I had a capsulorrhaphy revision done about 6 weeks ago from lateral displacement, bottoming out, and a ruptured implant. What is the chance that the implant ruptures again and the "internal bra" to come apart or give out?
Doctor Answers 11
This is a demanding procedure, and requires more post-op patient cooperation than does the primary procedure. If your repair has held up for six weeks, chances are you have had a permanent fix. Wearing a bra that supports the repair during the early healing is essential.
Returning to full activity is a decision to be made with your surgeon's participation. For most surgeries, 6 weeks is standard, since by that time the sutured areas have reached 90% of the strength they will attain. But it this setting we are talking more than just skin. When athletes have ACL repairs, they don't practice for months. I would lean toward at least three months before stressing the repairs with any upper body work out.
Chances of implant rupture should be very small, in the neighborhood of a few per cent over 5 to 10 years.
Thanks for your question, all the best.
Although I agree with both Dr. Rand and Dr. Zwiren, a critical part of the repair is what the surgeon does with the muscle on the other side (near the sternum.) In my opinion lateral and inferior displacement of an implant is almost always due to inadequate release and weakening of the muscle opposite it. A muscle that has not been released or weakened properly will usually result in lateral displacement. In the revision surgery if that muscle is not addressed properly then the displacement will recur no matter how strong the capsulorraphy is done or the strength of the tissues.
Ary Krau MD FACS
Capsulorrhaphy and Recurrence
Having performed this procedure many times, the repair is very durable or should be. Larger implant size compromises results, and most plastic surgeons will not upsize implants and may even recommend downsizing implants. Going back to exercise should be approached with caution, and your plastic surgeon will have the best answer for that.
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Capsulorrhaphy, or breast pocket revision, can be done with several different techniques. The technique of repair and the size of the implant will determine the risk of recurrence. If a suture repair fails, then the next step would be to use a smaller implant and perhaps an acelullar dermal matrix for added support.
There is always a risk of a capsulorrhaphy failure. Technique is important and certain products such as acellular dermal matrix (ADM) may help reinforce the repair. Also, postoperative control of the pocket is important (ie - bras with cup support). Implant rupture depends upon the type of implant. Although "internal bras" do have a failure rate, in experienced hands this is a valid technique for correction of malposition.
A capsule repair for lateral and inferior displacement is not for the inexperienced surgeon. Judgement and excellent technique and much experience are required for the best chance of success. Also the quality of your tissues and your cooperation with postop restrictions plus not going bigger all are key to success. Some patients need additional strength in the form of ADM to have success. If you look good now and if you follow the surgeon's instructions specifically, your chance is greater than 80% success long term.
The implant rupture rate is quite low, on the order of 1 in 10,000 in 10 years. The risk of the implants rupturing, of course, would be the same as the manufacturer describes. McGhan implants have a slightly higher rupture rate than Mentor implants. So, in that regard I will leave you look to the manufacturer’s published information for the specific data points there, as I do not know which brand of implants you received.
The bottom out dilemma is more significant. The bottom out rate for a person who has already had this technical problem because of their tensil strength is always slightly higher than if they never had it at all. But if you have already had a capsule tissue utilized for your suspension of your fold, then you still have probably a 5 or 10% chance of this happening again. If you have been supported or supplemented with an Alloderm or implant material like Strattice, then your bottom out rate is significantly lowered even if you have chosen to use larger implants than your original surgery. I would have your surgeon discuss this with you in a technical way because I am certain that he or she has data for you from their own practice if they do these with any frequency.
To your health and beauty,
Dr. Paul Vanek, Board Certified Plastic Surgeon in the Cleveland area
Chances of recurrence after a surgery for implant malposition
Capsulorraphy is a tricky surgery and is to be perfumed with caution with much ideal of shape appearing while the surgery performed. If the tissue where the surgery is performed are strong enough then perhaps it may not re dislocate. If you PS thought it to be week tissue he can always supplement it with some kind of synthetic layer to reinforce that area.
Begin by Consulting with a Board Certified Plastic Surgeon
Your procedures should always be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery. You will then greatly improve your chances of getting the result you desire, and, without the need for a revision surgery. It is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision. Please be advised that each patient is unique and previous results are not a guarantee for individual outcomes. As with all cosmetic surgery, results will be rewarding if expectations are realistic. With any surgical procedure, there are some risks which your doctor will discuss with you during your consultation.
In my opinion, returning to certain activities too soon may increase the risk of recurrence of breast implant displacement/malposition. The type of exercise/activity patients should avoid will depend on exactly what type of capsulorraphy was performed. Therefore, In my practice, I ask patients to avoid upper body weightlifting, stretching, and strenuous activity in general respectively for at least 4 to 6 weeks after the surgery. Sometimes, depending on the type of capsulorraphy performed, this time of rest is even longer. For example, for symmastia correction capsulorraphy, I ask patients not to abduct their arms for several months after the procedure. The use of specific supportive garments may also be helpful.
One of the problems associated with this type of revisionary breast surgery: often, patients do not experience much discomfort with this type of surgery. This may lead them to return to activities too soon unless they are aware of the potential problems that may occur.
I hope this helps. Best wishes for outcome that you will be pleased with long-term.
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.