A good Breast Augmentation surgery will result in increased breast size that will hopefully make patients happier and more confident. However, not all the results are positive. Breast Revision surgery is performed when the results of a previous Mammoplasty were less than ideal due to skin elasticity, internal structure, or a less trained surgeon, or when implants need to be replaced. Breast Implant Revision surgery is a procedure used for revising or correcting a prior reconstructive or cosmetic breast surgery. This includes changing the size or type of the breast implants and fixing and correcting any complications or unsatisfactory results from prior surgery.
There are several medical and cosmetic reasons why Breast Implant Revision is needed. In some cases, breast implant revision may be required due to complications following breast implant surgery, breast enlargement surgery, breast augmentation, or other aesthetic plastic surgery. The following are some of the reasons patients may opt for this procedure.
Sometimes after the breast augmentation surgery, women realize that their breasts are too big and want them to be smaller. When exchanging larger implants for smaller ones, the surgeon’s concern is ptosis, sagging breasts, and redundant breast tissue and skin.
Therefore, the procedure to downsize the implant is accompanied by a breast lift procedure to ensure there is no sagging skin or excess breast tissue. For patients that want to upsize their implants, the surgeon will focus on creating a bigger pocket where the surgeon will place breast implants. If the implant location was subglandular, the surgeon will change this to submuscular and create a new implant pocket for the bigger implant while removing the former implant.
Both saline implants and silicone breast implants can get leaks and ruptures. For saline leaks, patients may slowly notice a decrease in breast volume or asymmetry during or after the healing process, especially if only one side of the round implants is leaking. Silicone ruptures are more difficult to spot and patients may need an ultrasound or mammogram to see the leak.
When breast implants leak, surgeons will need to remove them and replace them with new implants to help the patient achieve their desired outcome again.
A capsular contracture is the response of the immune system to foreign objects in the body and the formation of an abnormal “capsule” of scar tissue around the implant. A capsular contracture is a tight and thickened scar tissue that the body creates in order to protect the important organs from the foreign object inserted during the surgery. The tight scar tissue makes the breast appear unnatural as the movement of the implant is restricted. It can also lead to feelings of discomfort.
To address this, surgeons remove the hardened scar tissue around the implant and replace the implant in a new position relative to the patient’s chest muscle.
Sometimes, the breast implants are placed too high in the chest wall or in a different position during breast enlargement surgery. The surgeon hence, has to perform a second surgery to move the implant in the right position to create balance in the chest, remove its capsule and create a new pocket lower than the previous one. The surgeon will then insert the new implant in the correct position.
This occurs when Breast Implants are placed too far apart during a previous surgery. Because of their distance, the breast shape doesn’t create the desired cleavage. To address this, the surgeon will use stitches to minimize the side of the previous pocket, insert the new implants, and put them towards the body’s midline, or simply provide the patient with bigger implant size.
The bottoming out of breast implants may be due to the skin’s loss of elasticity, weak internal muscles, or a less-trained plastic surgeon made the breast implant look low and the nipple too high. This is addressed by the surgeon replacing the implant and then making the pocket higher. The surgeon will then place the implant in the elevated pocket and suture the lower pocket.
Rippling usually occurs in thin patients. This is when ripples from the breast implants are seen on the skin’s surface. To hide these, the surgeon will either utilize fat grafting to increase the volume of soft tissue under the skin or use Acellular Dermal Matrix (ADM) as a scaffold to create a more natural-looking breast. Both surgical procedures help provide camouflage for ripples.
Symmastia can happen in breast surgery patients. This is when the implants are placed too close to one another, appearing to form a uniboob. In rare cases, the skin and muscle between the breasts and over the sternum may detach and the two pockets for the breast implants come together into one pocket. A Uniboob look may also be the effect of implants that are too large inserted in a thin woman who has a small chest circumference.
Whichever the reason, symmastia can be addressed by extending laterally and outwards from the midline breastbone. This will create more space between the implants. This involves creating an incision below the implants and expanding the pockets laterally. The chest midline is then fixed with sutures.
In very rare cases, a treatable type of lymphoma may develop around breast implants. This may occur in patients with implants that have textured surfaces. BIA-ALCL is a type of cancer of the immune system and not breast cancer.
Symptoms for this may include pain, breast enlargement, asymmetry, a lump developing in the breast or armpit, rashes, fluid retention, or breast hardening. Symptoms can occur anywhere from 1 year to 8-10 years. Patients should see their doctor right away to be evaluated.
If this happens, the surgeon will need to remove the implant and the scar tissue around the breast implant including any lumps. Affected patients, may also have to undergo additional treatments.
Criteria to consider for Breast Revision Surgery candidates are:
Breast Implant Revision surgery is more complicated than the original breast enhancement surgery. Some of the challenges for surgeons include the presence of scar tissue, anatomical changes caused by previous implants, and the stretching of muscles. These factors make it harder to predict the surgical outcome.
The surgery steps are relatively straightforward:
Post-operative care tips for the Breast Implant Revision surgery are similar to the previous Breast Augmentation post-op care tips. Things to remember include:
The recovery time for Breast Implant Revision surgery is similar to that of Breast Augmentation. There is usually minimal discomfort that can be managed with pain medication.
In most Breast Implant Revision cases, patients can return to work within a few days with some discomfort. However, the actual length of recovery will depend on the type of surgery performed.
During Breast Implant Revision surgery recovery, patients must avoid heavy lifting and all strenuous exercise for a minimum of six weeks.
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