My husband has been doing some additional research for me and seems to think that a revision is inevitable any where from 5-9 years. Is this the majority?
Is a Breast Revision Inevitable After a Maxopexy with Augmentation?
Doctor Answers (7)
Not inevitable, but certainly possible.
Augmentation mastopexy is perhaps the most difficult cosmetic breast procedure to perform. The complexity comes from competing goals -> increase the size of the breast while decreasing the skin envelope of the breast. In an augmentation mastopexy, we are typically dealing with breast tissue that has proven to have poor tone, poor skin quality, and a tendency to droop. Placing an implant, lifting the nipple, and removing excess skin has significant impacts on the blood supply to the nipple and skin, and relies to a large degree on the ability of the scars and remaining skin tone to hold its shape (in the presence of more weight from the implant!). The revision rate is much higher in this operation both due to complications from altered blood supply early on, and from poor skin tone later on. Revisions for early complications (wound healing problems, skin or nipple necrosis) tend to be required. Revisions years later for recurrent ptosis or droopiness are considered elective. Thankfully, the later revisions tend to involve much less surgery to correct. So are revisions inevitable? Not necessarily, but it is good to be aware that there is a higher likelihood for revision than most other cosmetic breast operations.
Breast lift and implants
Yes, this combination does have more revisions than the two operations considered separately. Is it "inevitable"? That's a little bit of a strong term....
Really, the mastopexy and the augmentation are working at cross-purposes. The mastopexy is trying to tighten the breast skin. The breast implant fills out and often stretches the breast skin. Droopy breasts have shown that the skin and support tissue isn't very good - and has drooped under the weight of the breast. Breast augmentation adds more weight to the breast. Not always the best combo...
So, while it's a combination that can be done, it isn't always "simple". We can't control what your skin does, or how it stretches. So, if you decide to go for the combination, you might well need a revision as time and gravity do their inevitable things! But that's not the surgeon's fault.
Breast augmentation together with breast lift
It is a good question. Breast augmentation is not like other plastic surgery. One facelift, rhinoplasty, abdominoplasty etc most often does the job and lasts years as long as you take care of yourself except of course for the continuing aging process. Breast augmentation is quite different in that a patient can look great a month or 2 after surgery and then look quite the opposite a short time later due to capsular contracture, implant rupture etc. Therefore even in skilled hands breast augmentation surgery has higher revision rates than other cosmetic surgery.
Few patients know what their surgeons reoperative rates on breast implants is. They know a friend had a good result, the doctor has a good reputation etc. On the other hand the surgeon may not even know exactly what his/her reoperative rate is as their patients may go to another surgeon for reoperation for geographical or other reasons or the surgeon may have never taken the time to calculate it. If a prospective surgeon's patients are all being reoperated within 2 years then he/she should not be your surgeon, even if your friend looks good 1 month after surgery. Since you know you will need more surgery after the first breast augmentation (unlike other cosmetic surgery where this is not a given) the goal of surgery should be a good looking result and no additional surgery for 3 or 5 or more years.
It is very difficult for even the best surgeon to plan and do breast lift and augmentation procedures at the same time. Everyone is reluctant to do it as 2 separate procedures for fear of losing the patient. The problem is that the markings for the lift are placed before the implants are in. Due to differences in skin elasticity though we do not really know how the skin envelope will respond over time to the presence of an implant. In fact each breast's skin may respond differently which makes it even harder. Therefore the incidence of touch up procedures after breast augmentation with lift procedures is even higher. In fact it is inevitable. The questions then are what type of revision is required and when should it be done
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
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Is a revision inevitable after augmentation and breast lift?
First of all, having implants means that you will most probably need to replace them at some point...it may be 20 years from now, but it is likely. Revisions for capsular contracture are in less than 10% of patients, but a risk. Patients who need lifts are much more complex situations than patients who do not. The interaction between implants and the overlying loose tissues that are tightened in a lift are not always favorable or completely predictable, and since the results of lifts are not necessarily permanent, revision lifts or retightenings may be needed over time...and probably more in implant patients than in lift patients without implants. And there is a significant risk of needing a revision when implants and lifts are done at the same time, especially if the lift is a major one, both for technical reasons and due to the difficulties of dealing with two "variables" at the same time...enlarging the breast and tightening the skin envelope Nevertheless, despite having to be aware of the risks and limitations of any procedure you consider, the results of lifts and augmentations can be quite excellent and a significant improvement in patients who would benefit from the procedures.
Gravity will effect your breast no matter what you do. So yes a revision will most likely be necessary over time. But when is dependent on you to some degree physically and what size implant you have. A good bra is so important. Gravity wants to push your implants down and out. Remember the chest is a curved surface with a round implant on it. It will naturally want to be pushed down and out laterally by gravity and the muscle with function (submuscular implants). So, having a good bra with lateral breast support will help keep the implant centrally located . Fighting this displacement. Hopefully delaying your revision. Good Luck.
Revision rates after lift with breast implants
If you look at just breast implants alone, the revision rate within five years is as high as 25% in some practices including revision for size changes, though can be lower in others. When we look out to five to ten years, we start to see rates climb as implants begin to leak at about eight years, and most will need replacement (revision) within ten to fifteen. If we consider a lift as well, the revision rates, perhaps small scar or even recurrent droop, the revision rate may creep higher. Significant yes, inevitable, no. When you consider that the satisfaction rate for the procedure is 90%, and have the attitude or acceptance that implants need some maintenance, we still have a winning situation for most.
Best of luck,
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.