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Breast Augmentation Revision Surgery

Breast augmentation revision is sometimes necessary. Factors leading to this include outcomes related to implants as devices such as rippling, capsular contracture, rupture, malposition, and dynamic distortion. Other issues may also arise such as dissatisfaction with the aesthetic result or the size. In many cases patients come to me seeking a more natural result, requesting a smaller size or to change from a saline to a silicone implant. Additionally, the breast can undergo changes after pregnancy and weight loss. In some instances a patient will request implant removal. Over the years I have found that patients who request size change or to switch from saline to silicone or from a round to a tear drop shaped implant have been unhappy with their result for some time. Often they initially just wanted a small increase in size or sometimes a better breast shape, and ended up with implants that were overly large for them. As a result, they feel self-conscious. Often the initial instinct is for the patient to ask for removal of the implants altogether. It is very important for me as the plastic surgeon and the patient to have a thorough conversation about what her motivation was at the time of the initial surgery, what her goals are now and what is possible given all the implant options that are now available. In this way, I can make a surgical plan that will meet her goals.

In some case patients have had multiple prior revisions. These cases are often very difficult to correct. The aesthetic result of the revision can be critically affected by the previous surgery. However, obtaining the prior operative records and having a thorough consultation allows me to determine whether or not I can improve the patient’s result. In some cases the patients have not consulted with qualified surgeons prior to having breast operations performed. This is why it is so important that patients do their research before selecting their plastic surgeon. The best chance of getting a good result is with the first surgery. As a plastic surgeon who specializes in breast augmentation revision surgery, I and my staff are well aware of the emotional, physical and financial burden of revisional surgery. We do our best to support you during the decision-making process and throughout the post-operative period.

Implant removal alone is a very straight forward procedure that usually takes less than an hour. If the implants to be removed are saline, this can be done under local anesthesia in most cases. All other revisions are usually performed under general anesthesia.

Capsular Contracture
Capsular contracture can be treated by total capsulectomy (removal of the capsule) and placement of a new implant. It can also be treated by changing the pocket the implant is placed in. The key is to create a fresh,new space for the implant. I usually use a textured implant. Drains are often used.

Implant Displacement
Implant displacement can be due to inadequate release of the pectoralis major muscle or an oversized pocket. In cases where the pockets connect across the midline, we call this synmastia. Oversized pockets resulting in implant malposition can be treated by neo pockets, such as a neo-subglandular or neo-subpectoral pocket or pocket conversion. These advanced techniques may require supporting material such as Strattice, Galaflex or Seri.

Breast Revision Surgery Success Rates

Breast augmentation revision surgery is one of the most challenging in plastic surgery. The operations can be technically demanding, time consuming and expensive. It is very important that the patient has a good understanding of what is possible and what cannot be accomplished. Of paramount importance is that the patient has trust in their surgeon and feels confident moving forward. No guarantee can be made as to the outcome. My patients and I feel like we are a team, working together to get the best possible result.

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