Breast Implant Revision-How to Fix Breast Augmentation Problems
In my experience, most Breast Implant (Mammary Prosthesis) or Breast Augmentation results are excellent and patients are very happy with their fuller look. Realself.com reports a 92% “worth it” rating for this procedure among visitors to their website who have had it done.
As with any surgical procedure, however, there are potential problems that can require revision after surgery. Although FDA statistics report a 20% revision rate, subsequent studies demonstrated that when proper patient selection and proper surgical technique was used that revision rate dropped to 6%. These statistics emphasize the importance of selecting an experienced Plastic Surgeon who is certified by the American Board of Plastic Surgery when you decide to have Breast Implants.
Breast Implant Problems That Require Revision
· Implants Too High- It is common to “look too high” immediately after surgery. Most often it takes 6 weeks to 3 months for Implants to “settle” and achieve their final position. However, in some patients the result remains too high, most commonly after Sub muscular or Sub pectoral placement. In these cases a fairly simple “pocket revision” or muscle release will solve the problem.
· Rippling or Visible Folds- Visible Rippling is most common with Saline Prostheses but can also occur with Silicone. Rippling is also more common when the device is placed under the gland, Sub glandular, as opposed to under the muscle, Sub muscular or Sub pectoral. Visible rippling is also more common in thin women with little glandular tissue. The best solution is converting from Sub glandular to Sub muscular and in the case of Saline, converting to Silicone. In some cases it may be necessary to cover the Implant with a biologic material such as Alloderm™ or Strattice™ to increase coverage of the visible deformity.
· Snoopy Deformity-Breast Ptosis- When Breast Augmentation is performed on sagging breasts without a concurrent lift; the gland can “hang down” over the Implant. From the side this has the appearance of the profile view of the cartoon character Snoopy. The solution is to have a lift or Dermal Mastopexy.
· Bottoming Out-The Inframammary Fold is that fold of skin underneath the Breast. It holds the gland onto the normal position on the chest wall. When this structure is violated during surgery the Implant descends or drops down on the chest wall. The appearance is that of fullness below the Nipple Areola Complex. Correction of this problem is fairly straightforward using a procedure called a Capsulorraphy in which the pocket is revised and the Inframammary Fold is reconstructed.
· Double Bubble- This is similar to “bottoming out” in that the Inframammary Fold has been disrupted. The term Double Bubble refers to the appearance of two bulges on the chest wall-the Breast mound and the outline of the Implant below. Correction is the same as with “bottoming out.”
· Visible Implant- This problem is similar to Rippling or Visible Folds and is most common in thin women with Sub glandular placement although it can occur after Sub muscular Augmentation. Today this problem can often be solved by Fat Injection to cover or hide the visible area.
· Capsular Contraction- Capsular Contraction or Contracture is caused by scar tissue which results in hardening of the Augmented Breast. Traditionally the Implant and scar tissue are removed and Alloderm™ or Strattice™ wrapped around the new prosthesis. Recently Fat Injections have been shown to soften Capsular Contracture.
· Symmastia- Symmastia, also called “uni-boob” occurs when the Implants are placed too close together and the cleavage disappears or is elevated. This can be corrected by converting Sub glandular to Sub muscular. If Symmastia occurs after Sub muscular placement a more complex revision with Alloderm™ or Strattice™ may be required.
· Implant Rupture- Silicone Implant rupture is best detected with an MRI. If it occurs removal and replacement is recommended by the FDA. Newer “cohesive gel” Mammary Prostheses have eliminated the risk of gel migration which was a problem with older devices. Rupture and deflation of a Saline Mammary Prosthesis is a very obvious decrease in size and replacement is indicated.
Choose an Expert
Most patients who choose to undergo Breast Augmentation are happy with their result and do not need a second procedure for the problems listed above. I wrote this article primarily for patients who feel something is wrong with their result but do not understand exactly what the problem is or how to fix it.
However, the most important factor for you or anyone considering this procedure is the skill, training and experience of your surgeon. Proper patient selection and surgical technique reduces the rate of secondary surgery from 20% to 6%, a very important statistic.
Today some doctors who are not certified by the American Board of Plastic Surgery are advertising as Cosmetic or Plastic Surgeons and performing Breast Augmentation. So you need to do your homework and check the background, training and Board Certification status of a surgeon before having surgery.
Is your surgeon a member of the American Society of Aesthetic Plastic Surgeons? Membership requires certification by the American Board of Plastic Surgery and experience in Cosmetic or Aesthetic procedures.
See two surgeons before you decide and ask to speak to patients who have had the procedure by that doctor. Check for reviews on Realself.com and ask friends in your community who have had the procedure who they would recommend.
Careful planning and investigation will hopefully improve your chances for a happy result and freedom from problems which could require revision.