The patient is a 37 year old woman who had implants placed many years ago by another physician. She notes that over the years, her breast implants have become loose, to the extent that when she lies down, the implants fall to the side and into her armpits. Over time the breast implants also had stretched out the overlying skin envelope so that her breasts and the breast implants are sitting very low on the chest and there is moisture and chafing of the skin of the breast against the upper abdomen. Overall, she just felt that her breasts “were going all over the place and were drooping”. The drooping caused by the implants was causing her entire breast to droop and because the implant was low, the upper part of the implant was very low and so there was no fullness in the upper part of the breast creating an aged and mature appearance to her breasts. The patient liked her current size and she had heard that breast lifts can raise the breast to a higher level but she didn’t want to have any external scarring.
At the patient’s surgery, the implant was removed and the pocket (the space the implant is in) was explored and was found to be low on the chest. The space was expanded at it’s top to make way for the implant to rest at a higher position. Next, the pocket was raised from the bottom so that the implant could rest on new tissue that could better support it and at a higher position and also so that the upper pole of the implant could fill the upper part of the breast. Finally, the sides of both implant pockets were closed down for lateral support so that the implant would not be able to fall to the side. After this pocket modification, a new set of implants was placed to the patient’s desired size which was similar to the patient’s preoperative volume.
The patient did well after surgery. All patients who undergo pocket modification wear ace wrap support for four weeks to gently support the fold under the breasts and facilitate healing. And because more healing is required from this type of procedure patients are instructed not to do chest exercises or core for six weeks. We see patients the next morning after surgery for a check and then patients are instructed to walk outside immediately, at least twice a day and extend the distance of walking.
After six weeks implant position was excellent and the implants themselves were soft. There was no more lateral falling and the implant had good lower soft tissue support and there was good upper pole fullness. The patient was very excited about her new shape and no longer felt that her breast implants were moving all over the place and she was really excited that she didn’t have to have scarring from a breast lift to achieve her results!
