How are pockets made smaller?

Question

I'm due to have my revision surgery in just over a week and I'm interested to know how the size of my pockets will be altered.

Kenneth Dembny, II, MD · Answer

During breast augmentation revision surgery pocket modification may be required if the implant has descended too far inferiorly, the original pocket was created too large, or if the implant is being down-sized.
	These types of modifications are usually done with sutures to raise the level of the inframammary fold or to decrease the size of the pocket. I usually use a permanent suture to perform these modifications, but some surgeons may use a dissolvable suture.

	If the capsule around the implant is being left in place, then the suture may grasp the anterior and posterior capsule pulling them together – this is referred to as a capsulorrhaphy. This suturing may be done with interrupted sutures, or with a running suture. For more strength or purchase, the suture needle may be passed through the underlying chest wall fascia and muscle, and/or the overlying breast or subcutaneous tissue, to incorporate these tissues as well as the capsule. 

	If the capsule has been removed, then the sutures are placed between the breast and/or subcutaneous tissue, and the chest wall fascia and muscle. In this situation patients can feel some more prolonged discomfort at the sites of the sutures; they may report an aching or pulling sensation with certain activities. This generally improves with time, but may take several months to resolve.

	Speak with your surgeon, and I’m sure s/he will be happy to describe the type of pocket modification they plan to perform.

	Best wishes, Ken Dembny

Kenneth Hughes, MD · Answer

If you are having pockets reduced due to implant malposition or the like, capsulorrhaphy sutures are usually placed to tighten the pocket and allow for better implant position, shape, and projection. Kenneth Hughes, MD Los Angeles, CA

Jourdan Gottlieb, MD · Answer

Pocket size is decreased by suturing off the areas of excess. In some cases, a biologic material such as strattice is used in addition. As to the particulars in your own situation, a discussion with your surgeon will be more productive than our responses on this site. Best wishes.

Alberto Di Giuseppe, MBBS · Answer

For reducing size of implants pockets we do use internal suture if really too large performing capsulorrhaphy.
	Suture are temporary . Once repositioned a new internal capsule will form and keep implants in the correct position.

Sugene Kim, MD, FACS · Answer

Implant pockets can be reduced or closed by placing internal sutures - capsulorrhaphy. It is done to correct or prevent the implant malpositioning. I usually use semi-permanent sutures although permanent sutures can also be used.

Steven Wallach, MD · Answer

In order to reduce the size of your breast capsules, a capsulorrhaphy needs to be performed in which sutures are often placed to make the pocket smaller.

Tom J. Pousti, MD · Answer

Thank you for the question.

	 As you can imagine, it is not possible to provide you with precise information with the limited  information regarding your situation. However, generally speaking breast implant pockets are made smaller by using internal sutures to close off the “space”. This internal suture technique is called capsulorrhaphy.  These techniques may be helpful in correcting breast implant displacement problems such as bottoming out, lateral displacement,  symmastia or when removing/replacing breast implants with smaller breast implants.You may find the attached link helpful.

	 Best wishes.

How are pockets made smaller?

Answers (7)

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