Breast Revision Surgery

Patients who have undergone either cosmetic or reconstructive breast surgery sincerely hope that the benefits they have enjoyed will last forever. Adults are, however, keenly aware that the process of aging is certain to take its toll on our youthfulness.

Loss of shape, symmetry, and volume are common issues for these women, and it is common for occasional revisions to be recommended. With a fresh approach and the desire for change, revision surgeries offer these patients an option for maintaining their autonomy.

Successful aesthetic procedures have their day in the sun, but eventually lose some of their luster. Fortunately, barring contra-indications, most prior cosmetic and reconstructive breast procedures can be successfully revised. These modest improvements can add additional years to the patient’s initial satisfaction.

Most patients seeking surgical revision have definable issues for which there are usually solutions.

The following is a list of common problems women have with previous breast surgeries:

• Asymmetry
• Ptosis
• Capsular contracture
• Implant rupture
• BIA-ALCL
• Implant pocket distortion
• Inappropriately sized implants
• Scars

Asymmetries of breast width, projection, volume, and shape are common complaints. First, understand that asymmetry is normal; no person is perfectly symmetrical. When the asymmetry reaches a personal threshold for the patient, they will consider revision surgery.

Treatment is based upon the root cause of the asymmetry and could necessitate changing the size of one or more of her implants and/or adjustment of the implant pockets. Other procedures used in the management of asymmetry include breast reduction, mastopexy (breast lift), and liposuction.

Ptosis is the medical term for sagging. Ideally, the nipple/areolar complex should sit at or above the bottom fold of the breast; the surgical method of correcting this problem is called mastopexy. Ptosis can occur naturally in women with no previous breast surgery. Pregnancy and prior breast surgeries may impact a patient’s risk of developing ptosis.

Ptosis associated with excessively large breast implants is best treated with mastopexy, pocket repair, and smaller implants. During mastopexy, your natural breast tissue is moved to a more optimal location in the breast and therefore can now significantly contribute to your breast’s size and shape. In other words, the mastopexy makes up for the reduction in implant size.

All breast implants develop a layer of surrounding scar tissue known as the capsule. This is a normal response to the presence of the implant and is usually of little consequence. If, however, the capsule becomes thickened and/or shrinks, then the implant will become progressively distorted and may become associated with pain.

The scientific community has not yet reached a consensus as to the etiology of capsular contracture and treatment for this condition is based upon severity of symptoms. A mild case of contracture might make the effected breast a little firmer to the touch and does not require treatment. In its severest form, the shrinkage of the scar tissue distorts the appearance of the breast and is associated with pain.

As a minimum, treatment for higher grade capsular contractures involves incision/excision of the capsular (scar) tissue and either removal or replacement of the existing implants. Unfortunately, patients who have developed significant capsular contracture in the past are at increased risk to develop a future recurrence, despite appropriate treatment.

Fortunately, implant rupture is infrequent. Sudden loss of volume from a saline implant is usually apparent within a few hours. Leakage from a silicone device may go undetected for a long time. Any sudden change in status with an implant should trigger a workup by the plastic surgeon. The breast MRI is a reliable tool to assess the integrity of a silicone implant.

FDA-approved silicone implants, available in the United States, are safe, excellent devices. However, they merit caution. After 15 to 20 years, a silicone implant will become old enough to have an elevated risk of leak or rupture. Older silicone implants should be electively replaced or removed. Saline devices may stay in place for as long as they are intact.

Implants with textured surfaces have been associated with an extremely rare type of non-Hodgkin’s lymphoma known as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). It is recommended that patients with textured breast implants have them electively removed, along with the entire capsule (total capsulectomy) and appropriate diagnostic studies.

As the years pass, the weight of a breast implant (saline and silicone) will influence the local soft tissue. Gradual stretching of the boundaries of the implant pocket will allow the implant to move in a down-and-out direction. Thus, when lying on her back, this patient may sense that her breast implants move toward her armpits, resulting in a loss of cleavage. Downward stretching – or bottoming out – of the implant pocket takes the implant out of its optimal location leading to gradual loss of fullness in the upper portion of the breast.

Implant pocket distortion may be associated with breast implants of all sizes, albeit it is usually more severe in patients with excessively large implants.

Treatment involves surgically revising the pockets and replacement with new implants. When the outer and/or lower boundaries of the pockets are tightened, the new implants are returned to their optimal location. The appropriately sized new implant, stabilized in its newly remodeled pocket will give the patient superior performance.

Excessively large breast implants are associated with predictable problems, such as premature sagging of the breast, stretching of the skin, and internal distortion of the implant pocket. These factors contribute to malposition of the implant. This problem can be managed with the appropriate breast lift procedure, a pocket repair, and downsizing the implants.

Scars of any kind are seldom welcome on the female breast. Patients may be bothered by the scars from previous cosmetic breast procedures or something as routine as the removal of a mole or skin cancer. Most can be successfully managed with scar excision and thoughtful repair.

Most women enjoy excellent results from cosmetic and reconstructive breast surgery. However, periodic upgrades may be required. Each patient has a unique set of problems and after a thorough evaluation a coherent plan of action can be formulated.

Dr. McGovern will discuss your options during your consultation in one of our two Georgia offices. Call 912.920.2090 or schedule your complimentary and confidential consultation online.

Meghan McGovern

“My passion is helping you find the best plan for the results you want to achieve. Whether it’s a surgical approach or a non-surgical alternative, I will always do what’s right for you. I am driven by providing highly personalized care and impressive results, helping you achieve your dreams.”