I Need a Pocket Revision Due to Implants Falling Down my Sides, Would I Be Better off Switching to Textured Implants?

I had a full breast lift and augmentation done 7 months ago, my implants are falling under my arms causing awkward shapes breast, dents, and discomfort. My PS recommended pocket revision and another breast lift. I seen a different PS that recommended pocket revision, switch my current implant (smooth saline) to a textured silicone implant to prevent implant falling down the sides. The new PS also recommended a Dermix Matrix for extra support, as well as a breast lift. I want what is best.

Doctor Answers 10

I need a pocket revision due to implants falling down my sides - would I be better off switching to textured implants?

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Hello! Thank you for your question!  Given your history of failed attempts at revision to correct symmetry and shape issues, consideration for either an acellular dermal matrix or mesh-type substitute is reasonable.  A capsulorrhaphy would be needed for revision of your breast pocket. If you do need such, the use of a dermal matrix or mesh may be considered if your tissue now has significant laxity that is failing in support or a significant deformity in which recreation of the breast pocket is required along with adding additional support and coverage of the implant.  Certainly, the larger the implant, the heavier the weight...thus, it may be useful to consider placement of a matrix or mesh. Otherwise, capsulorrhaphy for pocket revision using your native tissue should suffice.  It has been used safely and effectively to correct synmastia, restore the inframammary fold, mask implant issues (e.g., rippling, wrinkling, etc.), support the implant within a "sling", and improve aesthetic results in revisionary breast implant and reconstructive procedures.  However, only by physical examination would one be able to make recommendations on the benefits over the risk of using a matrix or mesh in your situation.  Pocket revision/support would do more for you than changing to a textured implant, in my opinion.

Consult with a plastic surgeon well-versed in breast procedures and the use of dermal matrices and mesh 

Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

I Need a Pocket Revision Due to Implants Falling Down my Sides,

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Difficult to give a useful answer without photos, preferably including before surgery ones.

Dermal matrix is often a good choice for pocket revisions, but they are pricey. I don't see much edge in using textured implants here.

Please consider posting some photos. Thanks, best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Shapes, Dents, and Lateral Displacement

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  If you have contour irregularities laterally, then the dermal matrix is a good idea for camouflage.   Textured will have no impact if the same pocket is used.  Dermal matrix contributes considerable expense to the surgery but may be worth it.  Please make sure that you find a board certified plastic surgeon with elite credentials to perform these more difficult revisions.

Breast implant falling to the sides

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Breast implant revision surgery is complicated. 

-You almost definitely need a pocket revision with lateral pocket tightening (capsulorrhaphy).

-An acellular dermal matrix can provide additional support and strength to the repair, but I would consider using this after a failed repair.

-Textured implant is not necessary, unless your surgeon is suggesting a form-stable silicone implant, then those are always textured.

Good Luck

Dennis Dass, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 185 reviews

Implant revision

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Without an exam it is difficult to properly evaluate you. Some surgeons use a dermal matrix for better support or camouflage from rippling.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Pocket Revision After Breast Implants

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Without examining you , it ids difficult to give advise about whether a breast lift would be helpful in repositioning your breast implants.  A support material such as Derma Matrix (or Strattice or Alloderm) is valuable in a pocket revision.  A textured implant is not beneficial unless you have a a fresh pocket because the texturing will not adhere to a smooth surface.  Good luck!

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 117 reviews

Textured implants to prevent recurrent lateral malposition not most important factor

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The idea of the textured implant is that it adheres to the scar capsule and can prevent the implant from moving. This is especially important for shaped implants (gummy bear). However, where there is already a pocket the new implant may not stick, and it is more important to have a solid pocket repair. The use of acellular matrix is probably more helpful, but textured implants do not adhere to them. My preference for this type of case is Strattice.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

How to fix implants falling to sides

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Implants that are too far to the sides may be caused by pocket stretch from saline implants or may be a result of the pocket being made too lateral to begin with.  Sewing the lateral pocket up (capsulorrhaphy) may stretch out again and a dermal matrix can help give it better support. I have had good luck cutting the pocket edges and sewing them up in 2 layers. I don't think you necessarily need a textured implant. Can't tell about a lift without seeing you. 

John Squires, MD
Denver Plastic Surgeon
4.9 out of 5 stars 82 reviews

Revising augmentation mastopexy

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This is a tough situation and why augmenting the breast with an implant and lifting it at the same time is hard to get all the factors to settle satisfactorily. One can't go back and rethink/redo it but revising both the implant/capsule and re-lifting the breast has some of the same complexity issues. 

I agree with the other responses that dermal matrix grafts are expensive but do provide a new capsule at the appropriate level and that a textured surface implant would not help the problem. The issue of implant malposition and more lift is best addressed by exam and requires judgment and experience. There is no simple answer. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Getting implants out from your armpits

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Lateral implant displacement can certainly be repaired, as you have learned from your consultations.  I don't know that switching to textured implants will make much difference, but I am a believer in using ADM (acellular dermal matrix, like Surgimend) as an "internal bra" to support the new implant position and hopefully keep them in the right place.  It's not cheap, but, in my opinion, it's the most reliable tool we have for this procedure.

Carmen Kavali, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 46 reviews

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.