Breast Revision Surgery

Breast revision surgery may be necessary as a result of complications of breast implant surgery performed by another plastic surgeon.  These complications include: 

Deflation

Saline breast implants deflate when saline leaks through a damaged implant shell or through a damaged fill valve.  Causes of implant deflation may include physical trauma to the breast and the implant or simple wear and tear.  The loss of implant volume may be immediate or occur slowly depending on how fast the saline leaks out of the implant.  As the implant loses volume the appearance of the breast will change and appear deflated.  The implant may not be palpable after most of the saline is absorbed by the body.  The diagnosis of a leaking saline implant is commonly made by examining the breast and by comparing the volume to the other side.  Patients are usually alert to the sudden change in the size and feel of the breast and are able to relate their findings to their plastic surgeon.   

Treatment: A deflated saline implant should be removed. The implant can then be exchanged for another implant.  The size of the new implant may be changed if desired. Implant replacement is not an emergency but should be performed in a timely manner before the implant pocket begins to contract.  Implant replacement may be partially covered by the manufacturer’s warranty. 

Rupture

Silicone gel-filled implant rupture occurs as a result of a tear or hole in the shell of the implant.  The ruptured implant may then begin to leak the gel contents.  An intracapsular rupture occurs when leaked gel accumulates around the implant shell and within the scar capsule surrounding the implant.  An extracapsular rupture occurs when the gel moves outside of the implant scar tissue capsule.  The causes of implant rupture include damage to the implant during breast implant surgery, trauma to the breast, compression during mammography, capsular contracture or wear and tear over time.  Silicone gel implant rupture is usually silent and often cannot be detected by simple physical examination.  Patients may notice a subtle change in the feel or shape of the breast but the breast size may not change significantly.  MRI is the currently the best method to detect a silent rupture. 

Treatment:  Once the diagnosis of a ruptured silicone gel implant is made the implant and any leaked gel should be removed.  The tissue capsule may also be removed depending on the extent of silicone migration.  Replacement with new implants may be performed if desired at the time of removal of the ruptured implants.  The implant warranty may cover some of the cost of replacement of the implants. 

Capsular Contracture

Capsular contracture is a tightening of the scar tissue that normally forms around an implant.  As this scar tissue begins to contract the implant will become compressed and feel firm to the touch.  Symptoms of capsular contracture may range from mild firmness and slight discomfort to pain and distortion of the shape of the breast.  Implant rupture or deflation may also result.  Capsular contracture may be more common after hematoma, infection or subglandular implant placement. 

Treatment:  If the capsular contracture is severe enough to cause distortion of the breast surgery may be required.  Open capsulotomy which involves incising the scar tissue around the implant in an effort to relieve the compression can be effective.  Surgical removal of the scar tissue around the implant known as a capsulectomy may be required.  Changing the placement of the implant from a subglandular position to a submuscular position may be helpful.  Capsular contracture may occur again despite surgical attempts to correct it. 

Breast revision surgery may be performed to correct dissatisfaction with the cosmetic results of previous breast surgery due to these common problems: 

Breast Ptosis (sagging)

After breast implant surgery the breast may still have a droopy appearance.  Attempts to correct sagging breasts are sometimes unsuccessful and result in a breast that still needs to be lifted.  Surgery to provide a lift to the breast through the use of a large implant in a hope to fill out a sagging breast is often ineffective.  The weight of a large implant may result in a worsening of the sagging over time.  In some cases a partial lift may have been attempted with poor results and a resultant nipple position that is still too low. 

Treatment:  Breasts that are sagging after implant surgery need to be carefully evaluated as to the degree of ptosis which is measured by the height of the nipple areola complex on the breast.  The size and position of the implant also needs to be analyzed.  For small amounts of sagging or ptosis a periareolar or vertical lift may be effective.  For severe ptosis a more extensive lift may be needed.  The implant may need to be changed to a different size and repositioned below the muscle in some cases.  Breast lift surgery or mastopexy does result in external scars on the breast which may not be acceptable to all patients. 

Implant Malposition

Breast implants that are not at the same level or position on the chest wall may produce an asymmetry that can range from mild to severe.  One breast implant may be perfectly centered behind the nipple while the other implant may be located either too medial or too lateral on the chest.  The implant may also be too high creating an overly implanted look.  The causes of implant malposition may be a result of the initial placement of the implant during the original surgery or a migration of the implant due to natural loosening of the implant capsule or the forces of capsular contracture.

Treatment: The treatment of implant malposition involves repositioning the implants to create symmetrical breasts.  In some cases enlarging the implant pocket may allow the constricted implant to be positioned at the correct level on the chest.  For implants that are in a pocket that is too large internal suturing of the capsule known as a capsulorrhaphy may be needed.  The use of Alloderm to reinforce the capsule is often effective in maintaining the implant position.   

Bottoming Out

A type of implant malposition where the implants appear too low on the chest wall is termed “bottoming out.”  In this instance the implant will appear bottom heavy and the nipple areola complex will be located at the upper portion of the breast.  This condition is not uncommon and may result from the low initial placement of the implant or as a result of loosening or weakening of the breast tissue over time.   

Treatment:  The treatment of an implant that has bottomed out is aimed at repositioning the implant at the proper level on the chest.  The inframammary fold may have to be redefined through the use of internal sutures.  Reinforcement of the base of the implant pocket with Alloderm may also be effective. 

Double Bubble Deformity

This condition occurs when the breast implant is not located behind the natural breast tissue.  If the implant is positioned too high there may be an unnatural fullness or bulge at the top of the breast followed by the rest of the breast tissue further down.  If the implant is too low the appearance of a bubble below the breast fold may occur.  Double bubble can occur from the initial positioning of the breast implant or from migration of the implant.  In patients with a high or constricted inframamary fold an implant placed below the fold may lead to this condition if the constriction does not resolve.   

Treatment:  Double bubble deformity can be corrected by repositioning the breast implant to a more central position on the breast.  The implant may need to be lowered or raised depending on the location of the double bubble.  A reinforcement of the inframammary fold may be needed to support the implant at a higher level.  Mastopexy or breast lift may be needed for patients that have sagging breasts that hang lower than the level of the breast implant. 

Wrinkling/Rippling

Breast implants have normal folds that may be evident in some patients.  The degree of implant rippling may be minimal or severe.  Implant wrinkling is influenced by the position of the implant, amount of normal breast tissue and body fat and amount of fill volume of the implant.   

Treatment:  Breast implant rippling or wrinkling may be reduced by several means.  Converting the implant from a subglandular position to a submuscular position can reduce the wrinkling and palpability of the implant.  Changing the implant from a saline to a silicone gel implant may improve the condition. 

Symmastia

This condition occurs when the breast implants are so close together that they meet to produce the appearance of the breasts being connected.  Symmastia may result from over dissection of the breast pocket in an attempt to create cleavage or from migration of the implants.  Excessively large breast implants may also create this deformity. 

Treatment:  The treatment of symmastia may require the use of internal sutures to control the border of the implant pocket.  Alloderm reinforcement may be needed.   A smaller sized implant may need to be used to prevent recurrence. 

Scarring

Breast surgery may result in unsightly scarring around the areola or oriented vertically or horizontally on the breast.  Scars may appear widened or raised or discolored.  Thickened scars known as hypertrophic scars can occur as a result of natural healing or from complications of surgery such as infection or wound healing problems. 

Treatment: Nonsurgical scar treatments include injection of steroid into the thickened scar, application of a silicone gel patch or laser and IPL treatments.  Surgical scar revision involves removing the scar entirely and repairing the wound using multiple layers of sutures. 

Poor Size

Dissatisfaction with the size of the breasts after breast augmentation is not uncommon.  Bra size cannot be guaranteed due to the variations in bra manufacturers and lack of standardization of cup sizes.  Lack of effective communication of breast size between patient and surgeon can contribute to disappointment after surgery.  Patients should understand that one size of implants may produce different results on different patients depending on their body proportions. 

Treatment: Breast implant exchange to a different size can improve the appearance of the breast and fulfill the patient’s goals.  The implant pocket may need to be enlarged or made smaller to accommodate the new implant. 

For more breast implants / breast revision information or a complimentary breast revision consultation with the Manhattan Plastic Surgeon please phone 212.481.3939. Please feel free to contact the NYC Board Certified Plastic Surgeon, Douglas M. Senderoff, MD, FACS, today at either of his NYC Plastic Surgery Center or his Westchester (New York) Plastic Surgery Center. The Manhattan Breast Revision Plastic Surgeon will respond to your questions within 24 hours.

Contact Information

Plastic Surgeon's Manhattan Office:
461 Park Avenue South, 7th Floor
@31st Street
New York, New York 10016
(212) 481-3939

Plastic Surgeon's Westchester Office:
90 South Ridge Street
Rye Brook, New York 10573
(914) 934-5000

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