Last updated date: 04-May-2023
Originally Written in English
Revision Breast Surgery
A variety of procedures may be employed in revision breast surgery to re-design or reshape the breasts. Some women have less-than-ideal aesthetic outcomes after cosmetic surgery, or their results may have changed due to weight fluctuations. Some women may suffer symptoms such as tightness or soreness following breast surgery. The results of breast reconstruction may have evolved, especially with implant reconstruction.
Correction of cosmetic breast surgery or post-reconstruction issues involves the surgeon's experience, judgment, and skill. Female plastic surgeons are well aware of how your sentiments about your breasts can affect your self-esteem and femininity. Their goal is to make you feel and look better by providing the outcomes you desire. As a surgeon who performs complex breast reconstruction surgery weekly, their skills and expertise are directly transferable to all types of breast revision, whether reconstructive or aesthetic.
Revision breast surgery may encompass a variety of operations such as revision of breast implants, contouring of previously elevated or lowered breasts, or correction of ugly scars. Breast reconstruction results can alter over time, especially with implant reconstruction. Revision can require several treatments ranging from fat grafting to removing the implant and beginning with a different type of reconstruction.
What is Revision Breast Surgery?
Breast revision surgery entails removing old saline or silicone implants and replacing them with new implants. If you notice any changes in the shape or contour of your breast, you should consider breast revision. Breast revision surgery is always more difficult than primary surgery because surgeons are operating in an area where scars and tissue have already been removed or altered. While there are no promises about the result, the goal is to achieve the most attractive result feasible from the tissue They have, with the best harmony and a natural outcome that is proportionate to the rest of the body.
Revision Breast Surgery Benefits
It is typical for the outcomes of your first breast augmentation to change over time, such as a change in volume, shape, or symmetry. As a result, one advantage of breast revision surgery is that it can help patients renew their breasts and recover confidence. Furthermore, both the implant and the breast tissue can age after childbirth, thus breast revision surgery can help to stretch the skin following an initial breast augmentation. Breast implants normally last between 10 and 20 years before they begin to change, requiring a revision to prolong the effects of breast augmentation.
Revision Breast Surgery Indications
The culpability of the implants. Sientra, Allergan, and Mentor are the three biggest implant manufacturers in the United States. Patients are covered by warranties from all three of these manufacturers.
Capsular contracture. Excess scar tissue causes discomfort, stiffness, and apparent breast deformity in some people. In these cases, a breast revision usually entails an open capsulectomy. The whole capsule that surrounds the implant is removed during this surgery. Often, removing the capsule softens the breast, reduces obvious deformity, and relieves the patient's discomfort.
Capsulorrhaphy. The capsulorrhaphy operation, also known as a pocket correction, is one of the most common breast revision surgeries performed. Internal sutures are utilized to seal the pocket that is causing the implant to slide.
Neo-submuscular pocket. When the initial or replacement implant does not fit adequately in the breast implant pocket, a new pocket is formed above or below the existing breast pocket. The new pocket can correct problems such as capsular contracture, implant malposition, rippling, and so on.
Rippling. Rippling can occur as the tissue surrounding the implant thins. Patients may notice and feel this rippling through their skin. In this example, a breast revision may involve a patient switching from saline to silicone implants, or switching from one type of silicone to a more cohesive silicone gel. Other techniques include injecting the patient's fat into the thinning portions or introducing an acellular dermal matrix (ADM) to the internal capsule, such as strattice, alloderm, etc., to enhance thickness.
Silicone gel implant rupture. Another reason individuals choose to have a breast revision is implant rupture. When a silicone gel implant breaks or ruptures, the gel stays within the capsule. Because very few changes in the appearance and feel of the breast may occur, establishing that a silicone gel implant has burst may necessitate an MRI or ultrasound.
Saline implant deflation. In contrast to when a silicone gel implant bursts, when a saline implant deflates, the size or shape of the breast usually changes. These modifications occur as the body absorbs the saline that has seeped from the implant. While saline is not harmful to the body, if you have saline implants and observe any changes, call your doctor. You should have a breast revision done as soon as you notice these changes. If you wait any longer, reopening the pocket may necessitate a more thorough breast revision procedure.
Double bubble deformity. When a patient has a double bubble, it means that the implants have fallen beyond the patient's anatomical inframammary fold (IMF). To correct this, a breast revision typically entails an open capsulotomy or capsulectomy with scar tissue release or removal, implant repositioning, implant exchange if necessary, recreating the original IMF (usually breached during the previous surgery to accommodate a large implant), and, times, formal mastopexy, which includes addressing skin laxity along the vertical and inframammary planes.
Bottoming out. Bottoming out reflects that the implants are too low in the chest, raising the nipple. This problem is more common in skinny people since they have less tissue and skin to support the weight of the implants. The weight of the implants leads to tissue strain, resulting in implant malposition. Bottoming out can be caused by either silicone gel or saline implants. However, this problem is more common when an implant is put above the muscle. Breast revision surgery to address bottoming out entails rolling up the scar tissue at the bottom of the pocket, capsulorrhaphy, ADM usage, or the creation of a neo-pocket.
Who is a Good Candidate for Breast Revision?
Ladies who have undergone breast surgery in the past and want to rejuvenate their results due to a shift in shape, volume, size, or symmetry. You should be in good physical and mental condition before undergoing breast revision surgery. Your weight should be constant and as close to your optimal weight as possible. It can take months for the tissues to settle and for the ultimate results of any breast surgery to be visible. If you have already had breast surgery and are dissatisfied with the results, doctors would usually recommend waiting at least six months, if not up to a year, before considering revision surgery. Allowing time for the final results to be visible also helps the scarring (particularly internal scarring) to mature and relax, making the tissue more pliable and simpler to deal with. You may, however, come in for a consultation at any time to receive information about your options and make plans.
Who is not a Good Candidate?
If you have pre-existing medical issues, you may be unsuitable to have additional surgery. This technique is not recommended for ladies who have unreasonable expectations or who have been urged to change their appearance to others.
Types of Revision Breast Surgery
The type of revision surgery that is best for you will be determined by previous surgeries, your difficulties, and your goals. Some ladies will have changed their body type since their initial surgery and now simply wish to be adjusted to be more in keeping, while complications from their previous surgery have caused the results to deteriorate over time, and a very small subset of ladies was never truly satisfied with the original surgery's outcomes. Whatever your circumstances, the revision strategy will be tailored to your specific anatomy and goals. Your treatment plan may include one or more of the following.
Breast Implant Removal and Replacement
Breast implants, unlike automobile tires, do not require replacement every few thousand miles. In the unlikely case that a breast implant ruptures, it should be removed with or without replacement. If you are satisfied with the outcomes and there are no problems, there is no need for additional surgery at any time. However, it is not unusual for changes in your weight, physique, or capsular contracture around the implant to change the results, and you may decide to replace your implants at this point to improve your contour or proportions. This may necessitate a change in the size or shape of the implant, and during the initial consultation, the doctor will go through the various options for implant kinds, shapes, and sizes that are most proportionate and perfectly suited to your body and desired outcomes. To improve results, your doctor may recommend adjusting the implant pocket or changing the plane of the implant to above or below the muscle.
Removal of Implants with or without Mastopexy
For several reasons (personal preference, weight gain, or aging), many women may choose to have their implants removed. Breast implant removal is quite simple; but, just as withdrawing air from a balloon deflates the shell, removing implants can make the breast shape somewhat flat and deflated. As a result, doctors frequently propose a mastopexy (breast lift) to restructure the breast tissue and leave an attractive but natural breast form.
Capsular contracture happens when the scar tissue around the implant contracts, causing the implant to change shape or position, apparent rippling, hardening of the implant, or even pain. A capsulectomy is the surgical removal of the capsule surrounding an implant and is commonly performed as part of breast implant revision.
Correction of Sub-Muscular Implant Animation Deformity
Some women who have previously undergone sub-pectoral breast implants are greatly bothered by the deformities. This is common among women who engage in a lot of upper-body workouts, such as gym work or other sporting activities. As a result, the breasts twitch or move with specific movements, making the implants appear visible rather than natural. It is feasible to return the pectoralis major muscles to their anatomical position on the chest and install new implants on top of them. This eliminates animation deformities and frequently alleviates discomfort caused by muscle contractions above the implant. At 6 weeks post-op, the breasts appear and feel more natural, and women can continue all upper-body workouts without limitation.
Re-Do Mastopexy (Breast Lift)
Changes in the body owing to having children, considerable weight change, or just aging can lead to a droopy shape of the breast with the nipple and areola laying low if you had surgery at a younger age or have before had implants. A mastopexy reshapes your breast tissue and elevates the nipple to a more attractive position. A prior mastopexy will have done this, but it simply resets the clock, not stops it, thus the influence of aging and physiological changes may have affected your long-term outcomes.
Following previous surgery, some women desire scar revision. Poor scar development is complex, although genetically driven for the most part. Scars from previous breast surgery that are enlarged, distorted, or unattractive may be improved by revision. During your consultation, the doctor will go over the history of your previous operation, delayed wound healing, infections, and any other scars you have. Scar revision may be a component of a total breast revision or maybe the primary purpose of surgery. Additional outpatient procedures will be considered with you if you are prone to severe scars.
Conversion of Implant-Based Reconstruction to Flap Reconstruction
Many women choose implant breast reconstruction after they are diagnosed with cancer since it is relatively rapid, has a shorter recovery time, and often does not have a tissue to allow repair at that stage. Some women are dissatisfied with implant-based reconstruction, either because it did not meet their expectations or because it changed post-radiotherapy. Some women discover, after a few years, that they have the energy and time to go to a free flap reconstruction, or that they now have the tissue to allow it. In practice, implant conversion to free flap reconstruction is rather common.
Minor touch-ups to improve contour can sometimes improve both aesthetic breast surgery and breast reconstruction. Liposuction procedures are used in fat transfer, but rather than throwing away the removed fat, it is processed, and the fat cells are isolated and re-injected into contour defects. This can enhance contour, conceal rippling, and make the results look more natural.
Revision Breast Surgery Preparation
Doctors spend a significant amount of time at their initial visit getting to know you properly and taking a complete medical history. The success of any surgery is dependent on you being open with your doctor at this point. The doctor must understand why you are seeking breast revision surgery, what you like and dislike about your breasts, and what you want to accomplish with revision surgery. They also need to know about your overall health, lifestyle, and medications, whether prescription or not. They are particularly interested in previous procedures, breast illness, and breast cancer therapies.
Your breasts, as well as your overall body form and skin quality, will be examined by your doctor. At the end of that meeting, he will outline the surgical options available to address your issues and create your unique surgical plan. There may be more than one choice for you, depending on your priorities at the time. At this point, the doctor will also discuss the risks and limits of the options with you. Before scheduling surgery, surgeons always arrange a second appointment to answer any questions.
Female doctors understand how a woman's thoughts about her breasts might affect her self-image and femininity. They work with you to reach your goals, whether they are to boost your self-esteem, regain your pre-pregnancy breasts, or even feel more symmetrical. Before undergoing surgery, you should be fit and healthy and at or near your optimum weight, which should be consistent. Your health will be evaluated before surgery, and if necessary, tests will be scheduled. Stop using aspirin, anti-inflammatory drugs, and any other non-prescription medications at least a week before surgery. If your health changes in the weeks leading up to your surgery, notify the doctor. When doctors are treating you, their major concern is your health and general well-being; therefore, if you are ill for any reason, surgery may be postponed.
Revision Breast Surgery Procedure
Breast implant revision and replacement surgery typically last 1.5 to 2.5 hours. Your prior incisions are normally used, but if the breast needs to be raised or skin excised, an incision around the areola and potentially a vertical incision, in addition to the incision in the breast crease, may be required. The prior implant is removed, and then it is decided whether the capsule should be removed in part or entirely. Another choice must be made on whether the implant's pocket placement should be changed. Following that, if necessary, the new implant is inserted in the new pocket and the wounds are closed. If an uplift is required, it is normally done at this time. Dissolvable stitches are then used to close the incisions.
Revision Breast Surgery Recovery
Following breast implant revision surgery, you will typically be able to return to the ward within an hour, and you will be urged to move around, eat, and drink before the anesthesia wears off. Drains are typically not installed. It is common to feel puffy and uncomfortable, which will normally necessitate analgesia.
There is frequently a feeling of pressure on the chest, as well as discomfort around the outside of the implant as a result of the pressure effect and the skin feeling tight and puffy. You should wear a support bra following breast augmentation revision surgery and keep this in place day and night for at least 4 weeks. You may be able to go home the same day, but breast implant revision surgery usually necessitates an overnight stay. Keep the wounds dry for the next week and make arrangements for someone to pick you up after surgery. You will also want some assistance at home once you are discharged.
You will be seen in the clinic a week after the breast revision surgery to have your wounds evaluated. Avoid exercising for the first week after surgery. When your implant revision surgeon clears you, you can resume light exercise, and after 2-3 weeks, you should be prepared for regular workouts.
How Long is the Recovery From Revision Breast Surgery?
Following breast implant revision and replacement surgery, you will be admitted to the hospital within an hour and typically discharged the same day. You must keep the wounds dry for the next week and avoid any exertion or forceful motions. After a week, your breast revision surgeon will see you in the clinic and will most likely clear you for very gentle exercise. You must wear a support bra day and night for a minimum of four weeks. You will require two weeks off based on the nature of your work. Full recovery will take around four weeks, after which you should be able to resume normal exercise.
Revision Breast Surgery Risks
Although the vast majority of patients are pleased with the results of implant replacement surgery, common early complaints include changes in sensation, bruising, swelling, and a little discrepancy between the two sides. Infection, hematoma, delayed healing, implant extrusion, seroma development, and thicker scar are all frequent early problems. General anesthesia also carries some uncommon complications, such as respiratory/cardiac impairment and deep vein thrombosis.
Infection is the most bothersome later consequence. In these cases, it is frequently necessary to remove the implants and wait for things to stabilize before considering reimplantation at a future date (often 3-6 months). This is very uncommon.
Implants do change over time, and even after breast augmentation revision surgery, all implants acquire a capsule. This is a protective layer that grows within 6 weeks following surgery. It can vary over time and thicken and scar. If this happens, it is known as capsular contracture, and it can cause a change in shape as well as discomfort. The likelihood of a re-operation for any reason following breast augmentation is roughly 1-3% every year. After ten years, approximately 10-30% of women will have had a re-operation. Aside from size changes, the most prevalent reason for re-operation is capsular contracture.
Following breast revision and replacement surgery, sensation frequently changes, and the nipples may be hyper or hypo sensitive. Permanent alterations in sensation are unusual, however, the sensation can take months to restore.
Although all implants can move within the pocket, anatomical implants can alter shape when they rotate. This is often self-limiting, but if it becomes problematic, the implants may need to be removed. This is unusual. You may also be able to feel the edges of the implants, especially if you are thin. This is an inevitable side effect of breast revision surgery that will not improve with time. Ripples or folds may become palpable over time, especially in specific positions.
Following breast revision surgery, some individuals may experience periodic swelling, and seroma production is more likely in revisionary cases. This generally resolves itself, but if it persists, it may necessitate more investigation.
The breast tissue, like the implant, ages over time. This is especially true after labor. Additional implant revision surgery to tighten the skin may be required at a later date, and anyone considering breast augmentation should be aware of the possibility of additional surgery for both the implants and the skin/breast tissue.
Cost of Breast Revision Surgery
The breast revision process is highly personalized to the patient's medical and aesthetic goals. If an implant replacement is required, the choice of new implants will have a considerable impact on the overall expenses of the treatment. The average cost of breast revision surgery is between $7,000 and $15,000, based on a variety of factors.
Breast implant revision surgery aims to replace outdated breast implants with new ones. Changing or improving the appearance of the breasts while updating the implant material is frequently the goal, which could include: a multiple simultaneous breast lift or reduction, reshaping the breast implant pocket to readjust the implant on the chest, and either increasing or decreasing the size, shape, or style of the breast implant.