Efficacy of Neopectoral Pocket in Revisionary Breast Surgery

BACKGROUND: An increasing number of patients present today with volume-depleted breasts from large saline or silicone gel-filled implants most commonly placed under the pectoral muscle. Revisionary (secondary or tertiary) surgeries are performed for late complications of breast augmentation, such as implant extrusion, gel bleed, rupture with extravasation of the gel, saline implant deflation, capsular contracture, palpability, rippling, "double-bubble," "Snoopy breast," symmastia, and implant malposition. Because most patients undergoing revisionary surgery in the past decade presented with subglandular implants, little has been published regarding the treatment of revisionary surgery in patients with subpectoral implants. OBJECTIVE: The authors describe the efficacy of a new technique for the management of late breast augmentation (augmentation mastopexy) complications. METHODS: A retrospective chart review was conducted of all consecutive patients who underwent revisionary breast surgery with the creation of a neopectoral pocket. Data were collected regarding the presenting complaints, original augmentation date, original implant location, revision date, type of implant used for revision, incision used in revision, length of follow-up, and any ensuing complications. RESULTS: There were 198 patients who underwent revisionary surgery with the creation of a neopectoral pocket over a four-year period. Patients' presenting complaints involved concerns related to either capsular contractures or implant malposition. Only three of 198 patients required reoperation for complications. CONCLUSIONS: The neopectoral pocket is a new type of site change operation. This procedure will address many of the issues seen today in revisionary aesthetic breast surgery for subpectoral implants that are already in place. These are frequently large implants that have displaced medially, inferomedially, inferiorly, or are encapsulated. (Aesthet Surg J;29:379-385.)