Correction Of Severe Bottoming Out With Inferior Capsular Sling
The patient to the right presents with silicone gel implants placed submuscular; however, due to poor inframammary fold integrity, she ended up with dehiscence of the inframammary fold and inferior displacement of the implants causing severe bottoming out. This can easily be corrected by inferior capsular sling in patients who have thick capsule and that is not of multiple revisions.
The patient specifically had a single operation with a formal mastopexy full breast lift anchor scar and silicone gel implants placed in the dual plane. She had dissent of the implants due to thinning out of the tissue and had significant bottoming out which can be corrected with an inferior capsule sling and secondary inframammary skin excision with tightening down to the subdermis. This patient underwent an inframammary fold release. Capsule was then taken along the inframammary fold and resected from the chest wall above the periosteum of the ribs, elevated approximately 2.5 cm and resected of all redundant capsule; 2-0 Monocryl sutures were used to reapproximate the capsule lifting the inframammary fold approximately three-quarters of an inch. The skin was then excised directly and the superior edges of the open wound skin were then sutured to the deep dermis which allowed secondary inframammary fold tightening.
Her postoperative results were at four weeks showing beautiful elevation of the inframammary fold. No acellular dermal grafts were needed for this patient as she had ample thickened capsule which can be used to re-advance the fold and elevate it almost one inch.