Breast Revision Surgery
An overwhelming majority of women who have had elective breast surgery including breast augmentation, breast lift or breast reduction have been extremely happy with their results. The impact on their lives physically, mentally and emotionally has usually been extremely positive. Among the happiest and most satisfied plastic surgery patients that we have are those women who have undergone either a breast enlargement or a breast reduction. In fact, a very frequent comment that we hear from our breast reduction patients is “why did I wait so long to do this?”
Nevertheless, not all results live up to expectations for any of a number of reasons and they also shouldn’t be expected to last forever. Some suboptimal outcomes can be technique or skill related where there were deficiencies in the performance of the surgery. Patient based factors can include genetics, compliance, misconceptions, injury and health related issues. Implants do not necessarily last forever and may eventually have to be replaced or removed. Finally, results do change with time and are not static – skin stretches, implants deflate or rupture, we get older, our weight changes or our tastes change. For these and many other reasons, there may be a need for a secondary procedure, also known as breast revision surgery, in order to address one or more of these issues.
Listed below are some of the more common or significant reasons for deciding to undergo breast revision surgery:
- Breast Size
- Breast Asymmetry
- Changing From Saline to Silicone Implants (or vice versa)
- Repositioning the Implants From Submammary to Submuscular (or vice versa)
- Malposition of the Implants
- Implant Pocket Configuration Issues
- Capsular Contracture
- Implant Rupture
- Implant Removal
- Implant Induced Rippling of the Skin
- Skin Stretching
- Saggy Breasts (ptosis)
- Breast Contour Issues
- Nipple-Areola Issues
- Undesirable Scarring
- Implant Exposure
For breast enlargement, it seems that the most common issues are … size, size and size! Most all of the time, the dissatisfaction is that the breasts either were not enlarged enough initially or that they are not big enough now. Rarely is the complaint that the breast implants that were placed were too large.
Breast reduction patients are extremely happy that they are much smaller and rarely do they voice concerns about size. Women who have had substantial weight gains or losses or continued breast growth subsequent to their initial procedures may decide later on to make adjustments to their breast size, either larger or smaller.
Virtually all women have some asymmetries of their breasts prior to surgery though they may have not noticed them previously. These can include differences in size, shape, location on the chest wall, chest wall irregularities as well as differences of nipple size, shape and vertical height. Although it may be possible to partially compensate for some of the asymmetries, the breasts never will be identical following surgery. Sometimes, some of these differences can even be magnified afterwards.
Changing From Saline to Silicone Implants (or vice versa)
Silicone implants provide a naturalness and consistency similar to the female breast which the saline implants don’t have. They are superior in many other ways including durability. Close to one hundred percent of Dr. Turkeltaub’s patients when switching implant types, will go from saline to silicone implants. It is extremely unusual for a patient elect to change from silicone to saline implants and when it is requested, the reasons are not aesthetic ones – usually related to cost.
Repositioning the Implants From Submammary to Submuscular (or vice versa)
There are several important advantages of having breast implants in a submuscular (behind the muscle) pocket, which is Dr. Turkeltaub’s preference, as compared to a submammary one (in front of the muscle). By repositioning the breast implants from in front of the muscle, the location which is most often associated with problems, to behind the muscle, many of these issues can be addressed. The reverse can be performed though there are far fewer indications to do it.
Malposition of the Implants
Implants may not be situated exactly where they should be on one or both sides. This can be the result of pre-existing anatomic asymmetries that weren’t taken into consideration or just a lack of precision in their placement. As a result, the implants may be too high or low or too close or far apart relative to their ideal position or even asymmetrically placed.
Implant Pocket Configuration Issues
In order to be able to insert a breast implant, a pocket (space) is surgically created either in front of or behind the chest wall muscle. When performed without precision, these spaces can be too large, too small, too close together or higher or lower than ideal. This can result in an abnormally wide space between the breasts or not enough resulting in a confluence of the breasts called symmastia (or a“uni-boob”). The implants can also be situated too low, not low enough or asymmetrically. When the pockets are over-enlarged, the implants can slide too far out to the side when a woman is lying down or even leaning to one side.
Capsular contracture is the situation where the body forms firm, constricting scar tissue around the breast implants, deforming their shape and causing the breasts to feel hard and appearing distorted. This was far more prevalent in the past particularly for those women whose implants were placed in front of the pectoralis muscle. The incidence was also much higher with the older style silicone implants versus the ones that are available today.
Even though breast implants are quite durable, they should not be considered to be permanent, lifetime devices. Given a long enough time, they will all have to be replaced or removed. Silicone implants generally last notably longer than saline implants.
Though it is not very common, some women decide that they no longer want or need their implants.
Implant Induced Rippling of the Skin
This is almost universally associated with saline implants. The severity and incidence is much higher also in those women with thin skin, large saline implants and saline implants placed above the muscle.
Because of the effects of gravity combined possibly combined with other factors, women who have undergone a breast reduction will note that their breasts won’t maintain their initial postoperative shape. Their skin will continue to stretch to variable extents and may descend on the chest resulting less fullness higher up and more lower down, a condition known as “bottoming out”. This situation can be exacerbated by significant weight fluctuations, pregnancy and not regularly wearing supportive bras.
Very large breast implants, particularly those placed in a submammary position in women with diffuse stretch marks, can also lead to markedly stretched and thinned out skin resulting in elongated, deformed breasts.
Saggy Breasts (ptosis)
Independent of surgery, most women’s breasts will droop over time due to factors such as gravity, aging, weight fluctuations, pregnancy, and genetics. This sagging of the breasts (ptosis) could be surgically addressed surgically by a breast lift (mastopexy) in order to regain a more normal, rejuvenated shape.
Breast Contour Issues
The breasts can be abnormally shaped due to congenital or developmental issues (tuberous breasts) or have contour irregularities or creases that may or may not be avoidable (double-bubble deformity) or are related to technical skills.
The nipple-areola complexes (nipples and the surrounding pigmented area) can be too large or small, too high or low on the breast or abnormally offset horizontally, asymmetrical in position or shape, irregular in configuration, inverted or over-projecting. The etiology can be congenital, post-surgical or traumatic in nature.
Surgical incisions don’t always heal in a desirable fashion, leading to scars that can be too wide, hyperpigmented (dark) or painful such as with hypertrophic scars and keloids. Scar revision or other techniques may need to be used in order to improve the ultimate appearance.
Fortunately, infections following cosmetic breast surgery and breast reductions are relatively infrequent. When they do occur, a course of antibiotics if often effective. If a significant infection occurs in the presence of breast implants, they may need to be removed either temporarily or permanently.
Infections are more common in breast reconstruction, particularly in women who have had radiation therapy. These can be far more difficult to successfully treat without removing the implants.
This is a relatively rare problem in which the breast implant actually erodes through the skin over time and becomes “exposed”. The most common situations leading to this occurrence are protracted breast infections, massively large breast implants (especially saline ones) placed above the muscle in women with poor elasticity and very thin skin, and implants that are improperly placed or are of inappropriate size in breasts previously irradiated for breast cancer.
Schedule Your Consultation Today
With more than 22 years of providing plastic surgery in Scottsdale and Phoenix, Arizona, Dr. Turkeltaub has extensive experience in breast revision surgery. Even though results can never be guaranteed, a patient has a much greater likelihood of obtaining a more ideal outcome by selecting a board certified Plastic Surgeon who is very experienced, has a comprehensive understanding and appreciation of aesthetic ideals, can offer and lucidly explain the full spectrum of options, and is highly skilled technically. Contact our office to schedule your consultation.