Dr. Pousti is double board certified in plastic and reconstructive surgery and is well known for his vast experience with revisionary breast surgery. Dr. Pousti has patients that fly in from over the world to have him revise their previous breast procedures. There are many different types of revisionary breast surgeries depending on the complications of the patient. One of the most common revisionary breast surgeries performed is a capsulorrhaphy (Internal Bra).
Description
The capsulorrhaphy procedure, also known as pocket correction or use of internal sutures/bra, involves closing a portion of the breast pocket to correct displacement of the implant.
Before – Patient has implant malposition present on her right breast.
After Capsulorrhaphy was performed on patient’s right breast.
Some of the most common forms of implant malposition are bottoming out, falling outward and symmastia.
Bottoming out
Bottoming out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the infra-mammary fold is too great. It is the loss of internal implant support where implant placement with partial, or no, muscle coverage, allows slow downward migration of the implants. This is because support of the implant by the skin alone is not always enough to prevent downward migration of the implants. Also, over-dissection of implant pockets at the time of surgery may cause immediate bottoming out. This is corrected by “raising” the infra-mammary fold using internal sutures(Capsulorrhaphy). This is done after careful measurements are made from the areola to the “new” infra-mammary fold.
Before- Patient had bilateral implant misplacement
After Capsulorrhaphy was performed
Falling outward (lateral displacement of implants)
This is when breast implants fall toward the axilla (armpits) and therefore the pockets need to be internally sutured to keep the breast implant in the correct position on the chest wall. In order to correct implants “falling outward” or lateral displacement the capsulorrhaphy procedure must be performed. The procedure takes from 1 to 2 hours. Usually an internal suturing technique is used to correct the pocket and therefore the implant placement on the chest. Board Certified Plastic Surgeon, Dr. Pousti takes his time in the operating room to make sure that he does what he can to achieve the patient’s results.
Before/After Capsulorrhaphy Procedure
Symmastia
One of the more common problems that patients are seeking Dr. Pousti’s help for is symmastia. Symmastia– commonly referred to as “bread-loafing” or “uni-boob”, occurs when two implants touch one another in the center of the chest. If the horizontal muscle that is connected to the sternum and goes across the implant is cut during surgery, then the implant can move toward the middle of the chest. Symmastia results from overly aggressive attempts to alter chest-wall anatomy trying to increase cleavage in patients. This outcome is made worse by use of larger implants in thin patients, and is a problem for implants over or under the muscle, though muscular implant placement allows the muscle to provide some softening of the transition to the cleavage area from the augmented breast mound. Capsulorrhaphy is used for symmastia correction.
Before- Patient had bilateral implant misplacement
After Capsulorrhaphy was performed
What To Expect After Surgery
Since the pectoral muscles have already been stretched and there is an existing pocket, there is very little pain or discomfort. Patients experience very minimal pain and there is less recovery time.
Patients are required to wear a supportive bra to avoid tension on the internal sutures.
Resumption Of Physical Activities
Driving may be resumed in 1-2 weeks.
Non-contact sports in 3 weeks.
Contact sports in 6 weeks ***resumption of activity is delayed (especially heavy lifting and moving arms away from the side) due to the internal sutures
Patient Testimonial:
I had nearly a dozen consults over the years before I finally decided to have breast augmentation surgery in 2007 at age 34. I chose to have my surgery in Alaska where I live (basically for convenience). I was extremely unhappy with my results and my surgeon’s lack of desire to address my concerns. I finally obtained a second opinion and was told surprising facts about my surgery that explained many of my issues. I also received confirmation that the recommendations provided by my plastic surgeon were not going to solve the underlying problems. I was heart broken. I had many concerns going into this elective surgery. I had put much trust in my surgeon and felt betrayed by her. I wanted to have revision surgery, but was scared to trust another surgeon. I had been blogging on several of the popular plastic surgery websites and Dr. Tom Pousti’s name kept popping up. Patient after patient told their stories of surgery nightmares and how Dr. Pousti was able to correct their problems and restore their broken spirits. I could not ignore their testimonials, so I researched him myself and decided to go about planning the revsionary surgery. First, I e-mailed his office and was shocked to receive a call from Dr. Pousti himself the very next morning! I e-mailed pictures and we discussed the revisionary surgery a few more times over the phone. His office staff was extremely helpful and quickly responded to any questions I had regarding the surgery and planning my trip. I met with Dr. Pousti the afternoon before surgery and had a completely successful surgery in the morning. I cannot thank Dr. Pousti and his caring staff enough for all that they have done for me! My breasts are healing beautifully and the results already far exceed my expectations. Dr. Pousti has true compassion for his patients. This is evident in the manner in which he treats them and the skillful work he performs on them. He is an impressive surgeon and artist and a truly kind person. I would recommend him to ANYONE considering plastic surgery. He is definitely worth any amount of travel. His office now considers me part of their “family” and I am proud to be associated with such an impressive team!
