THE CORRECTION OF SIGNIFICANT POST AUGMENTATION BOUNDARY DEFORMITIES WITH CAPSULORRHAPHY AND ALLODERM
Mark Sultan, MD, Mark Smith, MD, William Samson, MD.
Continuum Health Partners, New York, NY, USA.
Breast augmentation is generally a safe and gratifying procedure. However, not infrequently, unsatisfactory outcomes occur and must be revised. One of the more challenging complications to correct are breast implant boundary deformities in which the implants extend beyond the normal boundaries of the breast due to over-dissection of the pockets. These include iatrogenic “synmastia” and “double bubble deformities”.
A variety of techniques have been reported in the plastic surgery literature to correct these problems. No definitive technique has yet been established. Through experience and analysis of our results over the past several years, we have developed a reliable method to reestablish the normal boundaries of the breasts in these patients.
Preliminary percutaneous sutures are often first used to simulate the correct location of the breast boundary to be revised. We then utilize an open approach for all patients, most often beginning with an inframammary incision. The implant is removed and an internal capsulorrhaphy is performed with silk sutures as the percutaneous sutures are removed. A thick strip of Alloderm (acellular dermal matrix) is then sewn into position over the silk sutures to reinforce the initial layer of repair. A new implant is then placed completing the revision. Drains are not used.
We have utilized this technique in seventeen patients over the past five years. The boundaries requiring revision included primarily the inframammary fold in eleven patients, the lateral border in five, and the medial border in one. Six of the eleven patients in the inframammary group had distinct double bubble deformities. Six of the patients had previously undergone unsuccessful attempts at revision elsewhere. Satisfactory results have been obtained in all of our patients and no recurrence of implant malposition has been noted with a follow-up of six to sixty months. Deformities of the inframammary folds have been particularly well corrected by this method. There were no operative complications.
In summary, we believe that this technique including the use of Alloderm, provides a reproducible, reliable, and durable method for revision of difficult post augmentation boundary deformities.