What options are available after a failed capsulorraphy? (Photo)

Question

In May 2020, a capsulorraphy was performed and implants were changed to 355cc textured gummy (107s). Within 4 months, the implants bottomed out again, with the right side noticeably about 1 inch lower than the left. My surgeon recommended strattice however; the incision would need to be around the nipple, not under the breast. I was told that my nipples are too small, so the incision would be larger than my nipple. Are there any other options?

Richard Baxter, MD · Answer

The reason a capsulorrhaphy fails is that the tissues around the implant are too thin or weak to support the repair. This is true whether or not the sutures are permanent. An internal bra with Galaflex mesh or Strattice was designed exactly for this situation because these materials add a layer of reinforcement.

Donald R. Revis Jr, MD · Answer

Good afternoon!
I repair more bottoming out than anyone else, using the Original Internal Bra, my strong permanent internal suturing technique which corrects your bottoming out and provides excellent long term support moving forward. It comes as no surprise that you have recurrent bottoming out- it really cannot be fixed through a crease incision. Think about it- you're cutting back through the same tissue layers you're trying to repair and strengthen- it just doesn't make any sense. I think your areolas are small but adequate for the necessary incision to perform the repair. Strattice is an added option that about 20% of my patients choose. I first developed this technique 20 years ago, and today it is the most common revision I perform, 5-6 times a week- it works and it lasts!

Ronald J. Edelson, MD · Answer

It can be done from inframammary. I agree with the strattice but quite pricey. You might want to get other opinions.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  A large portion of my practice is dedicated to the revisionary breast surgery.  In fact, I wrote the very first paper on how to perform capsulorrhaphy over 20 years ago.  You have very large inframammary crease incisions, and these can be used to perform capsulorrhaphy.  I find that many surgeons do not adequately perform the capsulorrhaphy and often do not perform a mirror image capsulotomy to take tension off the repair.  You are an excellent candidate and should not need any biologic (Strattice) or mesh.  I would definitely not use Strattice for reinforcing capsulorrhaphy repairs as this ultimately stretches out and thins the tissue that it abuts.  Best wishes to

Farbod Esmailian, MD · Answer

I would say that your current incision can be used to fix the issue you are having.  The use of Strattice or Galaflex would be recommended to help reinforce the tissues in the repair.

I would recommend you see a board certified plastic surgeon who does revision breast surgery to discuss your options further.

Hope that helps.

Daniel Barrett, MD · Answer

Dear Cheller3825,
bottoming out occurs when the implant falls below the current breast crease or inframammary line. It's more likely to happen with inframammary incisions, which is why I try not to use the inframammary approach to any breast surgery.
Bottoming out can also occur if an implant is too large for the breast pocket. That is why it is important to choose an implant size that's correct for your body. I perform numerous measurements in the office to determine optimal implant size for my patient's bodies.
If you are concerned, please check it with your plastic surgeon for reassurance and to further discuss your options and possibility of revision.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Jason Pozner, MD · Answer

This can be corrected utilizing the existing inframammary incision. As your surgeon suggested some support is needed to help the repair. I use quite a bit of Strattice but in your case if there is no evidence of capsular contracture I would use Galaflex mesh. Its a bit easier to place and the shaped piece (previously called Galaform) works really well in cases like yours. I always try to use the previous incisions if possible. I would see a few more consults as I agree completely with you that your areolas are small and a larger incision there may not be aesthetically pleasing

Frederic H. Corbin, MD (license restricted) · Answer

Sorry for your problem but it can be corrected with an appropriate pocket revision and use of a mesh. So go on some consultations with experts and compare recommendations after a full examination and look at photos of similar patients and become fully informed about the desired procedure

Dr Corbin

Dr Corbin

Perry Liu, MD FACS - Account Suspended · Answer

Thank you for your question and sharing your pictures!

I’m sorry you are dealing with this, however, these things sometimes happen with breast augmentation surgery. After a failed capsule or feet to try to readjust the shape of your breasts, placing stratus to reinforce and support that. Paul is a very good option that would fix your problem. I typically do not perform revisional surgery through and Terry areolar incision. This approach and incision offers limited access and would make any revision surgery much more difficult. I believe the best approach for doing that Stess through and inframammary fold. Also, since you already have an incision there, it is best to use that incision rather than making another incision on your breast. Typically we perform press reconstruction surgery throughout never memory fold approach to hide the mastectomy scars. This approaches the best approach. Please discuss with your surgeon, or you can find another surgeon in your area that performs revisional or reconstructive breast surgery.

What options are available after a failed capsulorraphy? (Photo)

Answers (9)

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