Breast Revision

Some of the reasons include:

Capsular Contracture

About 23% of all first time breast surgery patients have a revision. The most common reason for breast revision is capsular contracture, or the hardening of the breast implant due to contracture of the scar tissue around the breast implant. This most often occurs in the first nine months following surgery but can also happen many years later. The leading theory as to why this happens is bacterial contamination around the implant — not enough to cause an infection, but enough bacteria to release enzymes that cause an inflammatory reaction in the scar tissue. There are various procedures that can be employed at the time of surgery to virtually eliminate this occurrence, but not all plastic surgeons utilize these procedures.

Treatment of capsular contracture is aimed at resterilizing the pocket where the implant resides. This is done by removing the breast implant and any the scar tissue around the implant. Very high-powered microscopic analysis has shown the bacteria on both the implant and the scar tissue. The bacteria are encased in a protein “cocoon,” which makes it difficult for antibiotics to reach the bacteria, which is why it must be removed.

Once removed, the area where the implant and scar tissue were located is irrigated under pressure with an antibiotic saline solution. A new implant then may be inserted along with a drain. Most of the time, a product by the name of Strattice or Alloderm is stitched into the pocket to further reduce the incidence of a recurrent capsular contracture.

Implant Malposition

The second most common reason for revision surgery involves implant malposition, when the implant does not settle into the optimal position. This may be an implant that drops on one side but not the other, an implant that drops too far, or even an implant that ends up too far under the arm. Rarely, an implant may drop too close to the midline of the chest, resulting in loss of the cleavage. Sometimes, the reason for implant malposition is caused by the technique employed by the plastic surgeon. Other times, it’s because the implant migrated over time. This is possible because surgeons do not stitch an implant into position, a detail many patients don’t realize. A pocket is created and the implant settles into position over time. This settling process may not be identical between the two breasts.

Repositioning a breast implant takes significant surgical precision. Usually, the scar tissue needs to be stitched down in one area of the pocket called a capsulorrhaphy (the area where the implant resides) while the opposite part of the pocket needs to be opened — called a capsulotomy. The implant, which is a circle in most cases, then moves into a new position. Oftentimes, it’s necessary to reinforce the closed portion of the pocket with a mesh-like material, which adds strength to the closure to offset the weight of the implant.

Absence of a Breast Lift

The third most common reason for breast revision is the failure of the original surgeon to perform a breast lift. Many times the patient doesn’t want the scar associated with a breast lift, but she learns after the breast implant settles that her natural breast looks like it falls off the breast implant.

When undertaking this type of a revision, many times the implant may remain undisturbed while a breast lift is performed. There are many types of breast lift surgery and many different ways to perform each type. There are a variety of ways to minimize scarring during this procedure. Breast augmentation with a breast lift requires a great deal of experience to create beautiful, natural-looking breasts.

Size Changes

Interestingly, exchanging a breast implant to attain a size change is not common. Sizing concerns can be virtually eliminated with our sophisticated 3D imaging technology. At Water’s Edge, we offer 3D analysis to show prospective patients what they might look like with 95% accuracy. If a size change is requested, it’s usually to go larger. That said, many patients who have had their implants for many years often request smaller implants.

Some examples of when a patient may request a change in implant size include weight gain or loss, pregnancy, or even age. In some cases, changes in lifestyle as a woman ages might warrant a smaller size or even breast implant removal. In the latter case, the procedure is often coupled with a breast lift, but not always. While many women are concerned during their initial surgery that they don’t want to go too large with their breast augmentation, once the swelling subsides, they may wish that they had.

Of course, occasionally breast revision surgery is required to repair a damaged implant that has deflated or ruptured.

Implant Exchange

Another contributing factor can be a preference in implant type. Many women change their mind after spending some time with their breast implants and feel a switch from saline to silicone or vice versa would be better for them. This may be to remove a rippling effect in the breast implant or simply to have a more natural feel.

One of the more unfortunate reasons for a breast revision surgery is poor surgical work. Women who may not be happy with the results from a previous breast augmentation will seek out a more experienced plastic surgeon to fix the resulting issues from the first surgery. And now, with so many different projections and types of cohesive gels available, many undesirable results can be corrected.

Regardless of the reasons for seeking breast revision surgery, it is important to know as much as possible about breast revision procedures. Each patient should arrive at their consultation with a list of questions to ask the Water’s Edge surgeon. Education is the best tool to have on your way to a successful procedure.

It’s vital that patients prepare for their plastic surgery just as much as our Water’s Edge surgeons prepare. Prior to the procedure, your physician will give you a list of instructions to ensure the best possible surgical outcome. It is important that you follow these instructions to the letter.

One of the biggest things a patient can do to ensure the success of their breast revision is to be open and honest with their doctor during the consultation process. A potential patient needs to share their medical history openly. If the operating surgeon knows about a patient’s medical history, including such things as high blood pressure or bleeding and blood clotting issues, the surgeon can better plan for the procedure.

It is also important to ask lots of questions and to set reasonable expectations. Managing expectations is key to success; revision surgery can be very complex and somewhat unpredictable by nature. By engaging in a dialogue well in advance of a cosmetic procedure, a patient is better informed going into surgery. Patients who are informed and have reasonable expectations are more satisfied with their final results.

For individuals who smoke, it’s important to stop smoking as soon as possible before your procedure to help ensure the success of the cosmetic procedure and recovery period. It is clinically proven that smoking can delay healing. A delay in healing can result in scarring and also increase the chances of bleeding from the procedure. In addition, patients are encouraged to eat a healthy diet, drink lots of water, and be in their best physical condition before going into surgery.

Prior to surgery, a patient will need to make other lifestyle changes as well, such as avoiding taking aspirin or products containing ibuprofen. These products present challenges to normal blood clotting. This can increase the risk of bleeding and bruising from breast surgery. Tylenol and products containing acetaminophen are safe to take for pain.

If a patient is prescribed medications by their primary care physician, they should continue to take them; however, they should stop taking any vitamins and herbal supplements prior to surgery. Our doctors will advise when it’s safe to resume taking these supplements post-surgery.

The patient should also avoid alcohol for one week prior to and after the surgery and should try to decrease their salt intake. Even moderate levels of salt consumption can increase swelling. Most of all, drink plenty of water. Water can flush harmful toxins out of your system and can help your body reach top form. For the recovery process to be the best it can be, drink plenty of water leading up to and after a cosmetic procedure.