Breast Implant Revisions

Breast Implant Problems?

Fixing a Bad Breast Augmentation

 

Revision of breast implants done elsewhere is our second most common surgical procedure.  We review and revise breast implants done from all across the globe on a regular basis, and take great pride in fulfilling the original goals of the procedure.  Similar to the aging process, the female breast image depends upon multiple anatomic and physiologic factors, and must be viewed in many lights to be understood and improved upon.  Bigger is not always better, and one technique never fits all patients.

Common Breast Implants Problems:

Patients often come to our office after obtaining breast implants by other surgeons at other facilities because they have suffered undesirable outcomes and wish to have their breast augmentation corrected. This is referred to as revisional or secondary breast implant.  The most frequent problems that we treat in our office are as follows:

1)   “My plastic surgeon didn’’t listen to me, and this is not what I want.

 

This is our most common scenario, and it often occurs when patients go to a non-board certified plastic surgeon for their breast augmentation.  The American Academy of Cosmetic Surgery is not a ABMS (American Board of Medical Specialties) recognized board.  They are not recognized as board certified Plastic Surgeons.  They, and others, often do not hold the same comprehensive understanding of the female breast.

In this situation, we start all over.  We review all of your records, if available, and treat the consultation as if it were your first.  We then plot a course to reverse the effects of the previous procedure, and provide you the best results possible.  We commonly offer either an implant exchange procedure with capsule modification, or in severe cases, a neopectoral pocket procedure.

2)   “When I lie flat, my breast implants fall into my armpit.”

 

Most common complaint in women over the age of 45.  As the breast ages, it commonly loses support laterally.  This can result in the breast implant falling towards the armpit over time.  Depending on the degree of laxity, this can be treated by oversewing the lateral breast, or with creation of a neopectoral pocket.  In severe cases, use of an acellular dermal matrix like Strattice is our treatment of choice as it durably solves this problem.

3)   “My breast implants changed shape and became hard.”

 

This usually means that you have developed what is known as a capsular contracture.  In this instance, removal of the implants and its capsule in its entirety is our procedure of choice.  Capsular contracture is an abnormal scarring response that occurs around the implant.  It can occur for many reasons, and is uncommonly a result of surgeon error.

In severe cases of contracture, our preferred approach to this problem is a total capsulectomy, or removal of the entire capsule with the implant.  This brings the breast back to its near native appearance, and has the benefit of removing all of the hardened, painful tissue.  This procedure is safe, but does have increased swelling as compared to an implant removal and replacement.

4)   “My breast implant ripples.”

 

Very common complaint in patients with larger sized saline implants.  Exchange of a saline for a silicone implant can commonly improve rippling along the implant.  As well, many women can be treated by moving the implant below the muscle.  For severe cases, however, we offer Strattice.  Strattice is a fairly recent addition to our plastic surgery armamentarium.  It is a biologic mesh that can provide permanent coverage and support for your implant.  It is safe, completely natural feeling, and offers a permanent solution to implant rippling.  We commonly employ Strattice in our practice, especially in female figure models, and body builders.  If you have less than 20% body fat, and are looking for a full D cup augmentation, rippling will occur with any type of implant.  We commonly use Strattice in this patient population in both primary augmentations and revision augmentations.

5)   “I went in with 2 boobs, and I came out with 1!”

 

This is called symmastia.  This is a complex problem that requires re-creation of the sulcus or gap between your breasts.  This is a very complex procedure that commonly requires a neopectoral pocket or total capsulectomy technique in addition to placement of a Strattice Sling.   The goal of surgery is to recreate the medial border between the breasts.  Time and experience have shown us that suture techniques alone are not as durable as newer techniques.  Thankfully, this is an uncommon complication, but it is one which we routinely encounter from both referring physicians and patients.

6)   “My breast implant is falling down onto my tummy.”

 

This is called bottoming out.  This occurs when the structural support of the breast is no longer able to maintain the weight of the implant.  In this situation, downsizing the implant and tightening the capsule provides a solid, durable result that pleases most patients.  In women that want to maintain their current size, or even increase, placement of extra support with a biologic mesh may be indicated.

7)   “My breast implants are up by my collar bone.”

 

This is either a technical error due to an inadequate release of muscle fibers during surgery, or a situation where the muscle randomly re-adheres too quickly to the chest wall.  This is commonly seen in women who receive a submuscular (below the muscle) implant.  Commonly, the implant does not appropriately fall, and rides high.  When this occurs, release of the muscle in conjunction with precise tailoring the of the breast capsule solves this problem.  This issue is not the same as a “Double Bubble”.  In a double bubble, the natural hang (ptosis) of the breast is involved, and causes a more complex problem requiring a different approach.