The Past 10 Months, Following my BA, Have Physically and Emotionally Drained Me!

BA resulted in redo in left breast(w/armpit drain)3 weeks later.Dr says pocket revision b/c to excess scar tissue, implant wasnt massaging like the other.Implant moves better but is now smaller, high, tight, crease scar is visible in standing position & entire breast aches and goes thru my armpit down my arm. Nerve damage?) With my f/u visits Dr told me we could do a redo in 1year or when scars healed. Yesterday that changed and he told me he had no solution & felt redo'd be worse.Yay 4 padding!

Doctor Answers 5

Breast Augmentation Revision

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Although you have been through the "ringer", do not despair.  The issues of capsular contracture, asymmetry, etc. can be dealt with by a qualified plastic surgeon experienced with revisions.  No one looks forward to additional surgery, and even qualified plastic surgeons can have patients who suffer from one or more complications, and THEY TOO can despair of trying to make things better.  You need to take your records from each surgery (op reports, implant information) and see at least one other plastic surgeon and discuss your options.

Changing opinion after breast augmentations

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It's hard to tell exactly what has happened with your breasts, but I would not accept just one "hopeless" opnion.  Get a copy of your records and see at least one other board certified plastic surgeon.  Make sure they have experience in breast augmentation revisions.  They are can be more difficult than the original surgery.  Good luck.

Lori H. Saltz, MD
San Diego Plastic Surgeon
4.3 out of 5 stars 29 reviews

Breast augmentation issues

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Sorry that you are having issues. It is important to get more of a history of yoru surgeries. You m ay want to seek another opinoin,. but I would have all the records available. You can request them from your doctor's office.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast augmentation nightmare can be improved!

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I am so sorry your surgical experience has turned out to be such an ordeal. Cases such as yours make candidates for this surgery question whether it is worth the risk, fearing this could happen to them as well.

You did not specify the reason for your left breast re-operation at 3 weeks, but you did state you had a drain placed, so I assume this was to treat a hematoma. Hemotomas occur, and all of us who do lots of breast enlargement surgery have to deal with breast hematomas several times a year (about 1% of the BA patients in my practice). As with your case, the hematoma usually doesn't occur right after surgery, it occurs in the second, third, and even fourth week after surgery, as your activities become more vigorous because you feel so good and you think everything's OK for increased . . . "whatever" caused you to bleed.

So now you have a capsular contracture, which occurs predominantly from bleeding or bacterial contamination, either (or both) of which can stimulate scar tissue to thicken and contract around your breast implant--causing the "smaller, high, tight" and "ache" you describe. It always baffles me that drains are used by surgeons in this setting--drains may allow blood and fluid out, but they also allow bacteria IN (especially from the armpit) to contaminate the implant, causing a biofilm that can induce or worsen a capsular contracture! Just evacuate the hematoma, coagulate or suture the vessel (if it is still bleeding), rinse the pocket with antibiotic or antiseptic, and re-close in as sterile a fashion as possible (skip the superhighway for bacteria). However, that train has already left the station in your case, but perhaps this description can be helpful for other patients!

At this point, you require at least capsulotomy, but more likely a complete capsulectomy, new implant (proper size if "too-small" was noted immediately post-op before your hematoma), perhaps steroid in the pocket (controversial but useful in select cases, with moderate risk of other issues such as poor healing or incision breakdown), leukotriene inhibitor and Vitamin E (also controversial and helpful only in about half of cases, but low-risk, so why not?), and a healthy dose of luck. Since you already have developed one capsular contracture, you have an increased likelihood of developing a second one, but living with your present result is not an option. Perhaps your surgeon's change of mind reflects the seriousness of the actual re-operation and the high(er) potential for failure. Or inexperience, Or questionable judgment in using a drain in the presence of an implant! Definitely time to move on.

You need an experienced, American Board of Plastic Surgery-certified plastic surgeon who does lots of breast surgery, and consulting with several of them will help you and be worth the time and effort involved, even if you like the first surgeon you see.

By the way, your pain may or may not be relieved by re-operation (and could be worse in rare cases). Some pain can be due to sensory nerves being caught in the contracting scar capsule--this may be relieved by capsulectomy, but not guaranteed. Or the intercostobrachial nerve may have been damaged in the initial surgery, or by the drain placement in your armpit. If this occurred (either cause), your discomfort may get better over time, but may not completely go away. There are ways of dealing with this also, but those are beyond the scope of this answer and this forum. Best wishes and good luck!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Revision breast surgery

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I would recommend you seek consultation with a second, or third, plastic surgeon who performs a lot of breast revision surgery. Have all of your records available for your appointment. There are cvertainly options for you.

I wish you well.

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.