Internal Sutures

Tom J. Pousti, M.D., F.A.C.S.
Article Courtesy Tom Pousti, M.D., F.A.C.S. | View Profile

About 1.5 million women per year undergo breast augmentation surgery. An estimated 40-45% of those patients seek revisionary breast surgery due to unsatisfactory results. Due to several complications such as Implant Displacement, Symmastia, and “Bottoming Out”, internal sutures would be necessary to correct these cosmetic issues. Internal sutures are sutures placed internally; there are no additional external scars.

Revisionary Breast Surgery with Internal sutures

Implant Displacement: After breast augmentation surgery, implants can move out of position at anytime. Sometimes implant displacement is caused by capsular contracture, muscle pull, or simply gravity. Implants can move superiorly, inferiorly, medially and laterally (left or right). When breast augmentation surgery is performed, and if the breast pocket is not made to fit the implant placed, while healing the implants may not fall into the breast pocket correctly. This causes the implant to move in the upward position. Patients commonly call this implant displacement “riding high”.

Before: Implants “Riding High” 3-weeks Post-op

Correction of Superior Implant Displacement When implants move inferiorly, typically this implant displacement is called “bottoming out”. When “bottoming out” occurs, the implants have settled in the downward position and usually the nipples appear to be forcibly pointing upwards which looks unnatural. Attempting to correct “bottoming out” is more complex and challenging, with internal sutures placed under the breast fold to correct the position, the weight of the implants can cause extreme tension in these areas. Sometimes, the use of AlloGraft is recommend for extra support.

Correction of “Bottoming Out” 1-year Post-op


Correction of “Bottoming Out” with AlloGraft When implant migrate medially towards the breastbone, cause the nipple and areola complex to point outwards, this implant displacement is called Symmastia. Symmastia occurs when the implant pocket created is made slightly too large which typically happens when surgeons aggressively try to increase cleavage in patients. The medial fold becomes week or is cut during surgery the implants can move towards the middle of the chest connecting together. In this case, internal sutures are placed medially to correct the placement. When placing internal sutures in a delicate area such as the sternum, scar tissue is rolled back and used to sustain the internal sutures; this type of surgical procedure is called Capsulorrhaphy.

Correction Of Symmastia        2-years post-op After revisionary surgery is performed with Internal Sutures, a “bolster” dressing is made especially for the patient to put support to the areas repaired and corrected. Internal Sutures generally take about 2 weeks to take on its new structure and become sturdy enough to hold the new implant position and the implants itself.

Correction of Implant Displacement

1-day Post-op with Bolster Dressing

2-weeks Post-op

Revisionary breast surgery is extensively more complex than the undergoing breast augmentation surgery for the first time. Revisionary surgery with internal sutures requires a surgeon with significant experience.

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