Internal bra capsulorrhaphy

There are situations in which a previously existing breast implant pocket and its surrounding capsule are not located in the wished or required place according to mammary anatomical landmarks of paramount importance like the nipple, the inner cleavage ligaments, the limits of the ribcage, the submammary fold crease, the upper chest extra mammary area, etc; should these frontiers be breached then we are talking about different kinds of displacement or malpositioning deformities which receive the corresponding different names.

The breast implants ride high when they are located eccentric above the nipple or oversized vertically; there is symmastia or tenting when they are eccentric too medial or are oversized horizontally invading the cleavage or even the opposite breast; side boob happens when the implants sit eccentric to the armpit or are oversized horizontally invading the flank; they produce bottoming out when are eccentric inferiorly or oversized vertically.

In all such cases the mammary prosthesis have to be either relocated in case they are displaced or malpositioned, or renewed by better chosen implants should they be oversized.

However the problem of the undermined or detached from the ribcage breast and skin remains unless an anchor method reattaches the soft tissues of the mammary mound to the deep hard structures, redesigns in shape and size the prosthetic pocket and forms firm barriers to prevent future shifting of the implants.

This anchoring technique is best executed by an internal multipoint capsulorrhaphy with dissolvable long lasting sutures in order to fix the skin, subcutaneous tissue, breast gland and periprosthetic capsule to the depth of the pectoralis muscle or ribcage structures; one anchoring stitch has to be applied every few millimeters so that no external bulge or gap between sutures is noticed, besides for preventing the tear and detachment of the technique; preoperative markings are of paramount importance, since they will set the new limits for the breast implant pocket; intraoperatively the skin markings are transferred to the inner surface of the pocket and onto the ribcage structures as reference to apply the sutures.

It is one of the most challenging and difficult maneuvers in breast revision mammoplasties and highly requires a surgeon featuring top class training, skills and experience in mammary capsulorrhaphies.

Such internal bra capsulorrhaphy is not feasible through approaches to the breast pocket other than areolar incisions, that is the reason why the latter is the mandatory access in these cases.