Correction of Incorrect Development of the Pocket
Correcting underdissection is very easy. Simply mark the patient while sitting or standing. In the operating room, re-open the pocket, remove the implant and dissect again to the margins of the markings. Then replace the implant and close the wound. The results are very predictable. But why get to this point anyway???
Correction of overdissection is much more problematic. As a surgeon, you don’t want to visit this place if you don’t have to. The approach surgically is similar to that of underdissection. Simply mark the patient while sitting or standing. In the operating room, re-open the pocket, remove the implant and this time close the pocket down to the margins of the markings. Then replace the implant and close the wound. The results can sometimes be unpredictable. But just how do you “close” the pocket down??? The only way I know of is to suture the tissue back down. There are of course, some variations as to how you do this. What thickness and type suture to use. Do you cut or remove the scar tissue capsule while doing this? Do you need to consider using acellular dermis (ACD)? ACD is a product made from cadaveric skin and processed to make it safe to use. An example of this is Strattice. Strattice is made from porcine (pig) skin and then highly processed and sterilized. Another alternative is GalaFlex/GalaForm. Unlike Strattice, GalaFlex (flat version) and GalaForm (curved version) are a surgical scaffolding that will stimulate the body to make extra tissue and then it disappears. Generally speaking, I like to use Strattice when there are issues of capsular contracture and GalaFlex/GalaForm when there is not. All these products act as a strengthening sheet of extra tissue to support the repair of your tissues. These products are considerably expensive, but are also invaluable in helping to achieve an optimal result. Sometimes your tissues just do not have the strength and elasticity to support a repair and the risk of failure is considerable. These materials provide the extra strength, like having an “internal bra” to support the repair and prevent the recurrence of the problem. It is absolutely essential to perform the first breast implant surgery correctly so as to minimize the risk of ever having to deal with a malposition later. Even when the implant is chosen correctly and the surgical procedure is performed perfectly, sometimes malposition can still happen due to the uncontrollable factors of wound healing and tissue characteristics. I