title: [Bottoming out in augmentation mammaplasty--correction and prevention].
abstract: Displacement of a breast implant beneath the original submammary fold is known as a rare but, in most cases, difficult to correct complication after augmentation mammaplasty. Suggestions for re-centering the mammary implant range from simple percutaneous sutures to the additional application of expensive alloplastic dermal grafts. Based on the latest findings concerning plastination histology of the fascial system of the breast and in the light of our own clinical experience regarding correction of implant ptosis we have developed a special treatment concept. When placing the implant, the vertical fibers of the submammary fold are saved as a precautionary measure. In cases where there is a risk of possible inferior displacement of the mammary implant, an individually manufactured belt-like bandage is applied for approximately eight weeks postoperatively. In cases requiring the correction of a severe "bottoming out" deformity, we either lift the capsular shell of the implant or, if the fibrous capsule is thin and vulnerable, we use a special capsular flap technique resulting in a hammock that catches the implant at the height of the new submammary fold. Postoperative application of our belt-like bandage is again indispensable.
authors.affiliation: Klinik für Hand-, Brust- und Plastische Chirurgie (Chefarzt: Prof. Dr. J. Hoch), Klinikum Neustadt/Holstein. JHoch@schoen-kliniken.de
authors.forename: J
authors.initials: J
authors.lastname: Hoch
authors.forename: A
authors.initials: A
authors.lastname: Stahlenbrecher
mesh_terms: D001458:Bandages; D001940:Breast / Q000601:surgery; D018427:Breast Implants; D005260:Female; D005548:Foreign-Body Migration / Q000517:prevention & control / Q000601:surgery*; D006801:Humans; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control / Q000601:surgery*; D017755:Prosthesis Fitting; D012086:Reoperation; D013524:Surgical Flaps; D013536:Suture Techniques