More popular than ever, breast augmentation surgery offers the vast majority of patients a thrilling satisfaction with their new proportions. There are, however, many patients that require additional surgery to correct problems with breast implants from previous procedures, to exchange outdated silicone gel implants, or simply to change to different size implants.
Dr. Sam Gershenbaum, founder and director of the Aventura Center, home of Dr. G Cometic Surgery near Fort Lauderdale and Miami, has developed a reputation for correcting breast implant problems and has achieved acclaim for his natural appearing breast augmentation results on first time patients.
Previous Surgery Corrections
First, 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 reversional 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.
Unsatisfactory results may be from one or more of several problems associated with breast augmentation including:
- capsular contracture (thickening, firmness and contraction of the layer of tissue around the implant)
- malpositioned or displaced breasts implants
- poor or unnatural shape
- synmastia (implants too close or joining in the midline)
- obvious rippling or wrinkling
- inappropriate size
- poor scars or firmness from excessive overfilling of the breast implants
Contact Dr. Sam Gershenbaum, located between Fort Lauderdale and Miami, Florida, if you are experience any of these problems with your breast implants.
Breast Asymmetry Correction
Dr. Gershenbaum also specializes in breast asymmetry correction surgery. Understanding that a large number of women have significantly asymmetric breasts, it is important to take into account the original shape and symmetry prior to any surgery. Many women do not realize their asymmetries until after breast augmentation surgery, when their inspections become more intense. 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. 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.
Capsular Contracture Correction
With breast augmentation, capsular contracture is one of the relatively common complications that has been significantly reduced by placing the implants in a submuscular position. Capsular contracture is still reported in some studies, from 3 to 5 percent and even higher in other studies The capsule refers to the normal thin, soft, fibrous scar tissue layer that forms 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.
The exact cause of capsular contracture is unknown. Capsular contracture may be caused by one or more contributing factors including: infection or “subclinical” infection, hematoma (collection of blood around the implant), talc powder on surgeons gloves, subglandular (over the muscle) placement, reaction from micro “bleed” of silicone gel from the older liquid silicone gel implants or by other yet unknown causes.
Even with all aspects of the procedure performed correctly, breast augmentation patients will still have to accept a small risk of capsular contracture to varying degrees, which may need surgical correction.
Treatment for capsular contracture generally entails surgically removing the firm and thickened capsule and placing the implant under the muscle. If the implant is already under the muscle, the capsule is incised and released creating a more appropriate and enlarged “pocket” or space to accommodate the implant. In some instances, the thickened and firm capsule (scar tissue) may be partially or completely removed as well. More recently the use of Strattice, an acellular porcine dermal graft, interposed into the area of the capsule that has been opened or placed partially around the implant has showed great success in treating the capsular contracture and turning firm breasts into soft, supple breasts. Although the exact mechanism is not yet understood, it is thought that the acellular dermal matrix, Strattice, when interposed into a capsular contracture, the continuity of the contracture is disrupted. Surgeons have varying opinions and approaches in using Strattice in treating capsular contracture and no guarantees can be made as to it’s effective use. Dr. Gershenbaum, however, has had tremendous success in treating capsular contracture with Strattice.
Breast implants may also be exchanged, depending on the original implants and any other associated problems. The off label use of Accolate® or Singulair, medications used for asthma, have shown some limited success in treating capsular contracture as well.
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. For those who have capsular contracture, this problem may recur again after corrective surgery-there is no guarantee although Dr. Gershenbaum has had great success with the use of Strattice. If the attempt at correction fails, and contracture recurs, it maybe decided to try a different type of implant. The only other options would be to live with the firmness or remove the implants altogether.
Additional Breast Implant Deformities
There are several different types of breast implant deformities that previous cosmetic surgeries can have resulted in. At our Miami cosmetic surgery center, Dr. Gereshenbaum specializes in assessing improperly positioned or misshapen breast implants by adjusting the capsule around the implant. It is this capsule that forms the walls or boundaries of the “implant” pocket or space. If an implant is too low and/or too far out to the side, the capsule is repaired or closed down along the bottom and/or side to reposition the implant. Conversely, if the implant is too high or too close to the middle of the chest then the capsule would be opened at the base or side allow greater room and repositioning of the implant. Frequently, corrections call for both releasing the capsule in one or more areas and repairing the capsule in the other areas. It may also be desirable or necessary to change the size or type of implants used when both breasts are to be corrected. Depending on the quality of the patients tissues and the extent of the problem, Strattice, an acellular porcine dermal matrix graft may be recommended to help secure the repair due to it’s inherent sturdy quality.
Strattice is also an option to correct synmastia, which is when the breast implants are too close or touching in the midline. Strattice is sewn to the chest wall and the anterior capsule on each side of the midline to prevent the implants from being too close together. At times this can be accomplished with the use of one’s own capsular tissues, however that would need to be determined at the time of surgery.
Poor shape may be due to the above problems of capsular contracture and/or malpositioned implants. Poor shape may also come from poor choices in implant size or implant shape. Was too large an implant used or an “anatomical” or teardrop shaped implant used that rotated and doesn’t look natural? Poor shape may also be due in part to original pre-operative natural problems in shape or symmetry that have been overly accentuated with breast augmentation. Maybe a more conservative size implant would not have made the original problems in shape or symmetry so obvious. For instance, if the “lower pole” of the breast, that area of breast below the nipple, is insufficient as compared to the upper portion of the breast, an implant will naturally tend to “ride” high. If too large an implant is used in this instance, the breast will be too full on top for a satisfactory result and the nipples will appear too low. A common mistake some surgeons make is to excessively over-dissect the natural inframammary crease to lower the implant which may create a “double-bubble” deformity. A “double-bubble” deformity is where the implant is excessively lowered in an attempt to make it fit., however a portion of the implant bulges unnaturally below the inframammary crease creating a “double-bubble” effect. This deformity must be corrrected surgically. Hence, there are certain shaped breasts that do not allow anything but conservative size breast implants.
The only alternative for a somewhat larger size would be to use the technique of “expansion breast augmentation” using expandable breast implants which expand the breasts over time using a multi-step procedure for expansion, thus allowing larger size breast implants. It is also possible that the original shape of the breast may also be improved at with this expansion breast augmentation procedure. For instance, “tuberous” breast deformity is a relatively common condition where the breast tissue herniates or bulges into the nipple area creating an overly full or protruding areola (pigmented area around the nipple). Breast implants in combination with this deformity or condition would tend to produce overly projected or pointed breasts. There are different procedures to correct this problem that can be done at the time of the original breast augmentation.
Poor shape may also be due to the wrong choice of procedures. Was only a breast augmentation performed when a breast lift was also needed producing a “snoopy-dog” appearance. In this case, some type of breast lift would need to be performed.
At times, especially in thinner patients, poor shape and a less natural appearance may be associated with implants placed on top of the muscle. Breast implants placed on top of the muscle are more likely to show waves or ripples made by the implant, especially textured implants. Smooth implants move inside the “pocket” or space under the muscle and slide to the most dependent area within he capsule which also more closely mimics natural breast movement. A textured implant, on the other hand, adheres to the overlying tissues and is much more likely to reveal noticeable rippling or waves on the breasts, especially in thinner patients. Implants placed over the muscle may tend to sag more over time due to the weight of the implants in the breasts.
The benefits of placing the implants under the muscle include a lower incidence of capsular contracture, a lower chance of obvious rippling or wrinkling, less ability to feel the implant, and a more natural slope to the breast because of the additional muscle coverage. Also, with the implants behind the muscle, mammograms are easier to review.
Other problems include deflation of saline implants, which has an incidence of approximately one percent in five years. Deflation can happen rapidly or slowly over weeks or months. The chances of deflation (leaking) can be increased by under-filling implants by the surgeon, which causes more creasing and eventual wear and tear overtime and premature deflation. Over inflating a saline implant likewise can cause premature deflation by having excessive pressure inside over time. The implant is warranted for life and will be replaced by manufacturer if deflation occurs. Manufacturers have programs available to help defer costs of replacement if or when deflation occurs.
Simple replacement of deflated saline implants can be performed through the previous scar and recovery time is very minimal compared to the original surgery.
There are times when simply too large of an implant was used to obtain a desirable result. Smaller implants may be all that is needed to improve overzealous attempts at breast augmentation. Conversely, some may wish to increase their breast size to improve body symmetry and proportions. This will generally entail exchange to larger, but appropriate size implants and further opening of the capsule to accommodate larger implants.
Attempting to improve or correct breast implant problems often involves many decisions and may require more than one procedure to obtain the desired improvement. It requires time and patience during the healing process as well. It is also important to understand that any attempt at corrective or revisional surgery will always carry with it some degree of unpredictability, as well as the associated risks and expense. This attempt at corrective surgery may result in no obvious correction of the problem or complication, unsatisfactory correction, worsening of the problem, or even additional complications.
Contact Dr. G for Breast Implant Correction Surgery
If you’re unhappy with the results of your previous breast augmentation procedure, get the best breast implant surgeon in Miami to make it right. For breast augmentation revision in Miami Florida or breast implant removal contact board certified plastic surgeon Dr. Sam Gershenbaum. Dr. Gershenbaum services areas throughout Florida including Aventura, Boca Raton and Palm Beach