Revision Breast Surgery
Breast Revision Common Indications
This is the most common complication after having breast implants. A capsule is the fibrous lining that the body naturally forms around the breast implant (like any foreign object placed in the body). Problems occur if this capsule becomes too thick and tight, causing pain and implant distortion.
Patients with implants who aren’t happy with the volume of their breasts can elect to have revision surgery and exchange them for different sized implants. Patients may also exchange saline implants for silicone and vice versa.
Diminishing breast size, uneven breasts, pain or swelling can mean deflation or a ruptured implant (saline or silicone).
When breast tissue droops over an implant which has been placed under the muscle, this is referred to as a double bubble or high-riding implant. This usually occurs with an individual who has sagging breasts before their breast enhancement surgery.
Breast implants that bottom out can have nipples that look like they are too high or an inframammary fold that appears unnaturally low.
The breasts appear too close together and the implants look like they are touching each other. Also commonly known as a “uniboob”.
There are many reasons why a woman may want to have additional surgery, or a revision, of her breasts. Some of the most common are implant deflation, implant displacement, capsular contractures, or improper breast shape. Other reasons are to change the size of your current breast implants to make them smaller or larger or to “upgrade” breast implants from saline to silicone. If you are not satisfied or are having problems from a previous breast procedure by another surgeon, Dr. Hamawy is an experienced breast surgeon that can help you.
Dr. Adam Hamawy is leading provider of plastic surgery in New York City who is well-experienced in breast surgery and revisions. He is certified by the American Board of Plastic Surgery and the American Board of Surgery.
Before you decide to have a breast revision surgery, think carefully about your expectations and make sure you discuss them with Dr. Hamawy.
Dr Hamawy was considerate of my feelings and concerns and genuinely concerned for my heath. He listened to me as an individual and treated me with respect. His diagnosis was right on and my treatment for my condition swift. My follow up care has been kind, courteous, swift and accurate as well. I feel safe under his care and trust in him completely.N.M.
Your Breast Revision Consultation
During your first visit, Dr. Hamawy will ask you about what specific concerns you have about your breast size, shape and anything else that bothers you about their appearance. This will help him understand your expectations and if your goals can be realistically accomplished by surgery. He will examine and measure your breasts considering factors such as degree of symmetry, type and size of implants, breast shape, amount of breast tissue present, the quality of skin and the current location of your nipples on the breast.
Be prepared to discuss any medical conditions you may have, allergies, prior surgeries including breast biopsies, and medications, vitamins or other supplements that you currently take. Please bring previous operative reports, if possible, since they are important to be able to determine exactly what was done during any prior surgery. A mammogram or MRI may also be required in order to better evaluate your breasts. Photographs will be taken during your consultation to help during the evaluation and for your medical record.
If you are a smoker, you will be asked to stop smoking at least 3 weeks before your surgery.
After your evaluation, Dr. Hamawy will discuss with you operative solutions for your specific problem with the limitations and risks of each one.
Common Problems Requiring Breast Revision Surgery
- Capsular Contracture
Capsular contracture is a hardening of the lining the body forms around a breast implant which can distort the shape of the breast and may sometimes cause pain. It occurs in up to 16% of women who have breast implants and can occur as early as one or two months after the original surgery. The chance of a capsular contracture occurring is slightly higher with implants place above the muscle rather than below. There are multiple techniques used to correct this condition depending on the most likely cause and your anatomy. These techniques include opening and releasing the capsule (capsulotomy), removing the capsule (capsulectomy), implant repositioning from above to below the muscle or vice versa, and possible implant replacement.
- “Double-Bubble” Deformity
A “double-bubble” is a term that describes the appearance of the breast after having implants placed when they also should have had a breast lift as well during her original surgery to address sagginess and excess skin that was present. This gives the appearance of mound on the chest where breast should be and a second mound drooping over it where her natural breast currently is. This is fixed by doing a breast lift which should have been done originally and may require repositioning the implants to different location above or the below the muscle.
- “High-Riding” Implants
While it may be normal for the implants to appear high the first several weeks after surgery, a “high-riding” implant is one that fails to drop into normal position after the first couple months. This may be due to incomplete muscle release, scar tissue or the fact that the implants were placed too high during the original procedure. While this may occur with any technique, it is has a slightly higher chance of occurring using the transaxillary or transumbilical approaches. Correction often requires release of the scar tissue or muscle that is keeping the implants from dropping and may require repositioning the implant pocket or exchanging the implants.
- “Bottoming Out”
Bottoming out occurs when a breast implant drops below the breast crease, also known as the inframammary fold, and gives the appearance of the nipples being too high on the breast. This can occur with very large implants that are unsupported or simply due to poor technique during the original surgery if the fold is lowered too much. This is a very difficult problem to fix. It usually requires reconstruction of the capsule internally and removal of skin along the bottom of the breast for a lift. Often, additional support by using biocompatible material is needed to recreate the new inframammary fold.
Symmastia is the medical term to describe breasts that are too close over the chest and the implants appear to be touching each other. This also is a difficult problem to correct and requires surgery to recreate separate pockets for the implants under each breast and form a natural cleavage. Commonly this involves repositioning the implants from above or below the muscle and the use of a biocompatible material like acellular dermis.
- Implant Rupture or Implant Deflation
Both saline and silicone implants can rupture at any time and should be replaced as soon as possible to reduce scar tissue formation. With saline, the implants immediately deflate when they rupture and it becomes apparent right away. The silicone implants tend to be less obvious when they rupture and often require and MRI to confirm the fact. In these instances, a woman often may complain of pain or a recent change in the way the breast looks or feels. The most common reason for an implant to rupture is normal wear and tear over time, which is why most women who have a breast augmentation will need a second operation or revision at some point later in life. Other causes can be due to breast trauma or accidental deflation during another surgical procedure near the breast implant. If the implants are not replaced soon after rupture, a severe capsular contracture can develop making it more difficult to reform a natural breast shape.
- Implant Exchange or Implant “Upgrade”
Many women are not satisfied with their current breast implant size and may want to have the implants replaced with ones that are larger or smaller. Larger implants can be replaced safely if there is ample tissue coverage and room to place them. On the other hand, going smaller may require a breast lift in order to reduce the size of the pocket and tighten the shape around the new implants. Finally, since the FDA approved the use of silicone gel implant again in the United State in 2006, many women who had saline breast implants before that are choosing to exchange them and “upgrade” to the new gel implants.
The Day of Breast Revision Surgery
Before surgery, you will be given medicine to lessen the anxiety and pain. You will be completely asleep under general anesthesia or “twilight” sedation if you prefer. You will meet your anesthetist before your procedure and he or she will answer any questions you may have about your anesthesia. Depending on the procedure and extent of the problem, the surgery usually takes from 1 to 3 hours. After your procedure, you will wake up in a recovery area where you will be closely monitored.
Surgery usually is performed as an outpatient procedure or at one of several local hospitals. Be sure to arrange for someone to drive you home and stay to help you the first few days while at home.
Your Recovery After Breast Revision
Surgeries and recovery vary tremendously depending on the type of revision and extend to the problem being corrected. Most women return to work within one or two weeks however, Dr. Hamawy will be better able to discuss your recovery and instructions after your consultation.
Your follow-up visits will usually start in 3-4 days following your surgery for a checkup then at 3 weeks, 3 months, 6 months and one year. Be assured that your relationship with Dr. Hamawy does not end after your surgery. If you have any concerns during your recovery, or have more questions at a later time, you can always contact Dr. Hamawy.