Breast implant revision surgery

Asymmetry or complications following breast augmentation may require revision.  Revision breast augmentation surgery is usually much more difficult than the original operation.

Implant malposition

This is one of the most common problems requiring breast implant revision surgery.  During breast augmentation, implant pockets are created and assessed for size and symmetry before implants are placed.  If the pockets are improperly created, there will be implant position asymmetry.  There are other issues during maturation of the implant pocket that can result in implant pocket asymmetry.

Treatment requires modification of the implant pocket on one or both sides.  This procedure is easy on the patient but tough on the surgeon.  Easy on the patient because there is very little pain afterward and can be done with light sedation.  Tough on the surgeon because symmetry is tough to achieve as it generally requires over-correction allowing for tissue relaxation with healing.

There are cases where the implant pockets will necessarily be a little asymmetric such as chest wall deformity or significant preoperative breast asymmetry.  Ideally, these issues are noted and discussed before surgery.

Exchange of breast implants for larger or smaller size

Choosing an implant size is an important component of the breast augmentation consultation.  In Dr. Yates office the most valuable tools are “trying on” implants and 3D imaging.  Occasionally, a patient will desire exchange of implants for a larger or smaller size.  This is a very easy procedure and can be done with mild sedation with a very easy recovery.

Capsular contracture

Capsular contracture is the development of an inappropriate amount of scar tissue around a breast implant.  This can cause unsightly or uncomfortable firmness of the breast.  There are a number of suspected causes of capsular contracture.  The most accepted causes of capsular contracture are subclinical infection or blood.  Silicone implant and implants above the muscle have a higher rate of contracture.

To help decrease the risks of capsular contracture antibiotics are given before and after surgery and the implants are “bathed” in antibiotics prior to implantation.  Steps to decrease risks of bleeding at the time of surgery and afterward are also taken.

Treatment of capsular contracture depends on the severity and how early it is diagnosed.  If caught early oral medications, including Vitamin E and Accolate, can be helpful.  Later presentation generally requires removal of the implant capsule (capsulectomy).  The risks of recurrence can be reduced by changing to saline implants or changing to a pocket beneath the muscle if not already performed.

Symmastia

Symmastia is a loss of cleavage between the implants.  This results from a pocket created too far medially with over-aggressive release of the implants medially.  This is a higher risk when the implant chosen is too large for the patients frame.  Correction is very difficult involving recreation of the medial pocket allowing the implants to separate.

Saline implant deflation

Saline breast implant deflation

Silicone implant rupture

Silicone implant rupture