believe that just suturing the capsule to itself (Capsulorraphy) does not hold up long term.I prefer with significant malpositions to use a patients own capsule as a flap to support the implant and also to reinforce the capsule with Galaflex which is an absorbable but longstanding mesh support---kindof like an internal bra. It is very rare to have recurrent stretch with this technique where capsulorraphy alone recurrences are very common. I would recommend you see a plastic surgeon with the most revision experience in your area as a second opinion and review with your current surgeon as well.All my Best!Dr B
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Answer: Stitches or Mesh for Lateral Displacement Stitches have traditionally been used, but since biosynthetic mesh (Seri) or acellular dermal matrix (Strattice or Alloderm) became available, it is possible to get the additional biomechanical strength of the repair that these materials provide. The drawback to using them is additional operative time and then expense of the materials (900-2800). Each case is individualized and the recommendation for the use of mesh is based on the expected ability of the stitches to hold, the thinness of the capsule, the size and weight of the implants, and the history of previous surgery or repairs. When there is more extensive displacement, e.g. inferior and lateral, the use of mesh may be worth it as recurrence of displacement is much less likely when mesh is used in addition to stitches.
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Answer: Stitches or Mesh for Lateral Displacement Stitches have traditionally been used, but since biosynthetic mesh (Seri) or acellular dermal matrix (Strattice or Alloderm) became available, it is possible to get the additional biomechanical strength of the repair that these materials provide. The drawback to using them is additional operative time and then expense of the materials (900-2800). Each case is individualized and the recommendation for the use of mesh is based on the expected ability of the stitches to hold, the thinness of the capsule, the size and weight of the implants, and the history of previous surgery or repairs. When there is more extensive displacement, e.g. inferior and lateral, the use of mesh may be worth it as recurrence of displacement is much less likely when mesh is used in addition to stitches.
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January 17, 2019
Answer: Stitches or mesh for lateral displacement? Thanks for your question. It is difficult to say for sure whether or not a suture repair alone would be sufficient versus use of synthetic mesh. The mash is very expensive and may not be absolutely necessary. I have had some success with suture repair of the capsule alone. I think others have made excellent suggestions including changing the implant location from below the muscle to above the muscle as well as possibly going to a smaller implant. The larger the implants, the heavier they are which will cause more downward and lateral displacement. I would talk to your plastic surgeon to get some treatment options and possibly get a second opinion as well. Best wishes.
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January 17, 2019
Answer: Stitches or mesh for lateral displacement? Thanks for your question. It is difficult to say for sure whether or not a suture repair alone would be sufficient versus use of synthetic mesh. The mash is very expensive and may not be absolutely necessary. I have had some success with suture repair of the capsule alone. I think others have made excellent suggestions including changing the implant location from below the muscle to above the muscle as well as possibly going to a smaller implant. The larger the implants, the heavier they are which will cause more downward and lateral displacement. I would talk to your plastic surgeon to get some treatment options and possibly get a second opinion as well. Best wishes.
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January 16, 2019
Answer: Lateral displacement of breast implants. Thank you for the question. I use stitches to close the lateral pocket but only after I change the implant pocket to above the muscle. The reason for the lateral displacement is the continued contraction of the Pectoralis muscle pushing the implant down and to the side where there is no muscle. I have had success with this technique without the use of unnecessary mesh. Hope that helps. All the best,Dr. Khuthaila
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January 16, 2019
Answer: Lateral displacement of breast implants. Thank you for the question. I use stitches to close the lateral pocket but only after I change the implant pocket to above the muscle. The reason for the lateral displacement is the continued contraction of the Pectoralis muscle pushing the implant down and to the side where there is no muscle. I have had success with this technique without the use of unnecessary mesh. Hope that helps. All the best,Dr. Khuthaila
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January 13, 2019
Answer: Stitches or mesh for lateral displacement? Lateral displacement is usually associated with implants placed behind the muscle. This can be a difficult problem to solve. To correct this is problem, a lateral capsulorrhaphy is needed to make the breast implant pocket smaller by closing the lateral aspect of the pocket with multiple sutures. This is the least expensive technique. Sometimes the capsule is very thin and, therefore, not very strong. So this technique can lead to recurrence. You can also add a biologic mesh, such as Alloderm, which is human dermis. This can be sewn into the breast pocket as an internal bra. This material will become incorporated into your own tissues. There are also absorbable mesh options. Revisional breast surgery is always more challenging than a primary augmentation. Good luck with your procedure!
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January 13, 2019
Answer: Stitches or mesh for lateral displacement? Lateral displacement is usually associated with implants placed behind the muscle. This can be a difficult problem to solve. To correct this is problem, a lateral capsulorrhaphy is needed to make the breast implant pocket smaller by closing the lateral aspect of the pocket with multiple sutures. This is the least expensive technique. Sometimes the capsule is very thin and, therefore, not very strong. So this technique can lead to recurrence. You can also add a biologic mesh, such as Alloderm, which is human dermis. This can be sewn into the breast pocket as an internal bra. This material will become incorporated into your own tissues. There are also absorbable mesh options. Revisional breast surgery is always more challenging than a primary augmentation. Good luck with your procedure!
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