Abstract
Background
Patients with long-term complications associated with subglandular breast augmentation are being seen in increasing numbers in the Southern California community. Late deformities include a characteristic “slide-down” deformity, as well as capsular contracture, implant wrinkling, and areolar enlargement. Repositioning the implant to a subpectoral pocket is a recognized revisionary technique to treat this problem; however, technical details of how this is accomplished are lacking in the literature.
Objectives
To review our technique for treating long-term complications associated with subglandular implants using subpectoral repositioning with partial capsule preservation and mastopexy, without the need for an acellular dermal matrix (ADMs) or mesh.
Methods
Retrospective review of all patients undergoing subpectoral repositioning over the course of six years was performed. Patient data and long-term outcomes were assessed. A technique is presented utilizing a partial capsulectomy that preserves a portion of the capsule as an ADM/mesh equivalent, ensuring adequate implant coverage and preventing window-shading of the pectoralis major muscle.
Results
Twenty-four patients with subglandular implants and slide-down deformity as well as other associated complications including capsular contracture, implant wrinkling, and enlarged areolas underwent revision surgery with a subpectoral site change. Often, patients presented many years after their initial augmentation (mean 18 years, range 4-38 years). Average patient follow-up was 3.1 years (range 1.0 – 6.8 years). Two patients required minor revisions with local anesthetic while another two revisions required general anesthesia.
Conclusions
Long-term deformities associated with subglandular breast augmentation can reliably be corrected by subpectoral repositioning, mastopexy, and utilization of residual breast capsule in place of an ADM or mesh.
Reply to comment to Long-term outcomes (>5 years follow-up) with porcine acellular dermal matrix (Permacol™) in incisional hernias at risk for infection: Negro P, D’Amore L, Ceci F, Gossetti F (DOI 10.1007/s10029-015-1406-1)