Over the years, I have done a bajillion implant revision cases. This comes with the territory of being in practice many years (27 years and counting as of this blog post!) and also with showing and voicing an interest in revisional surgery. Implant revision is a fact of life. Breast implants are not life time devices and in general what goes in must eventually come out. Here a primer on the vocabulary of breast implant revision. Your surgeon may throw around these terms. Make sure you understand what he/she is saying and ask for clarification if you need to. Here goes:
Capsule: The scar tissue that forms around the implant. This happens with ALL implants. It’s a normal response to a “foreign body”. Yes, breast implants (like all non-biologic implants) are a foreign body.
Capsular contracture: The presence of a tight and often thick and sometimes calcified capsule. This results in a “hard implant”. This is abnormal scarring.
Implant pocket: The space where the implant resides. In cases of submuscular implants, the pocket is between the pectoralis major and the rib cage. In cases of subglandular implants, the pocket is between the breast gland and the pectoralis major. Sometimes a change in the implant pocket is advised for implant revision.
Implant malposition: Implants that are too high, too low, too medial or too lateral. This is most often corrected by modifying the implant pocket.
Bottoming out: A condition that occurs when the implant settles too low and/or is too loose.
Inframammary fold (IMF): The crease under the breast that is densely attached to the chest wall. The IMF tends to go back to where it was before implants after implant removal.
Double bubble: A condition that occurs when the implant falls below the inframammary fold. This is often accompanied by a crease along the lower breast at the level of the native inframammary fold or the edge of the pectoralis muscle.
Waterfall deformity: A condition that occurs when the implant stays put but the breast sags as it ages and falls over the implant.
Synmastia a.k.a. unaboob: Implants that are too close together. This looks really weird and is very, very hard to fix.
The gap: The space over the sternum that separates the breast. Sometimes the patients anatomy will result in a wider gap than she desires. Trying to close the gap can result in really lateral nipples or the dreaded unaboob. See above.
Capsulotomy: Cutting open the layer of scar tissue either to loosen it up or to change the position of the implant. This can sometimes be done with a local anesthetic.
Capsulectomy: Cutting out the capsule. This always requires a general anesthetic. This can be very difficult.
Capsulorrhaphy: Putting stitches into the capsule to either tighten it up and/or to raise the implant. This usually requires a general anesthetic.
En bloc capsulectomy: Removing the implant capsule with the implant without opening the capsule. This is the preferred method for removing a ruptured silicone gel implant. This is not always technically possible.
Acellular dermal matrix (ADM) and surgical mesh: A sheet of collagen or other substance that controls position of the implant and may prevent recurrent capsular contracture. Alloderm and Strattice are two of the ADMs I have used. I have also used Seri surgical mesh. Think of these as an internal bra, a very, very expensive internal bra.
Perfect symmetry: Not possible but we try.
Touch-up: This term best used when referring to make-up application. I try to avoid this term when it comes to breast implants. It implies that it’s easy and it’s never easy.
Revision: This term best used when referring to repeat surgery on a breast with an implant.
So there you have it. Now you can translate what your surgeon has told you needs to be done. And again, if you don’t understand make him/her go over it again until you do understand. Tell them Dr. Sowder told you to do so. Thanks for reading and I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.
Dr. Lisa Lynn Sowder