Lateral Displaced Implants and Poor Cleavage
The case example shows a patient with inadequate cleavage due to lateral displaced implants. This patient presents with severe problems. No 1 is pectus carinatum. In the operating room it is found that she has lateral displaced implants with the chest wall obliquely slanted downward and off to the side. She also had implants pockets that were too large and the implants were low profile, causing a droopiness to the breast with poor upper pole fullness and inadequate cleavage.
The patient’s postoperative photo shows on Postop Day 1, the implants were replaced with style 20 silicone gel implants through the periareolar approach and open medial capsulectomy aggressively was performed. The muscle however was left intact to the parasternal ridge in order to avoid visible rippling of the bag. The high profile implants, as you can see, have given more upper pole fullness and the cleavage is enhanced. There has been no lateral capsulorraphy performed. She will now be placed in an extra small Dr. Linder Bra for the next six weeks which will allow compression to the midline and stabilization of the implant within the pocket.
Patients who present with inadequate cleavage can be brought to the midline in certain circumstances without capsulorrhaphies when a significant increase in volume of the implant size can be performed and the medial capsule can be successfully released with postoperative compression.