This 24 year old healthy female from Costa Mesa, California had previously had breast augmentation surgery with 350cc breast implants (performed by another surgeon). The patient presented with significant breast implant mal-position medially and inferiorly (the breast implants were displaced too low and too far toward the cleavage area), therefore causing the nipple-areolar complexes to be off centered and pointing outward.
She was unhappy with her results and desired her breast image to be corrected. She began a google search for a board certified plastic surgeon who had experience in symmastia repair and came across Dr. Pousti. 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.
She scheduled a consultation and had the opportunity to speak with Dr. Pousti regarding the options to correct her implant displacement along with the possible risks and complications associated with any surgery. For this patients specific case, she and Dr. Pousti discussed her symmastia, her breast asymmetry, her bottoming out and the combination of capsulorrhaphy (placement of internal permanent sutures) and the use of additional supportive material such as Strattice or BioSynthetic Mesh were discussed.
Dr. Pousti decided to use TIGR Mesh which is a BioSynthetic mesh that is non-human / non-pig but will provide additional support for this patient’s breast pocket repair. The measurements and markings are performed on the morning of the surgery and Dr. Pousti reviews all the procedures that will be performed.
The red shaded area shows where the breast pocket is going to be closed off through capsulorrhaphy. 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.
Below shows the right breast after capsulorrhaphy. The intra-operative sizer is used to assist Dr. Pousti in determining the best sized implant to help the patient achieve her goals.
The Tigr Matrix Mesh is used to help add additional support to the breasts. Tigr Matrix surgical mesh is a degradable surgical matrix made from synthetic resorbable polymers intended to support and reinforce tissue for 6-9 months and be absorbed completely by the body after 3 years.
The patient is shown below immediately after breast revision surgery surgery. She has bilateral 415cc high profile Sientra silicone gel breast implants.
The bolster dressing is used as a support between the breast implants to assist in preventing a recurrence of implant displacement.
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