Correcting 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 are NOT very predictable. 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. Do you need Seri? Seri is a surgical scaffolding that will stimulate the body to make extra tissue and then it disappears. They both act as a strengthening sheet of extra tissue to support the repair. They are VERY EXPENSIVE!! In my own practice, I have not found use for ACD, however, I do find that Seri is very useful as a means of increasing soft tissue support while reinforcing a surgical repair. I have found it to be quite useful. If you make the pocket correct the first time, then you don’t need to go there. Now, consider the fact that you have placed sutures in some tissue, maybe even ACD or Seri, to close down the pocket. Then what do you do? You put the implant back in. That is just what you DO NOT want up against a fresh repair of tissue: a breast implant now under more pressure in the pocket because you have shrunken the pocket from which it resided. Now you have more tension on the repair and this can result in full or partial breakdown of the repair. It is much better to never need to go here in the first place!