Surgeon 1 wants to do explant with capsulorrhaphy on the right, removing a lower section of the capsule and sewing it back together, leaving the rest of the capsules, with twilight sedation, for $3958 (surgeon's fee, facility, and twilight sedation). Surgeon 2 wants to leave the capsules intact and do internal sutures to correct the low pocket. He said that would be enough to bring the crease back up to my natural tissue. We can do local anesthesia. His quote is only the surgeon's fee, $1500.
Explant W/o Replacement: Do I Need a Capsulorrhophy/partial Capsule Removal, or is It Enough to Have Internal Sutures? (photo)
Doctor Answers 7
Confusing Choices in Correcting Breast Implant Malposition
Your breasts were asymmetric before surgery and are more asymmetric after the placement of large breast implants through breast fold incisions. It appears you have bottoming out of one of the implants. There are several ways of attempting to correct such complications, all with varying degree of complexity and even more variable and lasting rates of success.
- Placing EXTERNAL stitches through the skin hoping to close the lower pocket without going in and exposing the implant
- Going into the breast, staying outside the breast implant scar implant pocket and closing it from the outside with stitches
- Going into the implant pocket and closing the longer lower pocket with several internal stitches (capsulorrhaphy).
- Removing the lower extension of the breast implant pocket and closing it with internal stitches
- Going into the breast implant pocket, removing the excess lower extension and supporting the implant at the appropriate height with a biological sheet (such as Strattice).
The choice of WHICH procedure should be done should be based on a thorough examination and allowing you to decide which would be best for you.
Peter A Aldea, MD
Breast Implant Removal and Capsulorrhaphy?
Thank you for the question and pictures.
If I were doing this procedure, in order to improve breast symmetry in the inframammary fold area, I think it would be best to do as “Surgeon 1" is recommending. By removing a segment of capsule and performing capsulorrhaphy the chances of a successful pocket correction is increased.
Pocket issue for breasts
Correcting for the lower pocket displacement can be performed by excising a portion of the capsule and making the pocket smaller. An in office exam would be critical.
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Breast implant explantation
Breast implant explantation should include capsulectomy. If the capsule is left in, it may not stick together and may fill with fluid.
You have significan malposition therefore capsulectomy and good bra to allow the breast tissue and tissue to adhere in the right position. Need good support Bra after that.
What can be done to treat implant malposition?
There is no replacement for an in person physical exam and review of your previous medical records. From what I see in your submitted pictures, your right breast implant sits a little lower than the left. Your breasts naturally sit wider on your chest and your implants appear to be in a good position otherwise centered on your nipples. I have had good success with sewing the pocket to correct the malposition and replacing the implant. Other adjuncts that can be used to support the repair include the use of acellular dermal matrix which is a bit more surgery and has increased costs associated.
I hope this helps
Breast asymmetry correction
You would have a better chance of correction by opening up of the capsule and adjusting the capsule. This should help but it could recur. I would also like to see your pictures before you had your breast implants.
Bottoming out correction
Thank you for your question. You have bottoming out of the right breast. Correction of the inferior capsule by suture is the correct way of doing it. But, surgeon differ, some would take a piece of the inferior capsule and suture the predetermined capsule edges and some would only score the inferior capsule and perform capsulorraphy. You have to see before and after photos for both surgeons and decide who is more experienced and can give you the results you want.