Did my permanent suture fail for correction of lateral displacement? (Photo)

Question

I underwent lateral displacement surgery in February where my surgeon corrected the issue with a permanent internal suture. Everything looked perfect until last week as I’ve noticed my left breast has fallen back to its original position. Is there a correction that will fix this? Will I be expected to pay? This is my 3rd surgery. I feel so insecure and helpless at this point.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  It appears you had an excellent repair of one side of your implant displacement while the other may have stretched out again.  Unfortunately the only treatment is surgery to redo a similar procedure and you may wish to consider the use of mesh, ie internal bra, to limit the chance of recurrence.

Daniel Barrett, MD · Answer

Dear bretney15,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Stefan Mark Szczerba, MD · Answer

Hmmm tough questions!  I use Galaflex to support malpositioned implants and I do not rely solely on sutures any longer- too many recurrences.  The mesh does add cost to the procedure.

For ALL refinements of my surgeries, I have a firm policy on a "parts and labor" structure for any refinements/ revisions- you don't pay for the surgeon's fee, but you are responsible for anesthesia and facility fees.  I do however talk to each patient about this policy have all that in writing so the patient does not have questions later.

I would go back to your "before" pictures with this outcome; it looks good and the asymmetry may be really due to how you started before surgery.  Best Wishes!!

Gerald Minniti, MD, FACS · Answer

Suture capsulorrhaphy is not always a sure thing because the newly tightened capsule can either re-stretch or the sutures give way. The addition of an absorbable mesh like material can give much greater stability to the repair of the capsule. This is not a biologic material that requires drains, but instead a resorbable compound that lasts up to 2 years and contributes lasting strength to the capsule.

Camille Cash, MD · Answer

I'm sorry to hear of the issues you've had with your breast surgery.  From your photos it does appear that the lateral displacement correction has failed on the one side.  You may want to consider smaller implants, adding mesh support, or both to avoid this issue in the future.

Connie Hiers, MD, FACS · Answer

Your implant may be too heavy on your tissue and just pushes down and laterally. Using internal support with mesh might do well for you or go with smaller implants.

Peter Andolina, DO · Answer

Based in your photos and the information you provided in your post it seems as if the internal suture may have failed.  I would contact your surgeon to get in for an evaluation as soon as possible.  In regards to your question about payment, I would expect that you would only need to pay for anesthesia and facility fees and not the surgeon fee as long as you are redoing the previous surgery.  There are a few surgical options to consider when discussing repair of this issue.  You can definitely try to replace the lateral sutures again.  You may also want to consider changing the position of the implants, above muscle to under muscle or vice versa, and even changing the size of the implants.  A final option would involve the use of some sort of surgical mesh to help stabilize the implant.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.  I am very sorry to hear of your difficulty.  The third photo would suggest that the lateral displacement sutures may have been disrupted.  The first question would be whether you engage in significant physical activity which stresses the pectoralis muscle such as push-ups, chin-ups, or heavy bench pressing.

Can appears that initially you had a successful treatment.  The only additional procedure I can think of would be to buttress and strengthen the repair with a mesh in addition to suture closure of the lateral pocket.

I would guess that your plastic surgeon is disappointed with this result and would do his are her best to reduce the financial impact on the third procedure.

Did my permanent suture fail for correction of lateral displacement? (Photo)

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