Breast Revision

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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.


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 emot