Retrocapsular Pocket to Correct Symmastia

Harley, Oliver J.H.; Arnstein, Peter

doi:10.1097/prs.0b013e3182174661

Cited by 6 publications

(7 citation statements)

References 5 publications

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“…We included in our review 30 studies presenting different approaches for revision surgery following implant-based breast surgery (both aesthetic and reconstructive) 3–32 (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…[20][21][22]25 Specific surgical treatment depends on the individual patient. Factors to consider include whether Review --Bengtson 5 Review --Brown et al 6 Review --Chasan and Francis 7 Case series 75 Capsulorrhaphy Chopra et al 8 Review -de Benito and Sanchez 9 Review -de Mortillet 10 Review --Dickinson and Handel 11 Case series 264 Algorithmic approach to revision surgery Gounot 12 Review --Harley and Arnstein 13 Review --Hidalgo and Weinstein 14 Case series 180 ADM use for capsular contracture treatment Hartzell et al 15 Case series 23 ADM for malposition and wrinkling treatment Khan 16 Case series 58 Submuscular biplane pocket for dynamic breasts Khan 17 Case series 93…”

Section: Smentioning

confidence: 99%

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Revisional Breast Surgery: Are Surgical Plans Changed if the Patient Has a Textured Device?

Nava

Vita

Catanuto

et al. 2021

Plastic &Amp; Reconstructive Surgery

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evisional surgery represents a reintervention for a complication or adverse event following a surgical procedure. The patient who undergoes revision surgery has undergone the same or similar procedure but experienced a complication or adverse event that we are going to solve with a second procedure.A breast augmentation/breast reconstruction revision patient, one assumes, has had a prior breast augmentation/breast reconstruction, but the outcome was not satisfactory due to the occurrence of a complication or because the desired cosmetic result was not obtained.Potential surgical complications in breast implant surgery could be classified as preoperative and intraoperative complications and early and late postoperative complications. 1 Preoperative complications essentially derive from poor planning (e.g., wrong choice of surgical access or inaccurate measurements). Intraoperative complications are associated with poor surgical technique. Early and late postoperative complications derive from all steps and even from poor management following the surgical procedure.Even following the best pathway in planning and performing a breast augmentation, short-and longterm postoperative complications can occur, including infection, capsular contracture, hematoma and seroma, double capsules, late seromas, rupture of the implant, and implant malpositioning. For these reasons, a breast surgeon must know how to manage a complication and perform revision surgery.We reviewed the available evidence on revision surgery following implant-based breast surgery to treat all the possible complications or adverse events with the aim of investigating whether any difference in the surgical approach should be proposed if the patient has a textured device. METHODSThis review of the literature on revision surgery was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. 2 PubMed, Cochrane Library, and Google Scholar were searched from database inception to September 30, 2020. The following terms were used (including synonyms and closely related words) as index terms: "revision surgery," "breast implants," "breast surgery,"

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“…We included in our review 30 studies presenting different approaches for revision surgery following implant-based breast surgery (both aesthetic and reconstructive) 3–32 (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Section: Smentioning

confidence: 99%

Revisional Breast Surgery: Are Surgical Plans Changed if the Patient Has a Textured Device?

Nava

Vita

Catanuto

et al. 2021

Plastic &Amp; Reconstructive Surgery

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“…Neosubpectoral and neosubcapsular pockets are recommended for difficult cases. 54,55,66 The creation of a neosubpectoral pocket involves dissecting between the posterior muscle and the anterior capsule, removing the implant, and tacking the capsule to the chest wall to create a new space (Figure 7). A neosubcapsular pocket is created by dissecting posteriorly on the capsule, reflecting the capsule anteriorly, and placing the implant behind the posterior capsule in a new space.…”

Section: Pocket Asymmetry or Implant Malpositionmentioning

confidence: 99%

“…If the implants are already in the subpectoral plane, a neosubpectoral pocket can be made to recreate the appropriate medial borders. 66,70,71 Subpectoral implant animation deformity Some range of implant motion with flexion of the chest muscles should be expected after augmentation in the subpectoral position. Overzealous dissection of the pectoralis major muscle from the inferior medial border of the sternum can create atypical or asymmetric contractions.…”

Section: Symmastiamentioning

confidence: 99%

Secondary Augmentation-Mastopexy: Indications, Preferred Practices, and the Treatment of Complications

Spring

Macias

Nadeau

et al. 2014

Aesthetic Surgery Journal

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Increasing the volume of the breast while simultaneously decreasing the skin envelope equates to surgery involving opposing forces. Increasing patient demand and the evolving perceptions of surgeons have led to the growing popularity of the combined augmentation-mastopexy operation. In turn, secondary augmentation-mastopexies and revisional surgeries of primary augmentation-mastopexies also have increased in popularity. In this article, the authors describe indications for secondary augmentation-mastopexy, techniques for performing this combined procedure safely and effectively, adjunctive procedures, potential pitfalls, and the treatment of complications.

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“…Symmastia occurs when breast implants move across the sternal midline ( Figure 1), usually as a result of overaggressive dissection of the medial implant pocket (4). Many surgical interventions, such as capsulotomy, capsulorrhaphy and mastopexy, have been developed to treat symmastia; however, symmastia often recurs in patients after treatments (4)(5)(6)(7)(8)(9)(10)(11)(12). More recently, techniques, such as explantation with collapse of the implant pocket and placement of the implant submuscularly, either using xenograft or allograft, to make a new pocket have been used (13).…”

mentioning

confidence: 99%

A Surgical Technique for Treating Submuscular and Subglandular Symmastia Combining Standard Techniques with An Aggressive Medial Capsulorrhaphy

Vondrak

Fennema

Beltre

et al. 2016

Plastic Surgery Case Studies

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Symmastia, the medial confluence of breast implants producing a ‘bread loaf’ quality, has continued to be a vexing complication of breast reconstruction and breast augmentation, despite numerous proposed repair methods. Previous procedures include capsulorrhaphy, allograft or xenograft sling suspensions, mastopexies and, in cases of subglandular implants, collapsing the pocket and reinserting the implant beneath the pectoralis major muscle. In the present article, the authors outline a reliable long-term correction of submuscular symmastia, combining the techniques of capsulorrhaphy, use of porcine xenograft slings, submuscular placement of the implants, and use of capsular tissue folded and sutured onto the presternal fascia with nonabsorbable sutures. This technique places the porcine xenograft sling between the implant and the folded capsular tissue sutured with nonabsorbable sutures, protecting the implant from erosion/puncture by the nonabsorbable sutures. The authors also propose a similar technique for the correction of subglandular symmastia. The patient in the current article presented with submuscular symmastia and has been followed for <4 years postoperatively with absolutely no recurrence of symmastia, even with forcible application of lateral pressure on her breasts in an attempt to reproduce medial confluence. The technique offers a promising solution to the frustrating difficulty of symmastia, a complication with a high recurrence rate despite many proposed repairs across decades.

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Retrocapsular Pocket to Correct Symmastia

Cited by 6 publications

References 5 publications

Revisional Breast Surgery: Are Surgical Plans Changed if the Patient Has a Textured Device?

Revisional Breast Surgery: Are Surgical Plans Changed if the Patient Has a Textured Device?

Secondary Augmentation-Mastopexy: Indications, Preferred Practices, and the Treatment of Complications

A Surgical Technique for Treating Submuscular and Subglandular Symmastia Combining Standard Techniques with An Aggressive Medial Capsulorrhaphy

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