Breast Implant Displacement and Malposition Alternatives
A new treatment option for Breast Implant Displacement and Malposition
With 3 million Breast Augmentations done since 2005 breast implant malposition is often a common complication. This can occur without capsular contraction or scar contraction around the implant. Capsular contraction often results in malposition of the implant. The cause of malposition due to capsular contraction this is different from malposition without contraction and is treated differently.
There are several reasons that may lead to breast implant malposition without contraction. Skeletal chest abnormalities such as pectus excavatum (concave anterior chest) cause inward breast implant displacement and pectus carinatum(pigeon chest) causes displacement of the implant laterally. Release of the Pectoralis Muscle at the infra-mammary fold may result in the breast pocket becoming too large along the lower breast and the implant dropping too low. More commonly the implant becomes displaced to the lateral chest wall due to contraction of the Pectoralis Muscle over the implant. The outer portion of the breast pocket becomes too large and the implant becomes displaced into the lateral chest. This is commonly the result of doing push-ups and other chest exercises. Implants that are too large may result in stretching of the muscle and tissue and result in implant malposition.
If the implant malposition is due to an overly large breast pocket either in the lower or lateral aspect of the breast without capsular contraction the most common surgical treatment for this has been suture closure of the breast pocket. This is called Capsulorrhaphy. In the lower breast the upper portion of the fibrous breast capsule is sutured to the lower breast capsule or the lower border of the chest or ribs. In the lateral chest the lateral breast pocket is repaired and closed by suturing the lateral breast pocket to the lateral chest.
One of the problems with the suture repair and closure of the breast pockets has been recurrent malposition due to disruption of the breast pocket suture repair. This is often due to break or tear of the sutures.
A new concept for correction of this problem is breast pocket closure using an absorbable mesh. Unfortunately mesh is usually associated with attorney’s TV and billboard ads to contact them if you have had mesh. The problem with the mesh grafts that were placed in the past was that they were permanent and not absorbable. The non-absorbable mesh often created problems. The new mesh grafts are not permanent. The mesh that is now used serves as a scaffold and becomes remodeled to provide a strong lasting support and reinforcement until it is subsequently bio-resorbed.
Galaflex scaffold is presently used for this purpose. It has previously been used for hernia repair and rotator cuff repair. This is a family of poly-4-hydroxybutyrate monofilament scaffold. There is tissue and vascular in- growth at 6 weeks. Galaflex scaffold can now be used to close and repair the breast pockets for a more effective and lasting procedure for breast implant mal-position.
The cost of performing absorbable mesh breast pocket closure for correction of implant malposition is more expensive than performing suture pocket repair. This cost is however reasonable to prevent the cost of additional time and expense for recurrent implant malposition.
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- Adams,William P.Jr. M.D.: Moses, Arkha C. Ph.D. Use of Poly-4-Hydroxybututyrate Mesh to Optimize Soft tissue support in Mastopexy: A single Site Study. Plast Reconstr Surg. 2017;139:67-75.