Correction of Lateral Displacement / Lateral Implant Malposition
As I discussed previously, in order to treat lateral implant displacement/malposition, a thorough understanding of its cause is essential prior to surgical correction. The following questions must be addressed:
1. Is the deformity all due to stretching of the lateral of the breast with the lateral breast crease in the proper location (pocket dissection correct)?
2. Is the deformity due to the lateral (outside) breast crease being too far laterally on the breast towards the posterior chest (pocket dissection incorrect)?
3. Lastly, is the deformity caused by a combination of both of items 1 and 2 above?
Unlike isolated lower pole stretch of the breast with the crease in the proper place which rarely is a cause for concern, isolated lateral stretch with the lateral crease in the correct place will result in the implants displacing too far laterally when lying in the supine (on your back) position and will be more distressful to the woman. It will most likely NOT be noticeable when the patient is upright.
Like inferior implant migration which is due to the breast crease migrating downward, lateral implant malposition with the lateral breast crease too far laterally will produce a deformity that will compromise the aesthetic appearance of the breast and possibly warrant surgical correction.
The patient is marked in the standing position. If the lateral crease is displaced further laterally, notation is made of the current and desired position of the crease. Unlike isolated lower pole stretch in the lower breast where excess skin can be removed with the incision hidden in the lower breast crease, excising the extra breast tissue on the side of the breast is not an option because a new scar would be required which would be very noticeable. A compromise must be made and the lateral breast crease is moved inwards somewhat.
At surgery, an incision is made through the previous scar and the implant is removed for the time being and placed aside. The inner surface of the breast pocket is lined with a thin scar tissue capsule. The other edge of the breast pocket needs to be re-attached to the chest wall. A capsulorraphy is performed to suture the capsule from one side to the chest wall to close off some of the pocket. Occasionally, the capsular tissue is thin and will not hold sutures very well, so the repair will not hold. Sometimes a flap of capsular tissue is elevated from the chest wall and sutured to the underside of the lateral breast. Galaflex mesh sutured over the repair will add an extra layer of strength and support while it is healing. The Galaflex mesh will last for about two to three years, during which time the body will produce an additional three millimeters of extra tissue where the Galaflex mesh was placed, giving a more permanent solution to the repair. When the Galaflex mesh is absorbed by the body, the new tissue remains forever. This is a way to bio-engineer extra tissue, while reducing the risk of failure of the repair.
A word of caution – I would NOT recommend replacing the implant with a larger one to “take up the extra room in the breast pocket” – this will just lead to further tissue stretch and thinning of breast tissue, thereby worsening the deformity.
Will a lateral capsulorraphy work? I offer these comments.
1. No surgical procedure can change or improve the quality of a patient’s tissues.
2. A lateral capsulorraphy can close off a portion of the lateral pocket, BUT closing off a portion of the lateral pocket may not be a permanent fix if the tissues stretch further or if the sutures pull through the tissues, especially in thin tissues. That is why I recommend using Galaflex mesh as an overlay mesh to support the repair of the pocket. As the tissue is compromised, there are no guarantees.
3. The amount that closing the lateral pocket will re-position the implant toward the middle is limited, may not last, and in order to close a portion of the lateral pocket, you may have temporary or permanent contour irregularities along the side border of the breast.
4. The chance that a lateral capsulorraphy will totally correct your implant displacement is doubtful at best because of the characteristics of your tissues (the more compromised and thinner the tissues, the lower the chance of success) – you must accept at significant risk that after a lateral capsulorraphy, you may experience recurrent stretching of the tissues and recurrent displacement of your implant when you lie down.
5. The chance that you will have temporary contour irregularities along the side border of the breast is at considerable, especially with thinner tissue and the risk of permanent contour irregularities along the side border of the breast is also significant.
6. It is totally illogical and not in your best interests to place a larger implant in your breasts. Your tissues have already shown that they stretch excessively with the size implant you currently have. A larger implant increases your risk of even worse stretching and displacement of your implants, possibly even when you are standing.
So what is the best thing to do? That is an individual decision that must be made between the surgeon and the patient upon further discussion.