Internal sutures are often used in patients who need revisionary breast surgery. Due to displacements of breast implants, either laterally (outwards, towards the sides), “bottoming out” (implants settling inferiorly), or symmastia (Implants migrate medially). With the use of internal sutures, an “internal bra” can be created to position the breast implants into a more desirable place.
With the use of internal sutures, an “internal bra” can be created to position the breast implants into a more desirable place. The internal suturing technique is also referred as “capsulorrhaphy”.
AlloDerm Regenerative Tissue is sometimes used with internal suturing to help give more coverage to areas of the breasts that need extra support with breast revision surgery.
The Surgical Procedure
The operation time varies and depends on what exactly what would need to be performed. We will review this with you after Dr. Pousti has examined you.
For revisionary breast surgery, depending on the extent of the surgery, the procedure can take from 2-3 hours depending on how much work is involved. Board Certified Plastic Surgeon, Dr. Pousti takes his time in the operating room to make sure that he does what he can to achieve the patient’s results. The correction of implant mal-position requires additional surgery to move the implant back into the pocket of original placement.
- The tissue that encapsulates the implant is cut and rolled back to fit into the pocket.
- Tissue is sutured together to hold implant in place.
- The muscle is then sutured internally back in place.
- The incision is then sutured close.
What To Expect After Surgery
Pain is rarely strong, more commonly being a degree of discomfort. Swelling occurs but usually begins to subside by the third or fourth day. Some degree of swelling may persist for longer periods. A bolster dressing is made to fit and support the areas, which were reconstructed with the internal sutures and is worn for about 2 weeks while the internal suturing heals and take it’s new form. Along with the bolster dressing a well-fitted bra is worn day and night for three weeks.
The bra that is worn after symmastia repair is referred to as the “thong bra”. It is used to stabilize the area after symmastia reconstruction.
Resumption Of Physical Activities
- Driving may be resumed in 1-2 weeks.
- Non-contact sports in 3 weeks.
- Contact sports in 6 weeks.
Testimonial:
Prior to reading please note: “before” pictures were taken after nursing two children. My “before” pictures taken prior to nursing my children showed much more significant bottoming out and symmastia. My breasts “sagged” some after nursing and actually hid the full extent of the problem.
I refused to give up hope! I knew there had to be a doctor somewhere that could achieve my desired results. I would not believe poor implant placement was a problem that could not be resolved. If I went braless, or if I was without a padded bra or padded swimsuit, you could easily see my implants were low and off center by my nipples being high. I also experienced my nipples coming out of the top of some bras and swimsuits because my nipples were too high and my volume was too low. At the gym, at the beach, at clubs,… even at church, you begin to notice nipples! Why are nipples even? Why aren’t they pointing out or to the side? and Why are mine?… it is because my implants aren’t in the correct place! How difficult is it to place and secure an implant in the correct position so my nipples will shine straight ahead? It wasn’t that I walked around trying to show off my nipples, but I sure didn’t like having to worry about them all the time!
Then my secondary problems… as I nursed two children, I developed some “loose skin”. If I am going to have a correction… well… let’s correct this also! And,… during nursing, one areola became larger than the other, we’ll fix that while we are fixing.
After five procedures (total procedures prior to Dr. Pousti) I knew #6 (my last attempt) had to be performed by the best revision doctor… as there would not be another correction attempt. After searching on the internet for years (really!!.. about 5 years I researched during which time I breast fed my two children), and consulting with surgeons all over the U.S (Florida, Chicago, Dallas, California), Dr. Pousti was by far the man for the job. My decision was based mainly on his “before and after” photographs on his website. Doctors told me what they would do. Doctors told me what my results would be. Doctors told me what their skills were. Doctors professed their revision expertise. When I asked these Doctors to show me photographs/results of their work… they might show one or two patient pictures. Dr. Pousti had many pictures to prove his words… and pictures speak a thousand words! His website displayed dozens of breasts that displayed similar symptoms as mine (both more and less extreme than mine), but were corrected by Pousti. This is what he does… he’s a “fixer”. It also helped that Pousti said I could go larger to fill my loose skin and that I didn’t need a “lift” as other doctors told me I might need to go with a smaller implant with a “lift” to achieve my desired results.
Office staff, hospital staff, Dr. Pousti… they are all great, but I really wasn’t concerned about emotions and beside manner. I didn’t fly half way across the U.S. for a congeniality contest. I wanted results! In my opinion, the trip and procedure was expensive, but well worth the money spent!! I wish I had found Pousti years ago and saved several revision attempts and wasted money. This is being written 6 months post-op, and at this point I could not ask for better results.
H.H.
Before I begin to write the story of my “boob job nightmare”, I want to tell you that you have come to the right place!! Words cannot possibly express how grateful and thankful I am for Dr. Pousti. He came highly recommended from the Allergan representive himself who deals with hundreds of surgeons monthly. I saw 7 different surgeons before Dr. Pousti, none of whom I felt knew how to fix symmastia. I had 7 different opinions on what needed to be done! I decided to wait until I found the right Doctor.
I had my first breast augmentation in 2003 with saline implants after nursing my son for a year. They were terrible. Way to small, bottomed out, and severely rippled all the way around. I could not even wear a v-neck t-shirt.
I had my second surgery in 2004 with larger saline implants. I immediately noticed the skin over my sternum was raised and that the implants were low. I went to see the Doctor many times and he said this was because I am thin, and this is normal. I did my research and found out I had symmastia. The worst news about this is you can not enjoy your breasts in a bathing suit, sexy bra, low cut shirt, NOTHING!! It’s a terrible thing to experience, and can be pretty emotionally debilitating! I had another baby and nursed him for 15 months. About 2 months into nursing him my right breast started deflating. About 8 months later my left breast started deflating.
I had gone to see Dr. Pousti right when I noticed the Right breast leaking and knew immediately that when the time came I would have him do the repair. He told me at our first meeting that I would have to be finished breastfeeding for 3 months before I could have surgery.
I began to have pain when the deflated implant would travel across my midline, and into my armpit area. I went to see Dr. Pousti and he was very sweet, and confident.
A few weeks later, I had the surgery and trusted 100% in Dr. Pousti’s expertise. The nurse and anesthesiologist both told me he is the best surgeon they have ever dealt with, and I was in great hands. That says a lot since they work in a surgery clinic!
The healing process takes discipline and patience. But is worth it! I am 11 weeks out of surgery today, and my breasts are @%#^* BEAUTIFUL!! Too bad no one gets to see them naked except my husband, and Dr. Pousti!! I am sooooooooo excited to be able to wear normal bathing suits, and any outfit I want without having to constantly be checking my chest.
I know this is a long story, but seriously if you are scared, and have doubts about getting revisionary surgery done, I understand! Dr. Pousti is trustworthy, gentle, knowledgeable, and most important COMPETENT to perform the revision!
Thank you Dr. Pousti, and staff!! You will forever be special to me. You probably don’t even know how much I appreciate what you have done for me! These are the breasts I always wanted!!
I had nearly a dozen consults over the years before I finally decided to have breast augmentation surgery in 2007 at age 34. I chose to have my surgery in Alaska where I live (basically for convenience). I was extremely unhappy with my results and my surgeon’s lack of desire to address my concerns. I finally obtained a second opinion and was told surprising facts about my surgery that explained many of my issues. I also received confirmation that the recommendations provided by my plastic surgeon were not going to solve the underlying problems. I was heart broken. I had many concerns going into this elective surgery. I had put much trust in my surgeon and felt betrayed by her. I wanted to have revision surgery, but was scared to trust another surgeon. I had been blogging on several of the popular plastic surgery websites and Dr. Tom Pousti’s name kept popping up. Patient after patient told their stories of surgery nightmares and how Dr. Pousti was able to correct their problems and restore their broken spirits. I could not ignore their testimonials, so I researched him myself and decided to go about planning the revisionary surgery. First, I
e-mailed his office and was shocked to receive a call from Dr. Pousti himself the very next morning! I e-mailed pictures and we discussed the revisionary surgery a few more times over the phone. His office staff was extremely helpful and quickly responded to any questions I had regarding the surgery and planning my trip. I met with Dr. Pousti the afternoon before surgery and had a completely successful surgery in the morning. I cannot thank Dr. Pousti and his caring staff enough for all that they have done for me! My breasts are healing beautifully and the results already far exceed my expectations. Dr. Pousti has true compassion for his patients. This is evident in the manner in which he treats them and the skillful work he performs on them. He is an impressive surgeon and artist and a truly kind person. I would recommend him to ANYONE considering plastic surgery. He is definitely worth any amount of travel. His office now considers me part of their “family” and I am proud to be associated with such an impressive team!
Dr. Pousti and his office and staff met every expectation I had, and ones I didn’t know about beforehand. I was referred by a friend on a support group message board, and after researching online, called down to his office, and started the process.
I had found that there were no local surgeons that were experienced in going even remotely “large”. I called the offices of at least 10 surgeons in the Austin area, and not one had much experience going over 500cc’s. When I said that I was looking for 1000+, none of them were even interested. And I’m glad they weren’t, or I would have never looked outside of my local area.
Looking through Dr. Pousti’s before and after pictures for XL breast implants, I quickly came to realize that he had amazing skills, not only in the smaller sizes, but in making girls look great with well over 1000 cc’s.
I asked to go with as many CCs as was safe in terms of my health, and to reduce or eliminate the gap between my breasts, which was especially bad when I would lay down. After my first breast enlargement with a different doctor, my left implant moved so badly to the side, I felt very self-conscious about it. After my surgery with Dr. Pousti, which included an internal bra procedure as well the 800cc implants overfilled to 1200cc, I have amazing cleavage!
If you want a doctor who works well with out of state patients, and who has an incredibly helpful staff, and explain things in detail, then you need to seriously consider Dr. Pousti. I feel that I should have gone with him originally, and I would have been much happier with my results, and my self-image. He truly knows how to take your concerns and desires in mind, and try to give you as close to what you want as possible. There are so many doctors who want to talk you out of what you really want, because they don’t think like they can do it, but I never got that feeling with Dr. Pousti. He truly cares about making sure that you are happy, and that at the same time, he does the best job possible!
There are a bunch of amazing hotels nearby to Dr. Pousti’s offices, from high end, to affordable, yet extremely comfortable and nice. His office was very helpful in making my decision on where to stay, as well as accommodating my more limited schedule, due to the amount of time I could spend in San Diego before flying back.
AR