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Dr. Linder's Blog

Severe Bottoming Out Repaired by Internal Capsulorraphy of the Inframammary Fold

Posted On: June 15, 2017 Author: Dr. Stuart Linder Posted In: Breast Augmentation, Breast Reconstruction, Plastic Surgery

severe bottomingThe patient presents with severe scar tissue contracture of the entire collapse of the upper pole of her right breast causing lowering of the implant with the implant approximately 1.25 inches lower on the right than the left. Not only are her implants too large for her body, the technical error by a previous surgeon caused inferior displacement of the implant due to inadequate release of the superior pectoralis major muscle. The pressure has caused constant inferior creep of the implant down over the last three years. The photograph with markings in place show that the 397 low profile style 15 gels will be replaced with 350 cc high profile saline implants narrower and smaller. The superior upper portion capsulectomy was performed rendering complete muscle release up to the clavicle was maintained in the right breast. At this time you can see the photograph showing the muscle attached down to the intercostal space causing complete collapse of the upper pole.

The next photograph shows lifting of the capsule along the inframammary fold which is then released from the inframammary fold of approximately 2.2 cm or one inch.

The next photograph shows the capsule is now being sutured up using strong sutures in order to recreate a sling-like effect bringing the implant up and reducing the bottoming out. The next photograph shows the entire capsule has been completely sutured upward and reattached using a capsulorraphy. Finally, the wound has been closed with large sutures reapproximating the edges and postoperatively she now has a double fixation of the inframammary fold with not only capsulorraphy sling, but also with the skin excision tightening the skin as well as repositioning the nipple areolar complex into its symmetric position to the left side.

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