Aesthetic Breast Revision Surgery by Dr. Ludwig Allegra

Aesthetic Breast Revision Presented by Dr. Ludwig Allegra of Aesthetic Facial Body Plastic Surgery of Bellevue | Seattle: Sometimes Breast Implant | Augmentation and Breast Lift Surgery may not achieve all that you desired for your breasts. Sometimes, due to Breast Implants | Augmentation and Breast Lift Surgery, you can have things that don't turn out just like you wanted. Other times, your breast tissues may have undergone changes due to previous surgery. This is when Revisional Redo Surgery for Breast Implant | Augmentation or Breast Lift Surgery may be required | needed. To begin with Revisional Surgery is difficult. Hence going to a plastic surgeon trained in these types of cases is paramount.

Breast implant revision surgery, will most likely involve the removal and replacement of saline or silicone breast implants. It is usually done in the setting where larger or smaller implants are replaced or due to any complications that could arise. A good contour and shape will be our combined goals. Fat grafting techniques can also be used to hide certain defects in the breasts or improve shape and size. Removal of an old capsule or creation of a new pocket may be needed. In addition, placement of mesh ie. (ADM) may be needed to correct certain deformities.

When should you consider a Breast Revision?

1. If you have noticed that your breast implants are smaller or deflated indicating the saline implants have leaked or your silicone implant has leaked. Sometimes a CT scan or MRI can help determine this.
2. You have tight scar tissue (capsular contracture) that has caused your breast implants to shift or has caused significant discomfort.
3. If you just want to change your size either larger or smaller.
4. Sometimes with age and with some skin stretching you may need to have a revision to recontour the skin (Breast Lift | Mastopexy).

Ruptured or Leaking Breast Implants:

Saline or Silicone implants can rupture or leak. If saline implants rupture typically they will deflate and the deflated side will appear smaller or flatter than the other side. If silicone implants rupture or leak they may not show any deformity of the breast unless there is a large injury to the implant or shell integrity. Saline is reabsorbed within our bodies and is harmless. Silicone on the other hand can cause an inflammatory reaction in the tissues. Silicone gel implants can be monitored for leaks by MRI. This is a recommendation by the FDA. "MRI continues to be an effective method of detecting silent rupture of silicone gel-filled breast implants. If you have silicone gel-filled breast implants, the FDA recommends that you receive MRI screening for silent rupture 3 years after receiving your implant and every 2 years after that."

(http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm063871.htm)

If your breast implants have ruptured or leaked please visit with a plastic surgeon to discuss your risks and possible revision surgery or removal/exchange of the implants.

Capsular Contracture:

"Scar tissue" Capsule formation is seen after breast implants. This is a normal phenomenon. However sometimes they can contract or become constricting. This can result in a difference in feel of the breast, shape of the breast, and or discomfort of the breast. The Baker scale is generally used to grade the severity or level of capsular contracture. Treatment can involve techniques ranging from scoring the capsule (capsulotomy) to removing the capsule either partially (partial capsulectomy) or more definitively (total capsulectomy) Acellular Dermal Matrix (ADM) meshes such as Alloderm, Strattice or Flex HD can be used as support devices for the implant or reinforcement. There is data that shows ADM mesh use can decrease the rate of capsular contracture.

Rippling:

The soft tissue envelope consists of the breast tissue and overlying skin. If this is too thin the implant and its capsule may result in a rippling or wrinkling effect on the breast. These wrinkles may be seen more evident in certain position for example when lying down or bending down. They can be seen towards the sides of the breast or in the lower inner part of the breast where there is less soft tissue coverage. In general saline has a more tendency to ripple versus silicone. But both implant types can ripple if there is not enough soft tissue coverage. Attempts to correct rippling may involve, exchange of implants, fat grafting techniques or use of Acellular Dermal Matrix (ADM) mesh.

Malposition of Breast Implants:

Breast implants can move or slide within their pockets. This can occur overtime with stretching of the tissues or rarely can be from a technical issue during surgery. Malposition refers to the implants being either too high, too low, too medial (towards the breastbone - Synmastia) or too lateral (towards the armpit).

"Double Bubble":

Refers to a line or fold that can be seen along the lower breast. This can occur if the implant falls below the native breast mound creating too bulges at the lower pole area. It can also occur if the breast tissue slides off or down over the implant creating a "snoopy deformity." Certain breast types are more prone to the double bubble phenomena such as tuberous breast deformity.Correction of Malposition after primary breast augmentation can be performed. There are multiple techniques involved. Depending on the problem, techniques employed include; capsulorrhaphy, capsulotomy, capsulectomy, exchange of implants, and Acellular Dermal Matrix (ADM) mesh use.

Complications and Risks of Revision Surgery

With Revision or redo surgery the risks are higher compared to a primary procedure (having surgery for the first time on your breasts). These risks all depend on how many previous procedures you have had, what type of surgery is being done to attempt to correct the deformity, whether new implant materials are being used and your overall state of health. These risks should be discussed in detail with your surgeon.

Click here for our Aesthetic Breast Revision Photo Image Healing Diary.