Sanctuary Plastic Surgery

4800 North Federal Hwy

Suite C100

Boca Raton, FL 33431

Creating Elegant Breast Enhancements Through Personalized, Board Certified Care.

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Lateral Implant Displacement

In terms of body aesthetics a bit of lateral fullness or implant show on the sides can be attractive and can make an athletic body look curvier. Most Playboy playmates have some lateral fullness.

The problems arise when there is too much lateral fullness and not a lot of cleavage. This is lateral displacement and is what happens when breast implants fall too much to the side. In extreme cases they end up under a woman’s armpits. This is usually caused by surgical error and can happen with implants placed over or under the muscle. Typical patient complaints are that the implants are in “my armpits” or that “I keep hitting the sides of the breast with my arms.” This is not to be confused with not enough cleavage due to too narrow an implant. Sometimes implants will look great for some time after surgery but the action of the muscle pushes the implants to the side over time.

Lateral displacement may be seen when a woman is upright.

Lateral displacement may not be seen until a woman lays down. In our consultation I perform a “tilt test” in which I have the patient sit in an exam chair with her arms on the handles then tilt the table back to see the extent of lateral shift. This will determine whether or not breast constructive surgery in Boca Raton is needed.

Correction of lateral displacement depends upon what caused the problem and whether the implants are over or under the muscle. If the implants are under the muscle correction is either done through one of 2 ways depending upon examination and capsule thickness.

1) Capsulorraphy: This is when the capsule at the side is closed off or tightened. The incision used is the same as in the original surgery (areolar (nipple) or inframammary (under breast)). If the original surgery was transaxillary (armpit) or transumbilical (bellybutton) the patient is given the choice of areolar or inframammary. The capsule is opened and the implant removed. The lateral capsule is closed off with sutures (capsulorraphy). There is some debate over whether permanent or dissolvable sutures should be used for this. Currently we are using Quill – barbed, slowly dissolvable sutures as we find the barbed suture creates progressive tension and tends to do an excellent job. Most of the time we are also placing Strattice (acellular pig dermis) over the area that was closed off in the pocket to add additional support. A new implant (or the old one) is placed along with a drain if Strattice is used). The drain stays for a few days to a week and the breast is taped for 6 weeks for added support or placed in a good underwire bra if the patient has tape allergies. We let the patients return to light lower body workouts at 2 weeks but no significant upper body weights for 6-8 weeks.

Strattice is often placed to correct laterally or inferiorly displaced implants.

2) Neopectoral pocket: In this case the implant is removed and the capsule under the muscle (anterior side) is dissected off the muscle and a new pocket is created on top of the old capsule. A new implant (or the old one) is placed in the new (neopectoral) pocket. Sometimes Strattice is used for additional support. A drain may be used for a few days to a week and the post operative instructions are the same as for capsulorraphy.

If the original implant was placed over the muscle, conversion to under the muscle will correct the lateral displacement (and rippling). Sometimes Strattice is used to help support the implant. Post operative instructions are similar to casulorraphy and neopectoral pocket procedures.

In some cases a woman has a nipple areolar complex that is lateral to start with (nipple is not centered) and the plastic surgeon places the implant directly behind the nipple – the implant ends up too lateral and there is no cleavage. This is corrected by fixing the pocket and moving the nipple towards the center.

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