Among the post surgical problems that may be seen in association with breast implants is “implant malposition.” Implant malposition refers to abnormal positioning of the breast implant. Sometimes, breast implants can be too high (This is frequently seen in conjunction with capsular contracture), but they can also be too low (a condition sometimes referred to as “bottoming out”), or they can be too far off to the side or even too close to the midline (a condition known as “synmastia”). Corrective surgery to treat implant malposition is one of Dr. Handel’s areas of special interest. He has extensive experience in correcting all types of breast implant malposition.
When implants are positioned too low (bottoming out or descent of the inframammary fold), surgery typically consists of a procedure designed to reconfigure the periprosthetic pocket and raise the inframammary fold (crease beneath the breast). Sometimes, this is done in conjunction with insertion of a new breast implant. Dr. Handel has found that when it is possible to convert implants from the subpectoral or submuscular position to the submammary or subglandular position, this often facilitates the ability to correct downward malposition of the implants and also ensures a longer-lasting result. Santa Barbara’s Dr. Handel has done extensive research and has written numerous articles and book chapters and frequently gives lectures on the topic of correcting implant malposition. He is familiar with all current techniques available to achieve the best possible results.
When implants are displaced too far to the side (lateral malposition), the treatment is similar to when the implants are displaced in the downward direction. Again, an operation to modify the periprosthetic pocket is generally performed which is sometimes called a capsuloplasty or capsulorrhaphy. Also, as with downward implant malposition, it may be advisable to convert the implant from the submuscular to the subglandular or submammary position and sometimes, insert a new breast implant.
When implants are displaced too close to the midline, patients lose normal cleavage. This is a condition referred to by plastic surgeons as synmastia. While there are a number of techniques available to correct synmastia, Dr. Handel has found that “conversion” of the implant to a “virgin pocket” is often the most effective technique in achieving the desired cosmetic appearance and ensuring long-lasting results. By converting the implant to a “virgin” pocket (brand new space), it is possible to carefully control the extent of pocket dissection and eliminate abnormal medial malpositioning of the breast implant. Sometimes, synmastia repair also calls for the placement of new implants.
There is a condition known as “double bubble deformity” which is closely related to downward implant malposition. The double bubble deformity occurs most frequently in patients who have an anatomical predisposition to this deformity. These are patients who have either a tight lower pole of the breast, a short distance from the nipple to the native inframammary crease, or a so-called “tuberous” or “tubular” breast. Dr. Handel has extensive experience in treating the double bubble deformity regardless of what caused it. Usually, a double bubble deformity is treated by repairing the periprosthetic capsule (reducing the amount of space as indicated) and/or converting the implant to a new pocket, either to a neosubpectoral pocket or a subglandular pocket. Oftentimes, a new breast implant is inserted at the same time. Dr. Handel has considerable experience with correction of double bubble, he has written book chapters and articles about the double bubble deformity and is often invited as a guest speaker at plastic surgery meetings and symposia to educate other plastic surgeons about this anomaly and the best ways to treat it.
For more information on Plastic Surgery procedures and Medical Spa treatments performed by Board Certified Cosmetic Plastic Surgeon, Dr. Neal Handel please call (805) 682-9100 or click here to contact us. Office located in Santa Barbara, CA.