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A possible new way of managing breast implant rippling using an autogenous fascia lata patch

2004; Elsevier BV; Volume: 57; Issue: 4 Linguagem: Inglês

10.1016/j.bjps.2003.11.028

1465-3087

John C. McGregor, Hilal Bahia,

Facial Rejuvenation and Surgery Techniques

Palpable, and sometimes visible ‘lumpiness’ known as ‘rippling’ seems to be a fairly frequent observation associated with textured surface silicone breast implants placed in a sub-glandular pre-pectoral muscle pocket. It is probably the result of several factors including reduced capsular production, lack of substantial subcutaneous fat, and the natural tendency of these implants to form folds or ridges in a dependent position. A recent study related to Trilucent breast implant patients indicated an occurrence in 60% of studied cases so the problem is not necessarily related to the implant filler.1.McGregor J.C Trilucent breast implant—a personal review of the current controversies (May 1999).Scot Med J. 2000; 45: 176-179Google Scholar It has been suggested that undue folding of an implant shell can produce an area of mechanical weakening and this may increase the chance of implant filler leakage.2.Rizkalla M Duncan C Mathews R.N Trilucent breast implants: a 3 year series.Br J Plast Surg. 2001; 54: 125-127Google Scholar, 3.McGregor J.C Brown D.T Observations on a consecutive series of patients who have had Trilucent breast implants removed as recommended by the MDA Hazard Notice (May 2000).Br J Plast Surg. 2002; 55: 231-234Google Scholar The senior author has tried several methods and also sought advice from experienced breast surgeons regarding management. Possible ways include changing the implant position to sub-muscular pockets or changing the size or nature of the implant. None of these methods appeared to give a consistently good result. A possible solution to the problem, which we believe has not been tried before (to the best of our knowledge), is to use a fascia lata patch either within or on the outside surface of the area of the capsule where the problem exists. After careful discussion with a suitable patient, who while happy with the overall result of her silicon breast implants (inserted into pre-pectoral pockets), was concerned about a visible edge of implant on the medial aspect of her right breast (Fig. 1) , it was decided to use an autogenous fascial strip to patch the area concerned. She was made fully aware of the possible donor scar on her thigh and given no promise that this new technique would work. The procedure was carried out under general anaesthetic, the fascial patch (Fig. 2) being inserted through the original sub-mammary approach while the implant was temporarily removed to allow access to the inner aspect of the capsule in the area where the rippling occurred. The fascial patch was then carefully sutured in place using 5/0 vicryl sutures. The implant was washed in Betadine solution and replaced. Antibiotic cover was given. There have been no post-operative problems and 8 months after the surgery, the donor area scar is virtually invisible (Fig. 3) and the rippling area is no longer visible or palpable (Fig. 4) . On the basis of this, and because the patient was pleased, further fascia lata patching has been performed to try to correct two further areas of rippling in the left sub-mammary fold (Fig. 5) .Figure 2The fascial patch obtained from the lateral aspect of the left thigh and donor site before closure.View Large Image Figure ViewerDownload (PPT)Figure 3The healed donor site scar 8 months after surgery.View Large Image Figure ViewerDownload (PPT)Figure 4The right breast at 8 months with pressure applied to breast implant from above showing no visible rippling in operated area.View Large Image Figure ViewerDownload (PPT)Figure 5The left breast preoperatively showing two areas of palpable rippling in the inframammary fold and surface markings of proposed subcutaneous fascial patch to be placed over the exposed capsule.View Large Image Figure ViewerDownload (PPT) In this situation the fascial patch was able to be placed on the outside of the capsule without necessitating removal of the implant within (Fig. 6) . The early results of this appear to be encouraging. It may be the case that the use of synthetic mesh or similar material could equally well be used though the possibility of infection may be higher. The use of a pectoralis major ‘trapdoor flap’ for similar deformities has also been described recently but involves slightly more extensive surgery and may therefore be riskier.4.Collis N Platt A.J Batchelor A.G Pectoralis major ‘Trapdoor’ flap for silicone breast implant medial knuckle deformities.Plast Reconstr Surg. 2001; 108: 2133-2135Google Scholar