Stitches or mesh for lateral displacement?

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  

Hi, thank you for your question. 
Sutures are the most commonly used tool in correcting the implant pocket during capsulorraphy. However, if the overlying soft tissues are too thin or lack elasticity, the sutures will be ineffective. This situation requires the use of mesh material or acellular dermal matrix, which is sewn in to give the implant pocket a more sturdy repair. This is a very powerful tool and can be used to correct some of the most challenging problems. Based on your examination, your plastic surgeon may not have felt it warranted this additional material. However, a second opinion with a board certified plastic surgeon is never a bad idea. 
I hope this helps. Best of luck!

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!

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.

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. 

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

Hi. It really depends on your problem, your anatomy, the surgeon, and their experience with the techniques.  I've fixed most breast implant malpositions with stitches alone, but there is also a role for the acellular dermal matrices.  Actual "mesh" usually refers to an artificial material and that is never used (well, should never) be used in the breast.

When an implant is laterally displaced, it can often be repaired by suturing, but yes, there is a risk that the sutures will not hold or that the lateral pocket opens over time. If mesh was not an expensive material, we would all use it more to reinforce the such repair. If you are not opposed to the additional cost, you may want to discuss it with your plastic surgeon. He or she may determine at the time of surgery whether the mesh is necessary, but you need to discuss the cost first.

Hi.  Good question and the answer is that it depends on several factors.  The tissue quality plays a role - with good quality tissue, stitches may well hold up nicely and allow your body to heal that closure well.  With poor tissue quality, a mesh (likely an absorbably mesh that causes your body to form more scar tissue and therefore hopefully hold up the repair better) may be helpful.  It is typically more expensive.  And being more of a foreign body it can also have its down sides.  I would recommend consulting with a board-certified plastic surgeon with good experience in this area.Good luck and take care,Dr. Howell

for lateral displacement I think suturing the internal pocket works well. Mesh is expensive and should be used when suturing fails.