Malposition of Implants (Implants that Have Shifted within the Pocket)
We see patients weekly who have implants unfortunately placed in a malpositioned pocket. The most likely etiology is that the implants were placed through an approach that is difficult to allow for precise dissection, i.e., transumbilical and possibly transaxillary. The transumbilical approach is such a far distance from the umbilicus to the chest wall that absolutely precise release of the parasternal and the inframammary fold, pectoralis major muscle fibers and tendon, is extremely difficult to do, even in the very best of hands in a predictable manner, time after time, after time. Placing implants through the transaxillary approach, although a shorter distance from the armpit to the parasternal release of muscle, still especially under blunt dissection, can lead to implants that are malpositioned and superiorly positioned too high. The fibers of the parasternal muscle may not be completely released and thereby the implants are tethered superiorly.
Dr. Linder performs periareolar augmentation mammoplasty multiple times weekly, week after week, after week, year after year, after year, and we get a pretty much standard approach leading us to a predictable result through the periareolar incision. It is a very short distance with immediate direct visualization under direct headlight illumination of releasing the muscle of the parasternal and the inframammary fold. This is done quickly, safely and predictably and it is extremely useful, especially on breast revision surgery for patients who have malpositioned implants.
For more information on malpositioned implants and correction, you may also look at Dr. Linder's website, www.breastrevisionsurgeon.com. The most common correction of these implants when they are superiorly retropositioned is to perform an open capsulotomy inferiorly and release the capsule as well as possibly remove scar tissue along the inframammary fold. We often will change the implants. If moderate profile, we will go to a high profile implant with a more fuller upper pole. However, they are narrower on the side, so the women look thinner, less matronly and are much happier with the final results in general.
Transumbilical augmentation, although interestingly doesn't have scars on the chest wall, still significantly increases the rate of malposition and poor cleavage. Cleavage is associated with the insertion of the parasternal muscles along the costochondral junction. This is varied with woman to woman and each individual's anatomy. The more lateral displaced or the further off to the side the muscle inserts along the chest wall or the breast bone or the sternum, the greater the chance that the cleavage will be poor. It, however, is very important that some of the attachments of the muscle, at least 30% by Dr. Linder's theory, be left intact to the chest wall in order to maintain coverage along the cleavage area and so visibility and ripping does not occur from the implant.
Stuart Linder, M.D., F.A.C.S. is a Beverly Hills and Las Vegas Breast Revision Surgeon who enjoys performing breast augmentations, breast revisions, breast lifts, breast reductions and breast reconstructive surgery. He is a Diplomate of the American Board of Plastic Surgery and a Fellow of the American College of Surgeons and a Member of the American Society of Plastic Surgeons.
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Contributing Writer: Dr. Stuart A. Linder
Board Certified Plastic Surgeon
January 2006
"Rippling” Visibility of the Implant Edge
Stuart A. Linder, M.D., F.A.C.S. Las Vegas Breast Revision Specialist
4180 South Grand Canyon Drive Las Vegas, Nevada 89147
Phone: (702) 434-7205
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