Complete Removal or Capsulorraphy for Malpositioned Implant?

What's the difference between complete removal of breast implants and reinserting it months later, vs. doing pocket revision or capsulorraphy to correct bottoming out or implant malposition? For a patient who is 'flat' with paper thin skin and with no original fold to begin with, does it make a difference at all with the two methods? What is the best way to correct implant that has moved beyond the desired fold on one side (not both breasts)? If implant is completely removed for later reinsertion, does it require capsulorapphy as well to ensure the fold of the problematic side matches the other?

Doctor Answers 13

One stage capsullorrhaphy best option to correct breast implant malposition

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Bottoming out of a breast implant or lateral displacement of a breast implant after breast augmentation is a frustrating problem.

I have always had success in correcting breast implant malposition using capsullorrhapy and implant replacement as a one stage procedure.

This procedure addresses the problem by re-shaping the implant pocket to position the breast implant properly.

In your situation, never having a fold, the added capsular tissue around your implant will be a benefit in attempting to re create a natural inframammary fold. The capsular tisue can be sutured to the rib in the proper position to create an inframammary fold.

Removing implants and waiting for a second stage adds the risk of two procedures and if the old pocket has not completely resorbed, the second operation may be compromised.

Obviously, one operation is preferable to two, but I also believe that directly correcting the problem accurately is more easily achieved in the one stage operation

IMFreonstruction, capsulorrhaphy in one stage

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Implants are only removed to be placed at a latter date if there is implant exposure or infection in the pocket. Revision surgery for implant malposition is usualy done in one stage. In your case it seems like you will need an Inframammary fold (IMF)reconstruction in addition to a possible capsule manipulation (excision versus repair). Best of luck!

Capsulorrhaphy for breast implant malposition

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I think that, in general, it is possible (with high likelihood of success) to correct implant malposition problems of all kinds with capsulorrhaphy techniques that are performed correctly. I do not believe, that for most patients, removal of the implants ( as a first stage) is necessary.

There is a learning curve with this operation and I recommend that you seek consultation with a board-certified plastic surgeon with significant experience treating these problems. You may find the link attached below helpful.Best wishes.

Implant revision

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If your plan is to keep implants, it is probably easier to fix the capsule so that the implants are in good position in the same operative setting than starting over at a later time.

Correction of bottoming out

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We usually do it all in one stage.  We create the new fold in the correct position with multiple buried permanent sutures, and put in new implants.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Different options

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I am not sure that there is always one "right" way to address this problem. Without knowing all the information, and without benefit of exam, I am shooting in the dark, but I will hazard an opinion anyway.

I see this situation from time to time, and have corrected many (unfortunately, a few were my patients!) There may be several reasons for this including excessive dissection of the original pocket, inadvertant weakening of the floor/fold area, cogenitally weak tissues, and even post op trauma, maybe others too.

Anyway, one way is to stage the procedure, usually removing the implant and capsule in the first stage.

Unless there are good reasons to stage the procedure, I usually prefer to do the repair in a single stage, with the understanding that another procedure may be needed. I explain that this is ot a failure, but an attempt to save a second operation. Even if staged, the repair after the second stage may need additional surgery if things don't heal acceptably.

So what I will do will depend on what is needed. I will usually remove some capsle so that when repaired, the raw edges will heal and "stick" together. I leave capsule a strip of capsule adjacent to this usually as it tends to be strong, and helps to hold suturese. This will allow the implant to be securely repositioned.

Hope this helps.


After augmentation a poorly positioned implant can be corrected

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Bottoming out is a term used to describe an implant the has dropped below the natural fold of the breast after augmentation. I believe that this does not happen by chance, but by a pocket which is placed lower or a misjudgment of the fold position during the procedure. Thin skin or not, the pocket can be repaired and the implant correctly positioned to sit at the fold with the center of the implant centered on the nipple. It is very unlikely that a support bra, even right after the procedure will correct a poorly positioned implant.

There is no reason that the implant need be removed and later replaced. Some surgeons may suggest this solution, however most patients will not tolerate the asymmetry while the poorly positioned pocket 'heals'. Bottoming out is not inevitable, and there is nothing wrong with you. Ask your surgeon to fix the capsule and adjust the size and position of the pocket.

Best of luck,


Fixing a malpositioned implant with thin coverage

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Patients who are thin like you present a particular challenge with repositioning implants, because often there just isn't enough capsule tissue to hold the sutures from a capsulorrhaphy long term, or to support the implant. (Capsulorrhaphy is suturing the scar capsule from the inside in order to reshape the capsule pocket.) One procedure that can be very helpful is using a graft of a material called Strattice, which reinforces the capsule so the capsulorrhaphy is more durable and coverage of the implant is better too. Strattice is related to a similar product called Alloderm.

Correcting bottomed out implants

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There are many ways to handle this problem. In most instances, removal of the redundant inferior capsule and a capsulorraphy will work with immdeiate replacement of the implant. I ask patients who have had this to also wear a well-fitting underwire bra 24/7 for 8 weeks after in order to assist in externally splinting the repair.

Malposition of implants

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The cause and treatment for malpositioned implants are varied. One has to analyze the entire history of your breasts and the implant surgery to determine what the malposition is due to and what to do about it. Some malposition are inevitable due to use of inappropriate implants, some are a result of chronic displacement and drift, and others are due to surgical error. There are many ways or repositioning the implant from removing or manipulating the capsule ot pocket (capsulectomy, capsulorrhaphy), to removing the implants, allowing the pocket to obliterate, and beginning anew, to dissecting a new pocket (neo-capsule) around the old capsule. Which technique is performed is dependent on the problem and the specific surgeon and his comfort level. One technique is not inherently better or worse than another. They each have advantages and disadvantages.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

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.