When is Breast Augmentation Revision neccessary?
With the number of breast augmentations that are preformed yearly, it is easy to think that these
procedures are simple and consequence free, when in fact the surgery is quite complex given
everyone's body is unique. Many times, if proper surgical technique or attention to detail is
overlooked, women have to go in for revision procedures.
Unfortunately this happens when unscrupulous surgeons try to convince patients that all
procedures are the same - when in fact the nuances of a woman's body are very unique. From the
decision of implant size, to method of insertion, to the type of implant used is a personal
decision - that must be discussed thoroughly between patient and doctor.
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What are the problems that result in revision surgery?
Three of the most common revision surgeries are due to the following capsular contracture,
changing implant size, or improving the natural feel and appearance of the breast. In many
cases there are functional issues with the very implant, and must be treated with care, the
patient nor the doctor can be held responsible for that. However, all surgeries are individual
and unique, and the best way to prevent unnecessary revision procedures is through preventative
measures.
There are three major categories that revision surgeries fall into, but many times it is a
combination of several issues. They can be categorized as:
- Problems with surgical placement or implant position
- Problems with the patient's tissue characteristics
- Problems with the implants themselves
The important part of recognizing the issue is the ability to diagnose the situation and correct
within a minimal number of follow up procedures. It is important to be upfront and forthright
with your surgeon, it is your responsibility to arm your surgeon with as much information as
possible, so the correct revisions are made.
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Are there issues with implant positioning and asymmetry?
With issue pertaining to implant positioning, asymmetry can be an issue, this can happen when
one or both of the implants is laying high up on the breast area, or when one implant is too
far wide out, up, or down in relation to the other. Another noted issue can be "bottoming out" -
this happens when the implant is positioned too low on the chest cavity, in relation to the
nipple. The nipple may appear to be too high, or in an odd spot of the breast. Other cases have
been of "synmastia", otherwise known as bread - loafing, this happens when an attempt to create
cleavage goes awry, giving the appearance of two loaves of bread on your chest.
When dealing with tissue characteristics, the problems reported usually have to do with the
nipple and areola region. Many times either the nipple or areola region is too large and gets
affected during surgery. In most cases surgeons discuss this with patients and are able to
address it, but the change may only be apparent post- surgery. "Snoopy deformity" addresses the
issue of the nipple/ areola region attaining the look of droopiness- and is something that can
easily be addressed. In some cases when a woman has breast fed, or even with the natural
progression of age, the skin becomes very thin, and if not noticed prior to surgery, the implant
may be noticed as such. This can also happen with loss of elasticity from sun exposure, smoking,
and aging.
In dealing with problem stemming from the implant itself, it can be from dissatisfaction of the
implant size. In the past surgeons used to decide for patients what size they should be, but it
is important for the patient to have a firm idea of what their desired outcome is. This can be
avoided with careful planning. Sometimes there is a rupture of the implant, in the case of
saline implants, this is quite noticeable immediately, and must be addressed quickly to prevent
any further complications. In the case of silicon implants, an MRI or another scan may be
required to diagnose the issue, and these days, implants come with a warranty, providing you
with replacement implants at no cost.
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What is Capsular Contracture and the rippling effect?
Capsular contracture occurs when the body forms a thick layer of scar tissue around the implant
causing it to either change shape or harden. This can cause pain and frustration, but is less
likely in women with saline implants vs. silicone.
Rippling is one of those combination issues, where the implant may be underfilled or perhaps
under tissue that is thinning. The rippling effect is seen through the skin and at times can
be dramatic. Double bubble can be seen at times, and this occurs when surgical placement is
ill advised and one appears to have a round implant on top of a round breast, this may happen
on one or both sides.
Once you understand these issues can happen - and that you are not alone, it will be easier to
speak with your surgeon and discuss what revision options will be right for you. It is important
to have realistic expectations and goals when undergoing any type of surgery. After the revision
procedure, most patients notice an immediate difference. There will be mild swelling and possibly
some pain, but you should be able to resume normal activities within a few days.
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Cosmetic/Plastic Surgery
