Pocket revision breast augmentation corrects implant malposition that causes deformity such as bottoming out, “double bubble” (the breast appears to have two folds), and excessive lateral bulge. The idea is to allow the implants to settle into the most natural position, which is approximately at the center of the “breast mound.”
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently demonstrated pocket revision breast augmentation in his Snapchat account. It involved a patient who has had surgery done by a different doctor last year.
The patient’s right breast had its submammary fold positioned 2 cm lower than the other side. Dr. Smiley said the asymmetry was caused by incorrect pocket dissection—i.e., the previous surgeon made it too big—leading to implant drooping and thus causing “slight double bubble” due to the appearance of two breast creases.
The bottoming out of the implant not only caused unnatural placement of the right submammary fold, but also poor projection of the entire breast mound, excessive lateral bulge, and unnatural nipple position. Meanwhile, the left breast had no such problem because its pocket was done correctly.
“When you lift the base of the right breast, you would see that everything shifts. This means that correcting the bottom of the pocket can improve the symmetry of the cleavage, projection, nipple position, and lateral bulge. After all, the breast has a three-dimensional geometry,” Dr. Smiley said in the video.
Prior to surgery, the celebrity plastic surgeon performed extensive breast exam with the use of multiple measuring devices such as laser and vernier caliper. The goal was to improve the symmetry of both breasts in terms of base width, submammary fold position, and volume distribution.
The surgery was performed under local anesthesia. The patient requested for it so she could immediately see the results and decide if these would meet her aesthetic goals, explained Dr. Smiley.
Aside from pocket repair, the patient also requested for slightly bigger implants (from 350 cc to 450 cc) filled with silicone gel, which is known to provide more natural feel and contour than saline-filled implants.
To avoid additional scar, Dr. Smiley used the previous incision site created at the border of the areola. To prevent puckering of the skin and promote the best scar possible, he released the previous scar tissue and closed the incision in several rows of absorbable sutures.
The skin, meanwhile, was not “picked up” by any suture to eliminate tension on its surface (it was held together by a surgical tape instead), which is the key to the best scar possible.