Breast Revision Surgery Ohio
Re-do / Revision of Previous Breast Enhancement Surgery
Aesthetic surgery of the breast is a challenging and technically demanding art. There are no widely accepted methods or technologies available to determine the volume of breast tissue. Therefore, the surgeon must rely on his or her perception of size and symmetry when adding or removing volume from the breast. Furthermore, the breast is a dynamic structure and subject to the forces of gravity and can be significantly affected by the changes that occur with scarring, aging, and activity, making results quite variable over time. Because of these many variables, unfavorable results after aesthetic surgery of the breast can occur – thus the need for breast revision surgery.
When implants are placed under the breast and/or muscle, it is natural for the body to form a thin capsule of scar tissue around the implant. Infrequently, this process can progress to form a thick scar that can make the implanted breast feel very hard. More severe cases of this change, called capsular contracture, can lead to scarring that causes visible changes in the shape and contour of the breast and significant pain for the patient. Some factors have been associated with a lower rate of capsular contracture. For example, it is generally reported that saline implants are less likely to have contracture compared to silicon devices. Furthermore, implants that are either totally or partially under the muscle may also have a lower rate of contracture. Typically, the only correction for capsular contracture is with surgical intervention. There are different surgical options such as replacement of the implant, removal of the scarred capsule, and repositioning of the implant into a position that is beneath the muscle. Even though these interventions may correct the problem in the short term, capsular contracture can recur if an implant remains in the pocket, making removal of the implant (explantation) the most likely option for a cure in recurrent cases.
Symmastia occurs when the skin between the breasts is elevated off the breastbone (sternum). Normally, this skin is held in place by connective tissue between its deep surface and the bone that is deeper down. From a surgical standpoint, breast augmentation requires that pockets, or spaces, be created beneath each breast. If these pockets are created too close to the midline of the body, or if the implants cause the skin to become so tight that they lift off the sternum, Ssymmastia can occur. Correction of Symmastia can be very challenging. If the implants were placed under the breast, but over the muscle, moving the pocket to a position that is deep to the muscle may be beneficial. More recently, the use of acellular dermal matrix (a biological mesh that can serve a matrix for scar and tissue ingrowth) has shown promise when used as an adjunct to support the repair. Whatever techniques are chosen, successful, long-lasting correction of this issue can be difficult and it is best to avoid its occurrence with careful implant selection and meticulous surgical technique at the initial implant operation.
For most individuals, the breasts are not identical in size nor in shape. Breast enhancing surgeries, such as breast augmentation, mastopexy, and breast reduction can all be controlled to decrease these differences in size and improve symmetry. However, if an asymmetry is not dealt with at the time of these surgeries, it is possible that it will be exaggerated by the enhancement surgery and consequently more noticeable. When asymmetry is severe, corrective surgeries can be helpful to reduce the discrepancy in size and shape, potentially improving the balance and appearance of the breasts. These surgeries depend on the type of asymmetry and the patient’s goals but usually involve replacing an implant with a different sized one, correction of small volume and contour abnormalities with fat grafting, nipple repositioning with mastopexy, or a combination of the other operations discussed throughout this site.
Breast Implant Malposition
Implanted devices that are used for breast augmentation rely on the surrounding soft tissue to keep them in a proper position during the immediate days to weeks after surgery, while the body forms a capsule around the implant. It is critical at the time of implant placement that the surrounding anatomy is not disrupted as the implant pocket is created. Structures such as the inframammary fold (lower breast crease) and the skin over the sternum (discussed above under Symmastia) serve as critical boundaries in maintaining proper implant position over time. When an implant shifts, it will most often move down and outward. This type of malposition is challenging to fix in a way that will be durable over time. The surgical technique often involves rebuilding the lower part of the implant capsule and may require reinforcement with biologic mesh (acellular dermal matrix). Implants can also remain too high on the chest. Such high-riding implants are typically caused by the inadequate division of the lower attachments of the pectoralis muscle in cases where the implants are under the muscle. Implant malposition can also be caused by increasing scar tissue around the implant, or capsular contracture (discussed above).
Request Your Consultation
To learn more about breast revision surgery, you can schedule an appointment online or you can call 855-687-6227
*The information available on this page was created to educate our patients. It is not an alternative for a formal consultation with a board-certified plastic and reconstructive surgeon. Individual results vary per patient. For more information, we strongly recommend scheduling a consultation with our doctors.