REVISIONARY SURGERY using a purse string breast lift with implant change for capsular contracture and prosthesis rotational problems

 Background
 Patient Groups
 Patient Concerns and Planning
 Preparing for Surgery
 The Operation
 Recovery
 At Home
 Office Visits and Follow-up
 Outcome and Complications
 Case Histories (Before and After)

PATIENT GROUPS
Silicone Gel Implant Scar Contracture
Scarring of the implant pocket is the most common problem when it occurs, after a successful primary breast augmentation. This can present as varying degrees of implant distortion, hardness, and discomfort. It can be more common with older methods of insertion and implant preparation, use of first generation silicone gel implants, and when implants are inserted over the chest (pectoral) muscles. Often only one breast develops problems but the patients request bilateral action, and an attempt to restore all features considered ideal in the normal beautiful breast. Such restoration may be limited due to the degree of scar tissue and breast asymmetry, the patient's age, general medical condition, and financial considerations conducive to comprehensive surgical revision.


Breast Implant Nipple-Areolar Rotational Problems
Occasionally patients with previous breast implants can experience shifting in the breast pocket with no associated breast firmness. The nipple and areola may be displaced downward over the breasts causing a "snoopy effect" or the entire breast can slide forward over implants inserted beneath the muscles which is termed a "double bubble effect". This can be a late occurrence when total submuscular pocket placement is performed where the implant is sealed entirely under the muscle. It occurs less often when the implants are placed behind the pectoral muscles where some release of the pocket is made behind the breast itself. It can occur when the lower pole of the breast is constricted and the implant pocket does not properly stay open at the bottom of the breast leading to an upward shift. If can also occur when patients undergo maternity and breast feeding with moderate changes in body weight, where the breasts enlarge beyond their usual borders and do not contract back to the original position on the chest.

A common occurrence of rotational ptosis where there is a double bubble look is when the patient might have been a better candidate for a simultaneous breast lift at the time of augmentation. If there is moderate sag and the nipples are below the breast fold, the surgeon must decide whether a breast lift should be part of the augmentation. A nice internal tailoring procedure can be performed in patients having a borderline lift status where the nipple may be 1 to 4 cm below its ideal position. This tailoring method serves to open the breast tissue from the inside and allow it to expand downward, or perform the breast augmentation in a dual or double plane. The plane will be above and below the muscle and is becoming a popular way to address patients with smaller breasts who may also have a minimal need for breast lifting. The use of internal tailoring and dual plane implant placement can avoid the effort and expense of a combined lift with augmentation.