Management of displaced breast implants

Dr. Young: The first patient (Figure 1) is a 28-year-old woman who had bilateral subglandular breast augmentations with 350 ml smooth-surface, silicone gel-filled implants through a periareo-lar incision. Her breasts were symmetrical before augmentation. She has bilateral grade II capsular contractures. She is unhappy because the right implant is higher than the left implant. Dr. Elliott, what do you think caused this problem, and how can it be avoided? We would also like to know how you would correct this problem. Dr. Elliott: This is a relatively common problem that is usually caused by asymmetric upward forces associated with capsular contracture. For example, a grade III capsular contracture on the right versus a grade II capsular contracture on the left could displace the right implant superiorly. However, because the two breasts are equally soft, capsular contracture is not the cause, and I would assume that the difference exists because the right implant was placed higher than the left implant. Patients with this type of deformity are frequently unhappy with both breasts and usually have better results when both breasts are revised. The position of her nipples appears to be slightly low with a supraster-nal notch to nipple distance that is greater than normal (18 to 24 cm); I would measure this distance. I usually choose a distance of 21 cm from the sternal notch, assuming that the patient is 5 foot 4 inches to 5 foot 8 inches tall. If the nipples required elevation, I would use a periareolar mastopexy and discuss the pros and cons of silicone gel-filled implants versus saline-filled implants. In many patients who require replacement implants, silicone gel-filled devices are a better choice because they are associated with less risk of skin wrinkling and implant palpability. Unfortunately, for physicians who are not participating in the U.S. Food and Drug Administration (FDA) protocols, silicone gel-filled implants are not an option.