Subpectoral Implant Repositioning With Partial Capsule Preservation: Treating the Long-Term Complications of Subglandular Breast Augmentation

Adam T Hauch; Cameron S Francis; Jourdain D Artz; Paul E Chasan

doi:10.1093/asjof/ojab009

Subpectoral Implant Repositioning With Partial Capsule Preservation: Treating the Long-Term Complications of Subglandular Breast Augmentation

Aesthet Surg J Open Forum. 2021 Mar 2;3(2):ojab009. doi: 10.1093/asjof/ojab009. eCollection 2021 Jun.

Authors

Adam T Hauch¹, Cameron S Francis^{1

2}, Jourdain D Artz², Paul E Chasan^{1

2}

Affiliations

¹ Division of Plastic and Reconstructive Surgery, Louisiana State University, New Orleans, LA, USA.
² Dr Artz is a plastic surgery resident, Division of Plastic and Reconstructive Surgery, Louisiana State University, New Orleans, LA, USA.

Abstract

Background: Patients with long-term complications associated with subglandular breast augmentation are being seen in increasing numbers in the Southern California community. Late deformities include a characteristic "slide-down" deformity as well as capsular contracture, implant wrinkling, and nipple-areola complex enlargement. Repositioning the implant to a subpectoral pocket is a recognized revisionary technique to treat this problem; however, technical details of how this is accomplished are lacking in the literature.

Objectives: To review our technique for treating long-term complications associated with subglandular implants using subpectoral repositioning with partial capsule preservation and mastopexy, without the need for an acellular dermal matrix (ADM) or mesh.

Methods: A retrospective review of all patients undergoing subpectoral repositioning over the course of 6 years was performed. Patient data and long-term outcomes were assessed. A technique is presented utilizing a partial capsulectomy that preserves a portion of the capsule as an ADM/mesh equivalent, ensuring adequate implant coverage and preventing window shading of the pectoralis major muscle.

Results: Twenty-four patients with subglandular implants and slide-down deformity as well as other associated complications including capsular contracture, implant wrinkling, and enlarged areolas underwent revision surgery with a subpectoral site change. Often, patients presented many years after their initial augmentation (mean 18 years, range 4-38 years). The average patient follow-up was 3.1 years (range 1.0-6.8 years). Two patients required minor revisions with local anesthetic, while another 2 revisions required general anesthesia.

Conclusions: Long-term deformities associated with subglandular breast augmentation can reliably be corrected by subpectoral repositioning, mastopexy, and utilization of residual breast capsule in the place of an ADM or mesh.