Before and after bilateral breast implant revision in a 55-year-old woman with ruptured submuscular breast implants and superior malposition. Both implants sat high up in their pockets, giving the appearance of breast droop – called “pseudoptosis.” She had developed painful and deforming capsular contracture on the left (Grade IV) and firm contracture on the right (Grade II) along with the malposition.
Her revision involved removal of the old “1st generation” Dow Corning implants from the early 1970s, excision of all internal scar tissue (total capsulectomy) and sending a representative sample of capsule to the Microbiology lab for culture and sensitivity testing. Bacteria were found, and she was treated with an appropriate antibiotic for two weeks once the results were available.
Her pectoralis major muscles were returned to the chest wall and reconstructed back to their normal attachments on the ribs. A new pocket was created on top of the muscle, in the subglandular (prepectoral, also called subfascial) space. Smooth round silicone gel breast implants were placed in this new pocket.
Liposuction removed excess fat from her armpits and bra rolls. After surgery, she took two weeks off work and one month off exercise, avoiding pushing and pulling with her arms during that month as well.
Her drains were removed at one week postop. Drains are required any time the muscles are operated on, as bloody fluid accumulates around the implants – and bacteria love to grow in this space, especially with the components of blood that bacteria can thrive on.
Long-term follow up photos are shown 5 years after surgery, with stable results and two soft, mobile breasts. The last set of images shows the old implants and total capsulectomy specimens. Capsular contracture is indeed the most common breast implant-related complication, but it does not have to recur, especially if treated properly – with capsulectomy, culture of scar tissue, appropriate antibiotic therapy, use of drains, and regular long-term follow-up visits!
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
