When is skin excision necessary during a capsuloraphy for bottoming out?

I have bottoming out and lateral displacement two months after silicone implants under the muscle- 325/350. My original surgeon suggested just a capsulloraphy in s few more months, and I got a second opinion from a surgeon who insisted on skin excision in addition to capsulloraphy. I'm not sure which would be best in my situation. Is one option more reliable than the other long term? Thanks!

Doctor Answers 14

Capsulorrhaphy with skin excision

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Sorry to hear of your challenges. Without seeing photos or being able to examine you, it is difficult to say whether or not you would require skin excision.  Most commonly, if implants have lateral and inferior displacement, that sounds like the capsule is too large for the implant.  In this case, this can be addressed with a capsulorrhaphy alone, or possibly a revision of the capsule and a larger implant.

If, however, on exam you have excess length of the lower pole of your breast, then in some cases skin excision along with revision of the capsule may be beneficial.  This usually can be determined after breast measurements are made, and discussion with you regarding your ideal of an esthetically pleasing relationship between the position of the nipple on the breast mound, and the amount of fullness of the lower portion of the breast.

Best of wishes to you as you explore these options.

Salem Plastic Surgeon

Skin excision with revision surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thanks for posting your question. I am happy to try and help you. It is important to remember that a board certified plastic surgeon will be your best resource when it comes to an accurate assessment of your situation, and concerns.

Having said that, I do not excise skin unless there is already a scar there. If there is not a scar, I will typically do all of the work from the inside.

I hope you found this helpful. As always, ask your PS first about any questions. Have a great day.

Skin excision with capsulorhaphy

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Skin excision is not usually necessary with a capsulorhaphy since the skin will re-drape over the area., unless you are talking about excision in an area where a horizontal skin excision has already been performed while doing a breast lift or reduction.  It is also unusual to have "bottomed out" just two months after implant surgery.  One usually thinks of stretching over time as the cause of "bottoming out" but in your case, your lateral pocket could have been over dissected leading to a lateral and inferiorly placed implant pocket.

John Dean, MD
Baton Rouge Plastic Surgeon
4.3 out of 5 stars 23 reviews


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Skin is precious. It should not be sacrificed except in extreme situations and bottoming out is not an extreme situation.
However you could have some unusal situation. Only examining doctor is justified in giving concrete recommendation in your regard.    

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 24 reviews

Skin Excision Never Necessary

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Capsulorrhapy should be sufficient. The 'extra skin' just goes back down to your chest wall once the implant has been taken out of the way and replaced to it's proper position. 

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Implant Malposition

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Its impossible to give you any meaningful advice without a physical exam.  I would wait 4-6 months before opting for any revision surgery.  If its lateral displacement, then a lateral capsuloraphy (tightening of the lateral pocket) could be an option.  However, if you also have true bottoming out, you may need restoration of your breast fold with an internal bra technique with SERI surgical scaffold.   Please follow-up with your PS.  Best wishes,

Dr. Basu
Houston, TX


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I never excise skin to help with a capsulorrhaphy.  It leaves a scar on the breast, it not particularly effective, and the bottoming out should be correctable from the inside.

Skin excision with capsulloraphy

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Two reasons for skin excision, in your case, would be  if you needed to be downsized and a needed a lift. With limited information, it is difficult to give you a definitive answer. However, smaller implants may still be appropriate during capsulorrhaphy as same or larger implant would add considerable stress on the repair and risk recurrence. Best.

Zakir Sabry MD
New York Plastic Surgeon

Bottoming out with skin excision?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Hi gab0041

Sorry to hear of your problems.

To me your problem sounds like they resulted from the pocket dissection, or perhaps, a weakness that developed subsequently.  A capsule repair should take care of this.

Now, if a surgeon is saying that you need skin excision, it sounds to me like you either need a lift or a larger implant regardless of the capsules.  This is an issue that should have been reviewed pre op.

I recommend a third consultation, and an explanation.



{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
It is fair to say that skin excision is not often done for capsulorrhaphy. It is not appropriate to tell you if it is or is not needed in your particular situation. At the very least, photos are needed and a physical exam would be better in making that determination. 

Michael S. Hopkins, MD (retired)
Albuquerque Plastic Surgeon

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.