So the most common reason that someone needs a revision after a breast implant surgery is actually for a size change; either the size is too big or too small. A lot of the patients that I have seen have had implants put in because they, perhaps, said they wanted a specific size and their surgeon, rather than looking at all of the dynamic factors of their chest and breasts, have chosen a size on volume rather than really attending to what I think are the important concepts of breast reconstruction or augmentation, which are the same. And those three concepts are really an appreciation of the breast footprint, which is the top of the breast to the bottom and the medial breast to the lateral breast. That's the core foundation of the breast.
It's like the foundation of a house. So if you make a house too big for the foundation, the house falls over. If you make the house too small for the foundation, you're looking in the basement. Well, the same way with the breast. If you make the breast too big for the foundation or the chest wall, then it's going to be in your armpit. And if the implant is too small for the chest, you're usually going to have a widened cleavage, which so many women don't want.
So that's the first thing that's really important, and it's both important to a really successful breast augmentation and also to reconstructive surgery which is a large part of my practice. The second thing is an understanding of the creation of the skin envelope, and so knowing how tight or receptive the envelope is or knowing how thick or thin the skin and tissue is, that's an important part of decision making. And then thirdly, what material you choose to fill it.
And then we also have adjunctive factors such as fat grafting and liposuction and it's all to create the breast aesthetic ideal. So size is the number one reason. A lot of the patients that I see have had two, three, or even more attempts at revising a breast reconstruction, either for capsular contracture or ruptured implants. I think that in that situation, someone who does a lot of breast reconstruction is a little more skilled at evaluating and deconstructing the pieces that are required to create a successful outcome from that situation.

3 Concepts of Breast Augmentation That, When Ignored, Could Lead to Revision Surgery

Dr. Karen Vaniver discusses what she says are the three main concepts of breast surgery that also apply to breast reconstructive surgery and that can lead to possible revision work down the road if ignored initially.