Top Reasons for Breast Implant Revision Surgery

December 23, 2013
Robert T. Grant, MD, MSc, FACS

Despite the best techniques and execution during a breast augmentation surgery, changes can occur within the breast or implant that can lead a patient to consider a breast revision surgery.

Despite the best techniques and execution during a breast augmentation surgery, changes can occur within the breast or implant that can lead a patient to consider a breast revision surgery. Tissue elasticity due to age, childbirth, or implant displacement can cause a patient’s breasts to lose their natural appearance. When such changes occur, breast implant revision surgery can restore the breasts back to their more natural state and position.

During the initial consultation with a plastic surgeon, a patient’s breasts will be evaluated to decide the best course of action for the breast implant revision surgery. It is important to be honest during this consultation in order to manage a patient’s expectations and ensure the best possible results. Factors such as plans for weight loss or pregnancy can affect the results of a breast implant revision surgery in unpredictable ways. As a result, it may be best to wait on a breast revision surgery until those planned body changes are complete.

Some of the top factors that can be addressed during breast revision surgery include:

Breast implant deflation

Saline implants can rupture or leak, leading to deflated, sagging breasts. While the leaking of saline is not a health concern, the aesthetic consequences can leave the patient with lopsided or less attractive breasts. The revision surgery can be as simple as removing the deflated implant and replacing it with a new one, which also allows the patient to consider a new size or type of implant. Many implants offer a lifetime guarantee, so the cost of the implant may be covered as part of the procedure.

Change in breast size

One of the most common reasons for breast revision surgery is the desire to go bigger or smaller. Many women believe that once they have had a breast augmentation surgery, they could have happily gone for a bigger size. Simply replacing the old implants with the new ones is one of the less complex revision procedures. Having information about the original surgery and size of the implants can make this revision process go even smoother.

Capsular contracture

Capsular contracture is a situation where the scar around the implant tightens, causing the breast implants to move into an unwanted position. This can be caused by a variety of factors such as trauma or bleeding around the implant, an infection in the breast, or any sort of other unknown factors. There are many ways to address capsular contracture, so deciding on the best approach depends on the severity of the issue, which is evaluated during the initial consultation.

Implant malposition

Implant malposition can occur when the pocket that holds the implant is too large, which allows the implant to drift out of the desired position. In this case, breast revision surgery often requires internal sutures to correct the size of the pocket to properly hold the implant and may require external remedies, as well.

Synmastia

Synmastia can occur when the pockets that hold the implants in place cross over one another and meet in the middle of the chest. This causes one or both implants to shift toward each another, creating the appearance of a single large breast. This can be a difficult problem to solve, but with proper planning, it can be corrected.

Double bubble deformity

Double bubble deformity looks as if the breast implant were stacked upon the breast tissue, creating a nearly 2-tiered breast. It can occur in women who have had implants placed below the muscle and may have been in need of a breast lift, or when an attempt is made in the initial breast augmentation to lower the infra-mammary fold. As with most revision surgeries, the treatment is unique to the patient and her needs.

Implant coverage issues

When the tissue that covers an augmented breast is too thin, rippling may occur around the breast. This can often be corrected by moving implants that are above the muscle to partially below it, which is called site changing. Other techniques include fat grafting to provide additional tissue to the area, though they are still in the research phase.

Changes in breast tissue

Age, pregnancy, and significant weight loss are some of the most common factors that can cause the breasts to undergo change. When the body changes, a former breast augmentation surgery may need to be revised in order to maintain the best results. Because the changes each person may go through are different, the approaches used in this instance are varied.

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Over time, even the most successful breast augmentation surgeries can require revision. It is important that any adverse reactions from a breast augmentation procedure are discussed between the patient and plastic surgeon as soon as changes are noticed, so that a plan may be put in place to correct them.

Robert T. Grant, MD, MSc, FACS, is Chief of the combined Divisions of Plastic Surgery at New York-Presbyterian Hospital-Columbia University Medical Center and New York-Presbyterian Hospital-Weill Cornell Medical Center. He is also Associate Clinical Professor of Surgery in the College of Physicians and Surgeons at Columbia University and Adjunct Associate Professor of Clinical Surgery at Weill Cornell Medical College. For more information about Dr. Grant or to contact him, visit his website at www.robertgrantmd.com.


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