Over dissected breast implant pockets. Side effects/complications to closing them up on sides? (photo)

I had 2 consults. Fist surgeon says if he puts stitches the stitches can become undone with in 6 mnths, if he sowed down pocket then there's a possibility he can damage a nerve causing permanent pain. Second surgeon, (surgeon who performed my first BA) says he can close off pocket no problem and make the inner part of my chest pocket bigger so Implants look closer together. I'm just worried about what the first surgeon said about the nerve and permanent pain to my breast with this procedure

Doctor Answers 6

Complications of breast revision?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

What you are describing is known as an internal capsulorraphy, or sutures in the capsule of the inside of the implant pocket. It can be an effective way of treating implant malposition. Having this problem does not necessarily imply that the pocket was over dissected originally. This is not an unusual problem for larger smooth surface saline implants after a few years,and is a result of the tissues being unable to support the implant over time. This technique generally works well with smaller implants but will often fail within 6 months with larger implants (over 350cc). The surgery involves suturing the implant capsule to the chest wall. When this done there is a small risk of nerve entrapment which can result in prolonged nerve pain. Usually it will resolve over time or can be managed with a small steroid injection.

Because of the risks of recurrence,some surgeons will reinforce the internal tissues with something called Strattice or Seriscaffold. These materials are effective in providing additional support to the implant and can reduce the risk of recurrence. The biggest objections with using these material is that they are expensive and time consuming to suture into position,and in very thin patients,they may become palpable or visible. My preferred approach in these types of cases is to use a textured surface implant in conjunction with suturing the capsule and performing a thermal tightening or contraction of the implant capsule. Textured surface implants will adhere to your tissues and help maintain the implant position along with the other techniques that are employed in order to prevent recurrence of the problem. This allows us avoid the use of the expensive tissue reinforcing  materials in almost all cases and provides the benefit of a soft and natural feeling new generation highly cohesive silicone gel implant.

Closing off implant pockets is a tricky operation.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Implant pocket modification, particularly closing the pocket down, can be very tricky.  The surgeon who warned about nerve damage and recurrence of the problem after 6 months is being very honest about the difficulty of this procedure.  There are products such as SERI surgical scaffolding and acellular dermal matrix (several types) that can be used to support the implants and rely less on the stitches placed.  Again, this is tricky surgery.  One other issue with you is that your photos indicate that you would likely benefit a lot from a breast lift.  I think you have a pocket problem and a skin laxity problem.  I would recommend you find a surgeon who has a lot of experience with implant revision.  This is difficult surgery I would be a little put off by a surgeon who thinks this is an easy procedure.  But then again, I don't think anything is easy!

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 77 reviews

Over dissected breast implant pockets.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I do not think it is reasonable to label your problem as being related to over dissected breast implant pockets without at least seeing preoperative photographs of you.  Reviewing the one photograph that you posted suggests to me that you would be a good candidate for mastopexy possibly with some degree of internal capsulorrhaphy.  I have yet to see chronic pain develop as a result of the surgery but it is remotely possible though unlikely.  Reducing your skin, lifting your nipple areolar complexes and exchanging to similar or possibly smaller pair of implants would be my first consideration for you.  Keep in mind that this is based on a review of a single photo and my opinion might be different seeing a patient similar to yourself in person.  Best wishes and good luck to you in making your choice,

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 34 reviews

You might also like...

Breast ptosis and breast augmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

An in-person exam is critical in making these decisions - I would guess that a breast lift with small volume breast reduction would reduce the surface area of your breasts, remove the sagging breast tissue that you have and improve your overall breast cosmetic appearance.

Over dissected pockets

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for your question and photo. A number of patients come to my practice each year that unfortunately have this problem. Repairing the inside of the pocket with sutures to make it smaller (capsulorrhaphy) has been very successful. In some instances in addition to the suturing, I reinforce the repair with a "mesh" material to make the repair even stronger. Any surgery carries risk and damage to the sensory nerves is one of them, however relatively unlikely. Best of luck, Dr. Kludt

Nathan Kludt, MD
Stockton Plastic Surgeon
4.7 out of 5 stars 35 reviews

Over dissected breast implant pockets. Side effects/complications to closing them up on sides?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I have several patients a year come to the office to have this problem corrected and it's pretty straight forward for an experienced surgeon. I haven't seen the sutures pull out but they do have to be placed correctly to prevent that issue. All surgical procedures have risk and nerve damage is an infrequently seen risk of this type of surgery and all other cosmetic breast operations. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 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.