How Do You Make a Brand New Pocket During a Breast Augmentation Revision, when the First Was Under the Muscle?

I am getting a BA revision and replacing smooth silicone under rounds with textured gummy bear anatomicals. I am going much smaller, as well. My surgeon indicated that he will be leaving the old pocket (collapsing it) and making another pocket for the Natrelle 410 (since it requires a new pocket so that it does not rotate). My current BA is under the muscle, so how does he still do a "dual plane" placement if the muscle has already been dissected? Will it be subfascial, or how does that work?

Doctor Answers 7

This is most likely a "neo-subpectoral" pocket

The technique of leaving the existing capsule in place and dissecting a new pocket just on top of it but still staying partly under the muscle is a well-described technique that allows your plastic surgeon to make a new space for your new textured implant. I would ask for more details from your plastic surgeon if this isn't very clear. Take care.

Dr. Edwards

Las Vegas Plastic Surgeon
5.0 out of 5 stars 35 reviews

New Pocket Dissection during Revisionary Breast Surgery?

For the most precise answers, it is always best to check with your plastic surgeon. Most likely, the surgeon will be dissecting a space above the pectoralis major muscle  and below the breast gland.

Hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Still possible to put implant under muscle and new pocket

Your surgeon can make a new pocket between the muscle and your old empty pocket. There are other ways of doing it, but that's the most likely. Good luck.

Armin Moshyedi, MD
Bethesda Plastic Surgeon
4.6 out of 5 stars 21 reviews

Creating a new submuscular pocket

It would be best for you to ask your surgeon exactly how he or she will be performing the surgery. Based on your question however it sounds as though your surgeon plans to remove your current implants and then separate the capsules surrounding your implants from the underside of your muscle. This will allow the capsule to collapse against the rib cage. A new implant is then placed behind the muscle and in front of freshly dissected capsular surface. This puts the implant between 2 freshly created tissue surfaces and creating a new pocket which is custom designed for your new contoured implant. Good luck

John J. Edney, MD
Omaha Plastic Surgeon
4.8 out of 5 stars 112 reviews

Neo-pectoral pocket pocket

Dr. Edwards explained this very well. The technique your doctor mentioned is well described and called a neo-pectoral pocket. (Google it) It involves dissecting the top of the existing capsule off of the breast tissue inferiorly and off of the bottom side of the muscle superiorly and collapsing the pocket. This creates a new pocket under the muscle - called a neo-pectoral pocket. This allows a tight pocket for a shaped implant.

Jason Pozner, MD
Boca Raton Plastic Surgeon
4.7 out of 5 stars 45 reviews

Breast implant revision

The type of revision you have depends upon what problem you are trying to correct.  A new pocket often can solve certain problems, but it is not always necessary.  Overall,,I do,not like so,called anatomic implants because of the issue you refer to, namely rotation of the implants.  This happens even in the best of hands.  Stick with a round implant is my advice.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Best Techniques for Breast Implant Revision

I have been doing cosmetic breast surgery in Denver for the past 20 years. It is the number one thing I do. To make a fresh pocket after submuscular augmentation requires subglandular placement of the implant. They may call it subfascial but the fascia is very thin and it is in reality a subglandular implant, which in my experience is not the best choice as there is a much higher incidence of rippling and capsular contracture. I do not like the gummy bear implants as I feel they tend to rotate and are much firmer than the cohesive gel implants. In general, I revise the old submuscular pocket and replace the implants with smaller oval cohesive gel implants. Sometimes a lift is necessary. Every plastic surgeon has his or her favorite techniques, but this is what has served my patients well over the years.

John Squires, MD
Denver Plastic Surgeon
4.9 out of 5 stars 79 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.