This is a patient in her mid 40s that came to see me with previous old silicone gel implants that were place 18 years before subglandularly (on top of the muscle) and likely ruptured. They had severe capsular contractions (extreme rock hard implants), malposition, and “bottoming out”. She wanted a better shape, smoother, and softer, and DID NOT want a breast lift.
She underwent a removal of the old silicone gel implants with full capsulectomy (removal of the scar tissue envelope around the implants), a “pocket conversion” to the subpectoral pocket (replacing the new implants under the muscle) to add tissue coverage and less chance of visible rippling. High profile 375cc silicone gel implants were replaced under the muscle. Strattice acellular dermal matrix was also used as an “internal bra” to resist and future capsular contraction, control the position of the implant, resist future bottoming out, and to “pick up” the breast without the need for breast lift incisions.