Will pocket be closed completely?

[imnyc]

Hi Dr. Rosenberg,

I wrote before regarding problems with 'bottoming-out' and an over-dissected crease on one side of my breast.  In addition, I had a delayed reaction with the PDS sutures 6.5 months post op, which had ultimately led to necrosis and an emergency surgery to remove the implant.  Now I am living with one implant on one side.

My question is that will the over-dissected crease ever be 'gone for good' now that the implant has been removed?  Or would I need internal stitches for pocket work when the implant is put back in in the future?

I have very thin skin, and the fact that I am pretty much allergic/ultra sensitive to most if not all suture material out there and have severe inflammatory responses as a result (with the exception of Monocryl), chances are that I may reject other foreign material such as alloderm and strattice as well.  

I am concerned about that my crease was over-dissected, and therefore would need pocket work in the future but there is no sutures suitable, in addition, that alloderm / strattice is too risky to use (as I know a few cancer patients who were rejecting them), and therefore, no support would be there and the possibility of 'bottoming out' again and/or thinning of the breast tissues and impending extrusion as it happened before...

Will implant removal allow the breast itself to return to its pre-op state completely and if a crease is created at the right location next time (i.e. higher), then even without pocket correction, the same problems I had previously will not occur?

Would appreciate your insights, as in the past, I think you are one of the very few PS who can say the right thing and explain situations with soiund judgement.

Thank you very much in advance.

[Howard Rosenberg, MD]

Now that your implant is out, the implant pocket has essentially closed and healed down to the underlying muscle and chest wall.  Re-creation of a new pocket can be achieved without regard to the old pocket.  In other words, re-operation on that side is essentially starting from scratch, so that the pocket can be created in a proper position.  The use of alloderm or strattice would not be required.

[imnyc]

Thank you so much for your response Dr. Rosenberg!  It is comforting to know and it gives me hope.  Thank you once again!