What risks are there with a second Breast Augmentation?

Question

I am having a second BA. I had one 6 months ago but they were put in between the pectoral muscle. 320ccs are to small and my surgeon put them too close together so the middle bit of my cleavage is all implant and is raised. My question is how risky is a second be.a combined with liposuction at only 6months apart. Bearing in mind my last BA I was under for 2hours... also I would like to know if it is possible to have my implants on top of the muscle now or will this cause trauma? ...

Andrea Marando, MD · Answer

Thank you for your excellent question. Secondary breast surgery is always challenging, as usually the surgeon has to correct something in the shape/size/position of the breast implant. Accurate planning is essential to reduce the risk of anything happening again and also to optimize chances of success. The problem you describe is called symmastia; it is sometimes challenging to correct but in the hand of an experienced surgeon, this can be addressed. Placement of the breast implants in a new submammary pocket (in front of the muscle) will be helpful to reduce the risk of recurrence of the symmastia, provided the new pockets are careful prepared leaving enough tissue in the sternal area. (sorry for being technical). However having the implants in front of the muscle might expose you to a slightly higher risk of visibility and palpability of the implants.Having a liposuction at the same time should not be a problem as long as you are not having too many areas treated at the same time.All the best and I hope you will satisfied with the outcome.Andrea Marando

Richard Baxter, MD · Answer

After 6 months it is reasonable to have revision surgery in most cases. I am not sure what you mean by "between the pectoral muscle" but if the implants are too close together there are several things to consider: Base diameter of the implants (not too wide), whether the pectoral muscle has been released, whether there is any animation deformity when you flex, and whether there is good tissue coverage. If implants are too close together (symmastia) then going on top of the muscle is not usually the best way to fix the problem. You may need an internal bra material such as SERI Scaffold, Strattice, or GalaFLEX mesh to reshape the pocket for the implants. The primary risk is that if the correction is not successful, each subsequent attempt becomes more difficult so the plan needs to be the one with the highest chance of success.

Steven Wallach, MD · Answer

I will often keep implants under the muscle and this is often a bit more complex then the primary procedure.

David N. Sayah, MD, FACS - Account Suspended · Answer

I
recommend my patients wait six months before considering breast implant
revision surgery, so I think your timing is fine. What you’re describing sounds
like synmastia, and it’s a problem of the implant pockets getting too close
together to the point where there’s no longer a division between them. A board
certified plastic surgeon with experience in revision surgery should be able to
correct this issue by repairing the implant pockets, and can change your
placement from submuscular to subglandular at the same time if you want. As for
including liposuction as well, it’s not uncommon to combine procedures in this
way, although this will likely increase the total time you’re in surgery.

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