Are you thinking of having your breast implants revised? You’re not alone. A study published in the Aesthetic Surgery Journal found that as many as 25% of breast augmentation patients had their breasts revised in the first year following their procedure.
A breast augmentation revision, or revisionary breast augmentation, is a cosmetic procedure that allows a patient to improve the appearance or comfort of her previously enhanced breasts. A surgeon can replace breast implants to reduce, enlarge, or reshape the breasts. Revisionary augmentation can also change how breasts feel; some women find they don’t like the feel of saline implants and want to switch to more natural-feeling silicone implants, while others have a complication that causes their breasts to become hard and firm.
For many women in Honolulu and Hawaii, breast augmentation revision is an opportunity to address dissatisfaction or complications with a previous breast enhancement surgery, and finally get the results they dreamed of.
To understand why some breast surgery patients need revisionary surgery, let’s first consider what they desired from their original augmentation results. Regardless of their particular size and shape goals, breast augmentation patients want soft and symmetrical breasts that will maintain their shape, size, and texture over time.
Most patients who seek a revisionary procedure do so because they want a change in implant size or style, but I also see patients who have experienced complications or are unsatisfied with the results from an augmentation they had performed by another surgeon.
Many breast surgery patients who seek revisions to their initial breast augmentations for reasons other than personal preference want to correct one of the following:
Malposition refers to the poor placement of one or both breast implants and can result in an unnatural appearance (e.g. one or both breasts are too high, too close together, too far apart, or unequally placed). Malposition can be prevented by choosing a skilled, board certified plastic surgeon.
Capsular contracture is the most common issue associated with breast surgery and arises from the body’s inflammatory reaction to the breast implant(s). When the breast tissue becomes inflamed, fibrosis occurs through the production of collagen, leading to excessively painful and firm breasts. Although it is the most common post-surgical complication, capsular contracture only occurs in roughly 10% of breast surgery patients.
Ptosis—the medical term for sagging—happens naturally in breasts over time. Waterfall ptosis, or the “waterfall effect,” refers to the ptosis of breast tissue over a stationary implant, creating a wavy appearance that is most visible from the side. Waterfall ptosis generally occurs in women with naturally larger breasts because a woman needs to have enough breast tissue for it to “fall” over the implant. If you are experiencing waterfall ptosis in your breasts and would like to address it, I may recommend undergoing a mastopexy to lift the breast tissue back into place above your implants and return the youthfulness and “perk” to your breasts.
At the Breast Implant Center of Hawaii, I regularly help patients who:
While I’m often able to access the implant through the original augmentation incision to prevent or minimize any additional scarring, breast augmentation revision surgery is by definition more complex and requires a special approach to create the most aesthetically pleasing results possible. These are some of the revisionary breast augmentation techniques I utilize:
I will typically create a new implant pocket within the breast if a patient has experienced the rare side effect of implant rippling (when you can see the folds and/or wrinkles of an implant in the breast), or if the implant needs to be repositioned. In this process, the original implant pocket is incorporated into the new pocket, which will have thicker muscle coverage and tissue to cover the implant.
I may choose to modify an existing implant pocket if a patient wishes to increase or decrease the size of her implant. I will also modify implant pockets to address capsular contraction in the breast by removing the implant and the hardened tissue surrounding it.
Another reason I may modify a breast implant pocket is to correct a flipped implant. While my patients never have to worry about their breast implants flipping because I only use smooth, round, silicone implants, implant flipping is not an uncommon phenomenon in breast augmentation patients. I regularly see patients who have had their breast augmentation performed elsewhere and have been victims of implant flipping. Though this isn’t a serious health risk, it can be uncomfortable, unsightly, and can cause long-term damage if not corrected. For these patients, I re-enter their breast pockets through their original implant incisions and “re-flip” their implants, as well as tighten their breast pockets to prevent another flip.
Breast implants are either located below your glands (subglandular) or below your glands and muscle (subpectoral, submuscular, or dual-plane). Placements in both locations are acceptable, however, surgeons will assess your unique body type to determine which implant position is right for you. I may choose to change the site of an implant to tighten breast skin that has stretched over time, or to remedy implant rippling and/or capsular contradiction.
Nipple-areola repositioning/resizing may be required if:
Often I am able to simply make a small incision on the upper portion of the areola, but occasionally an incision around the entire areola is needed to lift the nipple—in which case I maintain the areola’s attachment to the underlying breast tissue, helping to ensure healthy and aesthetically pleasing nipples.
Recovery from a breast augmentation revision is very similar to the recovery you experienced after your initial breast augmentation. Recovery from a breast implant exchange can even be shorter than the original breast augmentation since space has already been created in the breast, and the muscles aren’t forced to undergo any additional trauma.
Following your breast revision surgery, a compression bra may be worn to ensure your breasts have the stability they need to heal properly. Our expert staff at the Breast Implant Center of Hawaii and I will help you choose appropriate, supportive garments for your healing breasts.
In some cases, tubes may also be attached to the breasts to allow fluid to drain in the days immediately following surgery. While this may sound a bit unpleasant, placement of drains can speed your recovery and help you get the best possible results.
If you aren’t satisfied with your breast implant results and need revisionary surgery, it may be hard to know who to trust—and it’s true that you need to be especially selective when seeking corrective surgery. Choosing a board certified plastic surgeon with extensive experience in revisionary breast procedures is the best way to ensure you get optimal results from your revisionary breast augmentation.
My name is S. Larry Schlesinger, MD, FACS, and I am a board certified plastic surgeon with over 30 years of breast surgery experience. I specialize in breast implant surgery, including breast augmentation revision. Contact my practice, the Breast Implant Center of Hawaii, online or by calling 808-597-8835 to plan your personal consultation. I look forward to speaking with you!