Breast Implant Revision
Breast augmentation surgery remains one of the most popular cosmetic procedures around the world with the vast majority of patients thrilled with their new proportions. With the millions of women who have had breast augmentation, there are many who require exchange of outdated silicone gel implants, some others with a ruptured implant in need of replacement and those who simply wish to change to a different size. There are also many women requiring additional surgery to correct any one of a number of breast implant problems or complications. Unsatisfactory results may be from one or more of several problems associated with breast augmentation including:
- capsular contracture (thickening, firmness, contraction and/or calcification of the layer of tissue around the implant)
- malpositioned or displaced breasts implants
- poor or unnatural shape
- asymmetry
- synmastia (implants too close or joining in the midline)
- obvious rippling or wrinkling
- deflation
- inappropriate size implant placed
- poor scars
- firmness from excessive overfilling of saline breast implants
- Asymmetry or malposition of the inframammary crease
Breast implant revision expert, Dr. Sam Gershenbaum in Miami, Florida has developed a reputation for correcting breast implant problems and has achieved acclaim for his natural appearing breast augmentation results on first time patients.
It is important to understand that every plastic surgeon will have, from time to time, a patient who has a complication or a result that is less than satisfactory which requires a “touch up” or reversion surgery. Don’t be too quick to blame the surgeon. There are many factors and variables in surgery and in healing. It is important to realize that there is always some degree of unpredictability in the final outcome of the healing process.
It is usually beneficial and appropriate to follow-up and continue care with the plastic surgeon who performed the original surgery and work through any problems or complications. Obviously, anyone who experiences a complication or poor result wishes to have the problem resolved immediately. However, working through these problems may take extended periods and will require time and patience. Frequently, it is appropriate to wait any number of months after the problem or complication before moving ahead to correct the problem. Lack of confidence, obvious poor judgment, or failure after two or more procedures may encourage one to seek a second opinion or an alternate plastic surgeon.
Correction of Asymmetry
Dr Gershenbaum points out that large number of women have significantly asymmetric breasts, and it is important to take into account the original shape and symmetry prior to any surgery. Breast sizes and shapes vary, as well as position of the nipple-areolar complex on each breast. Some breasts may be higher or lower than the other, or the asymmetry may be due to posture or curvature of the spine. Most people also have differences in width, shape and projection of the boney rib cage from one side to the other which translates into asymmetry of the breasts. Many women do not realize their asymmetries until discussed during their consultation. Conscientious and meticulous surgeons will make every effort to make the breasts as symmetrical as possible, however, original asymmetries will prevent perfect symmetry. At times, asymmetry can even become more noticeable/obvious following breast augmentation. If pre-operative asymmetry is significant, two different size breast implants may be used to accommodate two different size breasts, thereby improving the asymmetry. If one’s asymmetry involves different amounts of breast projection or width from one side to the other, there are also options to use two different breast implant profiles from low to midrange to high. Fat grafting alone or in conjunction with two different size or profile implants may also be incorporated to improve symmetry. When asymmetry involves differences in shape or position of the nipple, it may be wise to choose smaller size breast implants, with a more conservative change in size so as not to accentuate the asymmetry. In those patients who have one nipple significantly lower than the other or one breast hanging or drooping more than the other, some type of lift for that particular side may be considered along with the breast augmentation. Careful planning before the initial surgery best helps to produce optimal results.
It is also important to understand that complete healing and the final result after breast augmentation surgery truly takes several months – approaching one year – and what may be unsatisfactory to a patient after surgery may be something that will improve or resolve over time. Do not be too quick to insist that the surgeon correct a problem or concern when more time is recommended. For example, a patient happy with the left breast noted the right breast implant placement appeared too high and requested it to be corrected. However, at just under one year the high riding right implant ended up in perfect position and the left implant ended up a little too low ! In reality, it was the left implant that needed to be raised rather than the right implant lowered. Patience in the healing process is very important.
Correcting implant problems may be relatively uncomplicated or they may require one or more surgical procedures. For some, it is possible that no satisfactory result can be obtained requiring living with and accepting the “best” that can be done or removing the breast implants altogether. If removed altogether, one should wait six months to one year allowing breast tissue recoil/contraction before deciding if any type of breast lift or any other procedure is desirable. If more obvious sagging (ptosis) is present, a breast lift may be performed at the same time.
Capsular Contracture
With breast augmentation, capsular contracture is one of the most common complications with a reported incidence of about 3% to10%. Other studies have reported that capsular contracture affects roughly 10% to 20% of breast augmentation patients. Even higher incidence of this complication has been reported. Capsular contracture can form in one or both breasts after breast augmentation with implants and typically will occur within the first several months after surgery.
What is capsular contracture ?
It is well known that the body always recognizes a foreign body or any type of implant and mounts a response to “wall off” or encapsulate this foreign entity. The breast implant capsule refers to the body’s natural healing process which forms a thin, soft, fibrous scar tissue layer around every breast implant. Capsular contracture occurs when this capsule abnormally becomes thickened, firm, and contracts around the implant causing varying degrees of firmness, distortion, and sometimes pain. The greater the capsular contracture, the rounder and harder the breasts become with implants that generally become too high as well. Capsular contracture is not dangerous, though, it can be uncomfortable and even painful along with unsatisfactory cosmetic results. It is important to understand that the possibility of capsular contracture exists each time breast implants are placed or changed or manipulated in any way regardless of the history of capsular contracture or not. Capsular contracture can occur with first time patients or in patients changing, revising, or repairing problems even if capsular contracture never occurred previously.