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Key Points
- Unless a breast implant patient is going to spend her life standing on her head, simple physics means that she will experience some degree of ptosis with her implants.
- Sharon Giese, M.D., F.A.C.S., developed the term "implant ptosis" to describe inferior displacement of the implant significantly below the inframammary fold, or complete obliteration of the inframammary fold.
- This technique uses the pectoralis muscle and the implant capsule to create an autologous sling that maintains the implant in the superior-medial position, creating cleavage.
NEW YORK In the world of breast augmentation surgery, one of the perennial aims has been to minimize the incidence of capsular contractures, to thwart, as much as possible, that troublesome scar tissue formation — unless you can make it work for you.
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Far left, 31-year-old patient with grade 3 ptosis pre-operatively. Middle left shows same patient presenting with implant ptosis following augmentation with concentric mastopexy. Middle right, patient is shown following implant lift at 4 weeks; and far right patient outcome at 71/2 years. The arrow lines indicate the location of the inframammary fold.
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One procedure that does just that is the brainchild of Sharon Giese, M.D., F.A.C.S., a board-certified plastic surgeon in private practice in New York. Like all other surgeons, Dr. Giese would see implants drop over time, but neither she nor her patients were willing to accept the status quo. So she developed a definition for this drop — and a procedure to address it.
TACKLING PTOSIS Unless a breast implant patient is going to spend her life standing on her head, simple physics means that she will experience some degree of ptosis with her implants. Dr. Giese observes that, with most patients, "You do the mastopexy, you put an implant in, and everything is beautiful for about six months. Then, by about a year, the implant, because of its weight, is kind of falling down and out."
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Dr. Giese
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She developed the term "implant ptosis" to describe this inferior displacement of the implant significantly below the inframammary fold, or complete obliteration of the inframammary fold. She follows the classic breast ptosis classifications developed by Paule Regnault, M.D., and applies those types (1 through 4) to implant ptosis. This modification of an existing classification, Dr. Giese tells
Cosmetic Surgery Times
, "gave me a term I could use clinically to describe and classify not only drooping of implants, but also to classify patients who will be at high risk of implant ptosis before surgery." She qualifies these as women who already have type 3 ptosis, those wanting very large implants and who have type 2 ptosis, and those who have poor skin quality.
Dr. Giese has spent the better part of the last decade developing and improving a technique that uses the pectoralis muscle and the implant capsule to create an autologous sling that maintains the implant in the superior-medial position, creating cleavage. Dr. Giese can identify patients that are at high risk for implant ptosis when they present for augmentation. "I inform them that, in the near future, they will need to have a secondary procedure [to create the autologous sling] and give them a lasting result." How long is a long-lasting result? Dr. Giese has been following these patients for more than seven years, and the results have been maintained.
