Implant replacement- neopocket vs internal bra vs do nothing? (Photo)

Dear bobbiesng,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

For this issue, neo-subpectoral pocket is the best solution. Capsulorrhaphy with mesh (internal bra) is difficult to achieve due to poor tissue dynamics at the sternal border, and the forces of the implant are constantly trying to undo the repair. Conversely, the repair by a neo pocket is actually reinforced by the implant forces. As an aside, infection is not an issue with mesh.

Your implants are very close together and you are almost at the point of symmastia. You will need smaller based implants with medial plication to prevent symmastia from happening.

Best Wishes,

Gary Horndeski, M.D.

Thank you for your question. You are an excellent candidate for an implant exchange and internal bra-capsulorrhaphy. A large portion my practice is dedicated to breast revision surgery. In fact, I wrote the very first paper on capsulorrhaphy over 20 years ago. You have a very straightforward fix and should a be able to have an excellent result. Best wishes to you.

With saline, I would suggest keeping them behind the muscle and tightening your medial pockets. You might need mesh. Usually, the capsule is thin with saline and it is best to keep all the tissue, including the capsule, if possible.

As far as your concerns with the pocket there should be no problem as far as infection or distortion is concerned. I need to know several things. Are your implants sub muscular or under the breast tissue? Did you want them this close together as I am concerned that using the same pocket may create two implants too close together creating the symammia. If you use the same pocket because there is no capsular contracture then I would recommend the use of mesh or acellular dermal matrix to control the implant placement and correct the descent of the implants especially raising the right one a little. You can always go to several consultations and decide which surgeon will do the best for you. Good luck in your decision. Dr. Steven Schuster in Boca Raton Florida

Before prescribing an operation, we generally start by defining the problem.
It would be helpful. If you could tell us what you don’t like about the outcome.
You do have some breast divergence and I think your surgeon compensated by placing your implants quite close to each other.
This appears more so on the right side.
Patient often complain of implants being lateral if they have a breast divergence..
Ideally implants should be centered under each breast but I can see the desire to create more medial pockets in your case.
The procedures you describe, are typically done for implants that have bottomed out.
Based on your pictures, your implants do not appear to have bottomed out at least not significantly at this point.
I don’t see a strong indication of revision surgery at this time.
Best,
Mats Hagstrom, MD