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Dr. Constance Chen is a leader in microsurgical breast reconstruction.  She specializes in DIEP, SIEA, PAP, TDAP, ALNT techniques. 

News - Zwivel Breast Revision

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DR. CHEN PROVIDED COMMENTARY FOR ZWIVEL ON BREAST REVISION SURGERY

Breast Revision Surgery: Addressing Implant Rippling and Other Common Concerns

August 28, 2017

There are different scenarios in which a woman may choose to have her breast implants removed or replaced. Here we discuss some of the many potential components of breast revision surgery.

Accordingly to the American Society of Plastic Surgeons, 98% percent of women who have undergone breast augmentation surgery say the results met or exceeded their expectations.

However, due to postoperative factors such as physical activity and scar tissue, these procedures are not entirely predictable.

If the results of a breast enhancement procedure are unsatisfactory, or if the results are compromised by an implant rupture, rippling or other unfortunate occurrence, non-surgical methods are usually ineffective. In these cases breast implant revision or replacement may be necessary.

When it comes to breast revisions, a distinction should be made between necessary and desired.

“Breast implant revision or replacement is really only necessary if a woman is having a problem with her breast implants,” says Constance Chen, MD, a board-certified plastic surgeon based in New York City. According to Chen the most common problems are capsular contracture, infection and rupture.

But some women decide to have the procedure to change their cup size or even opt for a complete overhaul to change the style as well as the type of implant (saline or silicone gel), and possibly add other surgeries such as breast lift, according to Gregory A. Buford, MD, a board-certified plastic surgeon in Englewood, Colorado.

In other words, there are many different scenarios in which a woman may choose to have breast revision surgery.

What Does Breast Revision Surgery Entail?

Before considering you for breast revision your plastic surgeon will need to review your medical history and conduct a thorough exam.

“This exam will also include details about any previous breast procedures including the type (saline or silicone), size, or style of implant used,” says Gregory Fedele, MD, a board-certified plastic surgeon in Beachwood, Ohio. “If there is a question about possible silicone implant leak or rupture, sometimes an MRI can help determine any implant irregularities.”

The techniques your surgeon will use during your breast revision surgery will depend on your unique anatomy, your reason(s) for having the procedure as well as what you’re trying to accomplish. General or intravenous sedation may be used. The breast implant replacement cost varies depending on the implant you choose, the complexity of the procedure, the surgeon’s fees and other factors.

Here are some of the many potential components of a breast revision procedure:

Implant Removal / Replacement

According to Chen, this is the most common type of breast revision. Breast implant replacement surgery is popular among patients that have experienced rippling, a rupture, capsular contracture, etc.

Your surgeon will probably use the original incision to access and remove the implant and replace it with a new one. If you opt for a larger implant, the surgeon will enlarge the space surrounding the implant (the breast “pocket”) so that it can accommodate a new implant. If you opt for a smaller implant, the surgeon will reduce the pocket using sutures.

If the original implants stretched out the skin, the surgeon may advise you to include a breast lift as part of the procedure. Again, the surgeon will mostly likely use the original incision to access the implant, and the capsule (lining around the implant) may be removed along with the implant.

Implant Removal Without Replacement

Not all women who have their implants removed opt to have them replaced with implants.

There are other options, namely breast implant removal without replacement or replacing the implant with healthy living tissue instead of an implant, the latter of which is popular among Chen’s patients. “This gives them soft warm breasts, much as their breasts felt before their mastectomy,” she says.

Breast Lift

Breast lift is a common component of breast revision procedures.

“There are a number of reasons why a breast lift may be necessary but the general indication is the need to address loose skin and tailor the shape of tissue overlying the breasts themselves,” says Buford. “Over the years, I have found the breast lift procedure to be an extremely powerful tool for achieving better symmetry and more optimal results overall.”

Whether or not a breast lift is needed depends on the specific needs of the patient as well as the surgeon’s individual approach to the overall procedure.

“For typical implant revision procedures a breast lift is not necessary,” says York Yates, MD, a board-certified plastic surgeon in Salt Lake City. “For patients who have had significant droop over time after breast augmentation they may require a breast lift for a tight, lifted look,” he says.

Other surgeons say the need for breast lift is quite common. “Many times there has been some sagging that has occurred due to pregnancy, weight gain or weight loss, age or gravity,” says Fedele. “In these cases, a breast lift or mastopexy may be required to get the desired shape and youthful appearance that patients are looking to achieve.”

And Chen adds that if a patient has very little native breast skin, and has breast implants removed after a breast augmentation, she may need a breast lift to minimize a deflated and even disfigured appearance to her breasts. However, the need for a breast lift is very individual and depends on many factors. This decision should be made in consultation with an experienced plastic surgeon.

Capsulectomy

This procedure corrects capsular contracture, or hardening of the capsule and implant. Capsular contracture can occur as early as a few months after your initial procedure to years later. While it is not dangerous, it can be painful, and it causes the breasts to appear misshapen and/or asymmetrical.

“Unfortunately,” says Buford, “many women are actually walking around with capsular contracture and are unhappy with the appearance and/or feel of their breasts but simply don’t realize that this can be fixed.”

But it can. In a typical capsulectomy the surgeon uses the same incision used in the original procedure to remove the hardened capsule and implant. The surgeon then irrigates the area and inserts a new implant. According to Buford, revision surgery to address capsular contracture can be performed in as little as 60-90 minutes and patients often return to normal activities within a few days.

Implant Rippling Correction

If you have saline implants and the edges are palpable or visible, your surgeon may be able to correct this by opening the original incisions and repositioning the implants. Another option is to replace the implants altogether. A new pocket may be created in order to cover the implant edges.

Implant Repositioning

In some cases the implant pockets may be positioned too close together or too far apart. This can be addressed.

“Implant malposition requires modification of the pocket to improve position,” says Yates. “This can be done in a variety of manners depending on the degree of malposition and support.”

Typically, the surgeon opens the original incision and works on the scar tissue of the capsule surrounding the implant in order to create a new breast pocket. The surgeon may have to use other natural tissues, or even use a special dermal matrix, to support the newly reconstructed implant pocket.

Nipple and Areola Repositioning

You and your surgeon may decide that your breasts would also benefit from elevating the position of your nipples and areolas. This will require additional incisions.

If you don’t need much elevation the surgeon can probably just create incisions around the upper edge of the areola, but if significant elevation and tightening is needed, this will most likely require an incision around the circumference of the areola, possibly including a vertical scar that extends from the bottom edge of the areola down to the inframammary fold (crease beneath the breast).

Women who have undergone massive weight loss, or who simply have significant excess skin, typically require a separate incision extending horizontally underneath the breast and following the curve of the inframammary fold. The surgeon will take care to make sure that the nipple-areolar complex remains attached to the tissue in order to preserve sensation and avoid interfering with the woman’s ability to breast-feed.

No matter what techniques your plastic surgeon uses, his or her ultimate goals should be to help you achieve beautiful, natural-looking results and to make your experience as comfortable as possible.

Choosing a Qualified Breast Surgeon

As with any invasive surgical procedure, it is extremely important that you choose a qualified surgeon with extensive experience. Buford points out that this is particularly true with revision procedures such as secondary breast surgery, which tend to be more complex due to the presence of scar tissue as well as other factors.

“These procedures tend to be far more challenging than primary breast augmentations and require a lot of creative thinking and the ability to approach the procedure with enough surgical experience,” he says. So if you’re interested in breast revision surgery, look for an experienced, board-certified plastic surgeon specializing in procedures of the breast.