Neosubpectoral Breast Revision

Neosubpectoral breast revision is a breast implant revision performed when a patient has a capsular contracture or implant malposition from their current breast implants. This revision is very effective in correcting a variety of malpositions including:

• When an implant is positioned higher or lower than ideal
• Repairing implants that are displaced to the side, either medially or laterally

AM I A GOOD CANDIDATE FOR NEOSUBPECTORAL BREAT REVISION?

A neosubpectoral breast revision is applicable to most malpositions but may not be appropriate for patients with very thin tissue. Whether a patient is a qualified candidate for the procedure can be determined during a consultation with an experienced surgeon. Neosubpectoral breast revisions are especially useful for patients that require bigger or complex adjustments since it is more reliable and precise than the capsulorrhaphy procedure which is limited to minor adjustments.

HOW IS NEOSUBPECTORAL BREAST REVISION PERFORMED?

Before the development of the neosubpectoral pocket, malpositions were corrected using a capsulorrhaphy technique where sutures were used to close off the aberrant space by stitching capsule to capsule incrementally until the implant space was the right size and shape. With the neosubpectoral approach, an entirely new space is developed in front of, or anterior to, the old space but behind the pectoralis major muscle to create a virgin implant pocket in which to place a new implant. The new pocket is situated just in front of the old implant space and repositions the implant to an improved position. The old pocket is collapsed and obliterated with sutures to prevent the breast implant from reentering the old space. The neosubpectoral repair can be reinforced with a layer of acellular dermal matrix (ADM) or other mesh which can be added as a protective guard that helps support the new pocket from stretching too much.  

RECOVERY AND DOWNTIME OF NEOSUBPECTORAL BREAST REVISION

Recovery time for a neosubpectoral breast revision procedure is similar to the initial breast augmentation procedure. The patient may be sore and have some bruising. As part of the procedure, a drain may be placed in order to prevent excess fluid buildup. The drain is normally removed approximately a week after the procedure. Patients will be limited for the first day or so but may resume normal daily activities after that. However, they should avoid vigorous upper body exercise for approximately three to four weeks. With the neosubpectoral breast revision procedure, there is usually no additional scarring because the incision will be made within the scar from the original breast augmentation.

RESULTS OF NEOSUBPECTORAL BREAST REVISION

The neosubpectoral breast revision procedure typically gives patients their desired results. The ADM, which is usually placed within the breast pocket during the procedure, reinforces weak tissue and supports new cell growth while helping to regenerate the patient's own tissue. The ADM also acts as an "internal bra" as it provides the implant with an extra layer of protection and support. Furthermore, the ADM assists the implant by helping to create a more natural looking result. The removal of scar tissue that is prevalent with capsular contracture helps to relieve any discomfort the patient is experiencing. Patients who suffered from malpositioning of their implants usually do not experience further issues after the neosubpectoral breast revision procedure. However, if an issue should arise again, another pocket can be created if needed.

LIMITATIONS AND RISKS

Neosubpectoral breast revision surgery is a good option for any woman who is having post implant issues like malposition or capsular contracture. In some cases of capsular contracture, a total capsulectomy may be the better option. Whether to perform a capsulectomy or a neosubpectoral approach is a technical issue and is best left to the judgment of the surgeon. Similarly, where the overlying tissues are especially thin, a malposition may be better repaired by using a posterior capsular flap reinforced with ADM or mesh.

A VERY POPULAR PROCEDURE AROUND THE WORLD

Neosubpectoral breast revision surgery has become a popular procedure and has been well received among breast surgeons all over the world as an effective treatment for implant malposition and capsular contracture. Many plastic surgeons who are experienced in revision breast implant surgery highly recommend neosubpectoral breast revision surgery for women experiencing either of the above conditions.   

Written by Cosmetic Town Editorial Team- SP

Based on an exclusive interview with Scott Spear, MD in Washington, DC