After multiple breast pocket revisions, which would work better: Galaflex or permanent sutures? (photo)

Dear aquestion,
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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hello,Though this question was posted several years ago, I think ongoing comments/discussion would be beneficial to other patients. Given you have had 4 surgeries, I believe the best option is to explant (remove your implants) and reconstruct the breasts with a mastopexy (breast lift). Once this has healed and settled (typically over 1 year), you can opt to volumize/shape the breasts with a fat transfer thereby eliminating any implant based options- which seems to be the culprit of all your issues.Hope this helps!Dr. Dev

Good morning!I fix a lot of bottoming out- mesh is fine as an addition to a proper suture repair, but the suture repair is the KEY to success. I can't tell you how many patients I have seen with failed mesh repairs over the years- for some reason some surgeons think its some sort of magic material they can just throw in there and voila- problem gone- wrong!I perform the Original Internal Bra, my strong permanent internal suturing technique. It is the most common procedure I perform, 5-6 times a week- it works and it lasts. In about 20% of patients I also add mesh. But the mesh is the icing on the cake, not the key. So- sutures come first, mesh second if your budget allows- no doubt!

In your situation, I would lean towards the Galaflex. The pocket can be revised using absorbable or permanent suture, but adding Galaflex would give better long term support. Fat grafting can also help with with overall shape of the breast.Best of luckDr. Baccaro

The weight of your implants exceeds the mechanical strength of your skin envelope.  Sutures are only as strong as what they are sutured into, which is thin skin and Galaflex offers only passive support.  The best option for you would be explantation and lift using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained, if not injured during your previous surgery.  Later, fat transfers can be performed if additional volume is desired.      Best Wishes,Gary Horndeski, M.D.

Because as you note your skin is stretched and thin, your tissues are not able to adequately support the implants. A Galaflex internal bra adds the support back. Permanent sutures do not necessarily mean long-lasting results, because it is the tissue the sutures are placed into that determines the result. I have done several revisions in cases like yours after a repair with permanent sutures, and the tissue just continues to thin and weaken around the stitches which are essentially sitting there doing nothing.

Hi aquestion,
Galaflex would likely help. I would also consider downsizing implants and getting a formal lift depending on your ultimate goals. Blessings on your journey!

I hope you and your family are doing well during the Covid. The reason for the revision failure is that your implants are bigger than your breast tissue can handle. One option is to explant and do fat grafting and possible lift. The other option is to down size and do the Galaflex with pocket revision. Please see the link that shows implant removal and lift/fat grafting in one session.

Realistically, you probably need to go done in size so that your heavy implant does not keep thinning your tissue and bottoming out because of the weight. I know you do not want to hear this, but this does occur more often with implants that are too large and heavy for your tissue to support. Large implants also thin your tissue with time so there is less to support the weight. The pocket itself can be tightened in a number of ways, including a capsular flap, and whatever has worked best in your surgeon's hands.

Thank you for the question and photos and a combination of downsizing to reduce the weight of your breasts and permanent sutures reinforced with an ADM or Seri maybe your best solution Dr Corbin