How precise dissection technique affects pocket creation for breast augmentation

Dr. Ho Cao Vu of the surgical department of Cho Ray Hospital in Ho Chi Minh City has directly performed numerous surgeries to remove gel breast implants, saline breast implants, and textured breast implants manufactured through the salt crystallization mechanism.

These implants have been in place for around 20 years.

He has observed that, in many cases, the breast implants remain intact and do not show signs of aging even after such a long period following breast augmentation.

According to the doctor, aside from the quality of the breast implants (from brands certified by the FDA) and severe external trauma, the precise technique of pocket creation by the surgeon directly affects cases where breast implants placed at the same time show differing outcomes, one remaining intact while the other ruptures.

Many cases of breast implants placed for around 20 years show that the implants remain intact and do not exhibit signs of aging. Photo courtesy of Dung Ho

Dr. Ho Cao Vu cites the case of Diem Thuong, 48, who underwent breast augmentation 22 years ago using 350cc saline implants from the Mentor brand.

Currently, with a relatively large bust, she wishes to have the implants removed and her breasts reshaped to a smaller size using the new-generation ultrasonic surgical scalpel.

During breast implant removal surgery, Dr. Vu observed that the left breast implant remained intact without signs of aging, and the implant pocket was clean and smooth.

However, the right breast implant had leaked and developed capsular contracture (in the lying position, the right breast did not fall downwards naturally and was firmer than the left).

Both implants were the same size, placed at the same time, and used the same surgical method.

Yet, after 22 years, one remained intact while the other ruptured and developed capsular contracture.

The underlying cause was the difference in the surgical technique used to create the implant pocket; one side had a sufficiently wide pocket, while the other side’s pocket was too tight, creating pressure on the implant over time and leading to its rupture.

Hoang Anh, 47, underwent breast augmentation nearly 20 years ago in the United States using 270cc saline implants from the Mchan brand.

Recently, she experienced unusual sensations in her breasts and decided to return to Vietnam for implant removal, opting for surgery with the new-generation ultrasonic surgical scalpel.

Upon examination, the doctor found that the right implant was intact, while the left implant had some fluid in the pocket; the implant was deflated, and the base of the implant had flipped within the pocket.

The remaining volume of the left implant was approximately 100cc, corresponding to its deflated appearance compared to the right breast.

After removing the implant, the doctor applied pressure to it and discovered a leak of sterile salt water.

Dr. Ho Cao Vu then used the ultrasonic surgical scalpel to reshape the left breast pocket at the outer quarter of the lower pole to accommodate a new 325cc implant.

The right breast implant (275cc) has ruptured, with the gel turning yellow, while the left breast implant (300cc) remains intact in both its shell and gel. Photo courtesy of Dung Ho

Bich Tram, 50, had breast augmentation 20 years ago using 225cc saline implants with textured shells from the Sebbin brand.

She now wishes to have her old implants removed and replaced with new ones using the new-generation ultrasonic surgical scalpel technique.

The right breast implant is intact. Dr. Vu examined the breast pocket and found it narrow at the outer quarter position.

He then adjusted the pocket to accommodate a new 275cc implant with a medium-high profile.

The left breast implant had ruptured, and the breast pocket was narrow at the lower pole. The doctor excised part of the pocket and released the muscle tissue that had not been previously adjusted in the narrow area to enlarge the pocket. He also took tissue samples for cytology.

In a case of CUI textured breast implant removal after 15 years, the left implant has ruptured while the right implant remains intact. Photo courtesy of Dung Ho

Le Phuong, 55, returned from the US after having undergone breast augmentation 15 years ago using 200cc textured implants from the CUI brand.

She now wishes to have her old implants removed and replaced with new ones using the new-generation ultrasonic surgical scalpel technique.

In the left breast, Phuong’s implant had ruptured, with the gel leaking into the pocket appearing white, dilute, and odorless, while the gel remaining in the implant was more viscous.

Dr. Ho Cao Vu removed all the gel and cleaned the pocket.

The implant pocket was wide and had fallen outwards at the 2 o’clock to 5 o’clock positions.

The doctor sutures the outer edge of the left pocket.

The right breast implant was intact, but the pocket was narrow.

Dr. Vu expanded the pocket in the previously marked under-expanded area and placed a new 215cc implant with a medium-high profile.

20 years ago, breast augmentation surgeries did not use modern surgical tools such as endoscopic equipment, no-touch funnels, or ultrasonic scalpels.

Despite this, many implants remain intact even after more than 20 years.

“This demonstrates that the primary cause of implant rupture after breast augmentation is often related to the technique of implant placement and the creation of the implant pocket by the surgeon,” said Dr. Ho Cao Vu.

According to him, when inserting breast implants into the pocket, it is essential to do so gently and without trauma, ensuring that the size and height are appropriate.

The pocket created should not be too narrow, as this can lead to breast firmness, pseudocapsule formation, capsule contracture, and implant rupture over time.

Conversely, the pocket should not be too wide, as this can cause implant flipping and asymmetry in both the breasts and their projection.

Dr. Vu compares the breast implant pocket to a pair of shoes: if the shoes are too large, the feet may slip around during movement; if they are too tight, they can cause pain at pressure points and areas of friction.

Similarly, the precise creation of the breast implant pocket is crucial in breast augmentation surgery to ensure that the implant is positioned correctly, remains soft, and lasts for an extended period.

Patients’ names have been changed for anonymity.