Which implant position is best for my revision?
3 years ago
My implants are currently behind the muscle . I have pectoral muscle deformity, This bothers me the most due to it being visible and deformed looking . bottoming out , need a lift , possible CC. Yet I still want a natural look
Doctor Answers 2
I would agree with Dr. Baxter that most augmentation contour problems related to the pectoralis muscle can be corrected by a full dual plane or split muscle technique while leaving the implant under the pectoralis muscle for the upper part of the breast.
The bottoming out aspect would need to be evaluated as to cause and best method of correction. Usually tucking and controlling the inframammary crease level through an inframammary incision will solve it but some bottoming out is caused by too large an implant for the base width of the breast and grafts that substitute for capsule are needed to correct the problem along with a smaller diameter implant.
This is a good reason, for example, of why it is not wise to just pick and implant volume in cc's and try to make it work.
Your situation sounds like the exact reason why the split muscle technique was developed. This places the portion of the pectoral muscle that was detached back to its original anatomic position (behind the implant) but leaves the upper portion of the muscle in front of the implant for a natural contour. With bottoming out you may need additional support with something like SERI Scaffold mesh or Strattice, the latter one being my current choice in cases of capsular contracture since it seems to prevent recurrence.
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