Can a Torn Pocket Under my Breast Implant Be Repaired... My Surgeon Says No.. Really?

Question

I had a breast augmentation 6 months ago.(440 cc silicone under the muscle) My breasts looked amazing. Last month I fell and injured my left breast. My surgeon says I have a lateral tear in the pocket of my left breast and he cannot repair it. Is this correct? I have lost the fullness on the top part of that breast and it is now visible wider than the other.

Richard H. Tholen, MD, FACS · Answer

Capsule repair (capsulorrhaphy) can certainly be performed, though the thickness and tensile strength of your capsule may be quite limited. As surgeons, we strive to obtain a thin, soft, pliable capsule so you end up with a soft, natural feeling breast. When capsule surgery is necessary (symmastia, implant malposition, or in cases such as yours), then having enough scar for the sutures to "hold" becomes an issue. Still, wearing a bra during the healing process easily helps healing in this (lateral) location, so I would ask your surgeon again, or "read between the lines" and understand that he or she does not want to help you with this issue, perhaps out of concern that "perfect" repair may not be feasible.

	Seek other advice from an ABPS-certified plastic surgeon if necessary. Good luck and best wishes!

Steve Laverson, MD, FACS · Answer

Not sure why your surgeon gave you the impression that implant displacement cannot be corrected or improved. Be sure your implant is not ruptured. If it is, replacement is definitely indicated, and pocket can be fixed at that time. Capsulorrhaphy, capsulotomy, and use of acellular dermal matrix are all popular techniques for restoration and improvement of post surgical abnormalities in implant positioning.

Gerald Minniti, MD, FACS · Answer

Hello Lajpon,

	I do not have the benefit of examining you or viewing photographs of you, but in general, implant pocket issues can be corrected routinely and accurately to restore the position of the implant and shape of the breast. These techniques should be performed by surgeons that are highly experienced in performing revision breast augmentation.  These surgeons are certified by the American Board of Plastic Surgery, and are also members of the American Society for Aesthetic Plastic Surgery.

	Best of luck!

Grant Stevens, MD · Answer

The pocket can be sutured , a new pocket can be made ( neo sub pectoral ) , adm such as alloderm or stratice can be used to correct implant malposition. I would need to see your photos and or examine you to know what the best approach would be. Good Luck. Dr Grant Stevens

Alan Weiss, MD · Answer

Repairs require surgery. Conservative treatment with a good supportive garment should be tried first. If that fails then repair might require removal of the implant, and revising and repairing the "pocket" it sat in. That repair is dependent upon suturing what may be, a capsule of modest strength, and of proportionate reliability. Adding any matrix support can increase the cost of the surgery substantially, but may be indicated. There are many things to be considered, and a Board Certified Plastic Surgeon, would be able to examine you and discuss them further. Good luck.

Peter A. Aldea, MD · Answer

RE: "...My surgeon says I have a lateral tear in the pocket of my left breast and he cannot repair it. Is this correct? I have lost the fullness on the top part of that breast and it is now visible wider than the other."

	When we perform a Breast Augmentation we surgically separate the chest wall/breast tissues creating a specific pocket where the implants sits. With time, the body creates a scar wall around the implant which further holds the implant in that location. (In 85% of women the scar, or capsule, remains soft while in 15% it thickens and hardens squeezing the implant and that is termed - Capsular Contracture). When you fell you applied a sudden great forced to the walls of the capsule and bluntly cracked and enlarged the side and bottom wall of the pocket ("Closed Capsulotomy"). As as result, the new pocket is no longer centered around the nipple and the implant dropped lower and to the side losing the upper pole fullness you had.

	This CAN be fixed and there are several ways to fix it, some requiring putting in a biological sling such as Strattice to prevent breaking of the capsule repair stitches. I SUSPECT since this mishap is not your surgeon's fault, he does not feel that he should have to pay for it and that he may feel that if the results of the repair do not produce the before accident results you may be unhappy with him. If you want him to do it, you should pay for the repair or ask him to refer you to one of his colleagues if he declines.

Remus Repta, MD · Answer

Hello,
Although an examination would be helpful, in general a breast capsule can be repaired or tightened.  The bigger question is whether the repair will hold 100% or if some of the repair will relax.  Very thin tissue that has lost its elasticity combined with a very large implant  will undoubtedly place some stress on any capsule repair.

All the best,
Dr Repta

Peter E. Johnson, MD · Answer

In order for your breast pocket to tear, the fall and pressure would have had to have been tremendous. Just ask any surgeon who is familiar with 'closed capsulotomy' in the past. If the implant is now wider and out to the side,  what you say must be true and a snug bra day and night might help hold the breast implant centered in the pocket. If this fails, then the pocket certainly can be repaired and closed, just as any other pocket issue such as a bottomed out or low implant.

	Best of luck,

	peterejohnsonmd

Daniel Yamini, MD, FACS · Answer

Sorry for your injury. I usually start with postoperative breast straps or garments to help the capsule in the pocket heal itself much the same way a cast on your arm helps the broken bones heal without surgery. This could take 4-6 wks. if that does not help, then a surgical procedure called capsulorrhaphy can be performed. If it is a very complicated repair, artificial dermal matrix like Strattice can be used. Best of luck.

Tom J. Pousti, MD · Answer

Thank you for the question.

	It is hard to give you accurate advice without examination. It sounds likely that after your fall you have sustained an injury to the breast implant capsule surrounding the breast implant. This has caused the implant to be displaced creating the change in appearance  (visibly wider). This implant displacement would also explain the loss of  &ldquo;fullness on the top of the breast" that you have experienced. 

	Based on what you're describing the repair of the breast implant pocket is very likely possible  using a internal suture (capsulorraphy)  technique.  I would need to see you in person to confirm.

	Best wishes.

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