How Long After Breast Augmentation Can the Revision Be Done?
- Asked by Kate 1964 in kentucky
- 4 years ago
Breast Implant revision
It can be quite an emotional roller coaster ride for a woman who, being self-conscious about her breast appearance, seeks out a surgical breast enhancement, chooses a surgeon, has a breast augmentation, and then ends up with a result that falls far short of her expectations - or even worse, results in a breast appearance about which she is even more self-conscious. I take this situation very seriously, and in my practice we do our very best to not only provide such patients with the enhanced breast appearance that they originally had in mind, but also to make the experience of consultation, surgery and recovery as positive and pleasant as possible.
The two most important aspects of correcting problems with prior breast augmentation are (1) taking the time to make an accurate diagnosis and to fully understand how the result falls short of the patient's expectations, and (2) creating a surgical plan that has the highest likelihood of improving the situation and meeting those expectations. In most cases that can be accomplished in just one trip to the operating room, however there are a few problems that are best managed by a two-stage surgical approach. One surgical procedure is far preferable to two, but not if a two-stage approach has a much higher likelihood of success. I feel obliged to do the operation (and occasionally the operations) that will be the most likely to turn a disappointed and frustrated patient into a very satisfied one.
Problems that can usually can be corrected in a single procedure include most cases of capsular contracture, most problems with implant position, distortion of breast appearance with contraction of the pectoralis major muscle, and visible implant folds and ripples. Management of capsular contracture includes implant removal, total capsulectomy vs. total exclusion of the original capsular space, creation of a new implant space, and placement of a new implant. Implant position problems are corrected by means of capsulorrhaphy, which is the medical term that describes suturing closed the implant space in areas where the implant projects too far - which in some cases may need to be reinforced with an allograft material such as Strattice (acellular porcine dermis, Lifecell Corporation). Breast distortion with pectoralis major contraction is corrected by selective repair and release of the muscle origin. Visible implant folds and ripples may be corrected by a combination of changing the implant position (e.g. submammary to submuscular), changing the implant style (e.g. saline to cohesive silicone gel), and adding tissue to help conceal the implant (e.g. capsular flaps and/or Strattice grafts).
An example of a revisional breast augmentation procedure that sometime requires a two-stage approach is the patient with severe capsular contracture and ruptured, liquid silicone gel breast implants - which fortunately are no longer in use. I believe that the liquid gel material that leaks from a ruptured liquid silicone gel implant is a potent stimulus for capsular contracture in some patients, and if the old implants and thickened capsules cannot be removed without spillage of a significant amount of liquid silicone gel into the new implant pockets, I will not put in new implants during that surgery (this happens in about a third of cases, so the good news is that most patients get new implants inserted the same day). If the gel material is indeed a stimulus for contracture, it just doesn't make sense to place new implants if there is significant spillage of that material into the new implant space. I instead irrigate the pockets thoroughly with a pressure irrigating system, place drains and close the incisions, and we give the body's natural scavenger system three months to `clean' up any remaining gel material. The re-augmentation is performed after three months, and in taking this approach I have yet to have a patient return with a recurrent capsular contracture. No patient is ever that excited about the possibility of going three months without breast implants, but most are willing if it gives them the highest likelihood of a lifetime of soft, supple, natural-appearing breasts.
Some breast augmentation revisions require a minor, in-office surgical procedure several weeks in advance of the main surgery which is preformed in the operating room. One example is the deflation or removal of overly large implants. Large breast implants act as tissue expanders and stretch out the skin of the breast, which usually creates a droopy and unsatisfying appearance when the large implants are removed and replaced with natural-appearing implants of lesser volume in a single stage. If the excessively large implants are saline, they can be deflated in the office using a needle and sterile tubing. If they are gel implants and have not ruptured (which can be confirmed by means of an MRI scan), they can be removed under local anesthesia through the incisions by which they were inserted. Deflating or removing large implants gives the breast skin an opportunity to contract and shrink over several weeks, so that when implants of a more appropriate size are inserted the breast profile is perkier and more youthful. In many cases this minor office procedure can avoid the need for a breast lift (mastopexy) procedure. It also allows the internal implant space (capsule) to shrink, so that the new, lower-volume implants are not placed into capsular spaces that are too large - which would allow the implants too much mobility (often manifested by the implants appearing too far apart on the chest wall, and falling off the side of the chest when a patient lies down).
Web reference: http://michaellawmd.com
Slow down on reoperating for breast augmentation
We've always been taught to wait for 3 months before exchanging implants - I've seen this problem before and have been very, very tempted to change earlier than that to meet the patient's wishes. The prudent thing to do is wait. There's no sense in hurrying up and getting the size wrong again.
The reality is that you want to wait that time so that you can see the result once it has settled in. Try these implants with several different outfits and bathing suits, you may end up prefering your current size. In any case, waiting that time is important for you to know how much you want to go up, right now is difficult to decide since there's still swelling present from the operation.
Timing for breast implant revision
Three weeks after surgery, your breasts still haven't achieved their final appearance. In a lot of women, the skin envelope is still relatively tight. For some, that means that the implants will drop somewhat and achieve a more natural look - you might like the appearance more when that happens. Regardless, waiting at least 3 months after surgery, to give the skin a chance to relax, will help you and your surgeon pick an implant size that you like more, but can still be accomodated by your body without appearing too fake.
Best of luck!
Recent Breast Implant Revision Reviews
Breast Implant Revision Photos
Dear Kate 1964
I am sorry that you are unhappy with the Breast Implant size. This is frustratiing and i am sure your doctor will guide you through this time and you will be very happy. Most surgeons like to wait 'for things to settle' which can be from 3 to 6 months- depending on the surgery. If you truly want to be much larger then you can consider replacing the implant sooner- allowing that your surgeon will do this.
With Warm Regards,
Trevor M Born MD
Revision After Breast Augmentation
It is amazing to me how often patients write to us complaining that they are unhappy with the size of implants that they chose. This goes back to the relationship between the patient and the surgeon. I have a plastic surgeon friend who's favorite statement is "I just load the trucks. I don't drive them." Meaning he just follows what patients tell him they want. This is exactly the wrong thing that plastic surgeons should do. We are the experts, not the patients. It is our obligation to educate and guide our patients to make the right decision. I hear how often his patients are unhappy about their implants but I've only had one patient that was unhappy. And this was because she didn't take my advice and later told me she should have.
With all that catharsis the answer to your question is at least 6 months. Implants need at least this time to settle and the breasts to accept the implants. In addition you will get used to the implants and may not be unhappy with them after 6 months.
Anatomical and emotional adjustment time
It takes a while for the anatomy to accommodate the implant. Some breasts look big and then shrink as swelling abates, and others look too small and tight but then increase in contour as the soft tissue stretch in response to the presence of the implant. Give your surgery a good 3-6 months to accomplish these things. In addition, a patient may take a variable amount of time to adapt to the new breasts. You have to 'wear' them in various situations to gauge how you feel about them. Breasts that look too small in certain clothes may feel too big when engaging in sports or other activities. Breasts in the bedroom may feel different in a business setting. You have to accept the breasts in their totality. Give yourself a few months. A revision will always await you. Also consider that the larger you go, the more potential long-term complications. Generally you have to go up two sizes within the same style to make a significant difference. Going too large may change other aspects of the breast contour and shape. Finally, I have found that while women who come out smaller than they want are a bit unhappy and regretful about the size, those who end up too big, are even more unhappy because they cannot hide the size.
Breast implant revision
I typically advise patients to wait 3-6 months before considering breast implant revision surgery. It takes time for you to heal and for implants to settle into their final position. Patience is important.
Sorry for you dissatisfaction regarding the size. The immediate postoperative period after breast augmentation can be an emotional time as patients regularly grapple with the question of size. To process these emotions and to heal properly, it is generally best to not consider a breast revision for 3- 6 months.
If you are not happy with the size at three weeks, I would wait a few months for things to settle down and the swelling to dissipate before having a revision.
Changing cosmetic breast implants
Breast augmentation with implants is a completely elective, cosmetic procedure and the patient chooses to do it with appropriate informed consent from the plastic surgeon. She can also choose to undo it by having the implants removed or replacing the implants with a different size or type. This would not be a revision. It would be a choice just like the one to have it done the first time. We call it a re-augmentation and it can be done a short time or years after the original procedure.
From a physical and practical standpoint, I require patients to wait three months before I will agree to a replacement procedure but it is not handled as a revision. The surgical fee for the replacement is half of the original charge for my patients but the cost of the implants and the facility fee is the same as a first time procedure.
It important to have a system to help the patient choose the size of the procedure and carry it out exactly the way that was agreed upon. It is also important to perform the procedure to take into account the possibility that the implant will need changing or replacing in the future. This requires the procedure to be done with an incision in the crease under the breast.
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.