Breast Revision Surgery
Dr. Hootan Daneshmand
Breast revision surgery refers to the removal or replacement of saline or silicone gel implants following complications from primary breast augmentation. The aim is to correct or improve poor results from prior cosmetic and reconstructive procedures. Unfortunately, not every plastic surgery procedure leads to perfect results. Some of these unfortunate results are avoidable while others are merely due to how the body heals in response to surgery. Sometimes the inability of a surgeon to connect with patients or understand their needs, the use of outdated techniques, or under-experienced or poorly trained surgeons, poor judgment, misinterpretations of the underlying problem may also play a role in unsatisfactory outcomes.
The more common reasons for seeking breast revision surgery include major and minor medical complications from a prior augmentation surgery and women who simply realize they would like to just change the size of their implants. In many cases, breast implant revision may be required for health purposes, or to relieve physical discomfort. These potential health complications may include capsular contracture (excessive scar tissue development which can place pressure on the implant), improper implant positioning, implant rupture or leakage, unnatural appearance, breast implants’ limited product life and other combination issues.
In some cases, women may choose to have their breast implants removed entirely, while others may opt for breast revision surgery. In cases involving capsular contracture, saline implants may be replaced with silicone gel alternatives. Although complications from a previous breast implant procedure may cause discomfort and pain, Orange County breast revision surgery can help correct the physical problems and resolve aesthetic flaws that may have been caused by a negative prior augmentation experience.
We hope that the following commonly asked questions can help you gain a more complete understanding of Orange County breast revision surgery. We welcome you to visit with Dr. Daneshmand to discuss your individual desires and questions regarding breast revision surgery and perhaps turning a previous negative augmentation experience into a positive one.
Am I a good candidate for surgery?
You may be a candidate for breast revision surgery if you have one or more of the following conditions: loss of saline implant volume – implant deflation, X-ray (MRI) suggesting a silicone implant with a shell leak, if you desire to change implant/breast size, tightening of the scar tissue around the implant (capsular contracture), breast implants that have shifted in position, and if your breast tissue has changed in shape or volume from skin stretch or weight loss/gain. How well breast revision surgery will suit you will depend on your individual examination and personal expectations. As long as there is an informed and clear understanding as to the reasonable expectations of the procedure, you can anticipate a satisfying benefit from breast revision surgery.
Is breast revision surgery safe?
Yes. Breast revision surgery is a commonly performed surgical procedure. The surgery can be performed in an outpatient setting. Women who choose breast revision surgery, can have immediate benefits for the cosmetic appearance of their breasts. Breast revision is proving to enrich womens’ lives, have a positive effect on their self-esteem and restore their self confidence. *Every surgical procedure carries some risk. For a discussion of the specific risks of breast augmentation please continue below.
Why Choose a Board Certified Surgeon?
One way to lessen the risks of breast revision surgery is to seek out an Orange County board certified plastic surgeon (certification from the American Board of Plastic Surgery). These qualifications ensure that you and your well-being are in good hands. Each ASPS Member Surgeon:
- Has at least five years of surgical training and a minimum of two years of plastic surgery training.
- Is board-certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
- Is trained and experienced in all plastic surgery procedures, including breast, body, face and reconstruction.
- Is peer-reviewed for safety and ethical standards prior to attaining the honor of active membership.
- Only operates in accredited facilities.
Should the implants be placed above or below the muscle?
There are several advantages to placing the implants below the muscle (submuscular). The extra coverage of the implant in the upper portion of the breasts assists in achieving a more natural contour and appearance. The implant is also less likely to be as palpable when it is placed under the muscle. The nerves that supply nipple sensation are less likely to be affected by this approach. There is evidence that scar tissue formation around the implant (capsular contracture) is reduced. Another important benefit is that there is less interference with mammography because the implant is partially separated from the breast tissue by the muscle. For these reasons, we generally feel that it is advantageous to place the implants below the muscle. However, breast surgery must be individualized and there are some situations where placing the implant above the muscle (subglandular) may be more appropriate.
Where is the incision located?
There are four main choices for incision location: periareolar, inframammary fold, transaxillary, and transumbilical. There are advantages and disadvantages to each approach.
- The periareolar incision heals with an extremely inconspicuous scar because of the natural color border present between the areola and surrounding breast tissue. The periareolar incision can be used in almost all patients and most choose this location. Another advantage is that if a small lift is necessary, it may be done through this incision to correct minor asymmetries.
- The inframammary fold location is also possible. The main disadvantage of this approach is that the potential for a visible scar if a bathing suit “rides up” when lying down.
- Although the transaxillary approach is not as widely applicable and has certain limitations, this works well for some patients. Again, the main disadvantage is scarring in a potentially visible area. The location of the incision does not influence the potential for numbness of the nipple postoperatively.
- An incision in the umbilicus (belly button) can also be performed. However,this may not be advantageous as it will void the warranty of the implants.
What type implants are best?
The shape or style of implant is dependant upon your breasts and your goals. Most women will get the best aesthetic result from round, moderate profile implants. High profile implants may be helpful in women with thin chests who require a smaller breast width for a given projection. Anatomic or “teardrop” implants are occasionally useful. Studies have shown that round implants are equally anatomic and natural appearing once implanted. The type of implant certainly must be individualized to the patient, but most often, round, moderate profile implants achieve the best shape. Implants also come in smooth and textured varieties. There are advantages and disadvantages to both types depending on the particular patient characteristics.
How does the surgeon know what size implants to use?
It is extremely important that you and your plastic surgeon are in agreement regarding your desired breast size and shape. Using named cup sizes is helpful, but not completely accurate because bra sizes vary among manufacturers. A combination of approaches is used. First, measurements of your chest wall and breast are taken. This is followed by getting a preview of your proposed look by trying on implants under a bra in our office and viewing other patient photographs. Another method of size estimation is to place dried rice in a Ziploc bag and measure the ounces (1 ounce = 30cc) to achieve the desired fullness. Finally, pictures of breasts that match your desire can help your surgeon give you the look you want.
Do the implants deflate?
Yes they can deflate (rupture), but this is not harmful to you. The salt water is merely reabsorbed by the body and the affected breast will flatten. Rupture of saline filled implants occurs at about 1% per year, per implant. It is usually a simple procedure to remove the implant and replace it with a new one into the pre-existing pocket. The implant manufacturers offer a warranty for implant rupture, which will help with replacement costs. At this time, it is also possible to change implant sizes or potentially switching to another type or style of implant.
Saline implants or Silicone gel implants?
Silicone gel implants can currently only be used in certain clinical situations dictated by the Food and Drug Administration. This is done under a research protocol and includes patients with a breast deformity such as tubular breast, those in need of reconstruction after mastectomy, and women who have ptosis (sagging breasts) requiring a lifting procedure. For women who undergo breast augmentation to enhance the size of their breasts without the need for a lift, saline implants are used. These are implants filled with sterile salt water. Saline implants, when used properly, can create a natural looking, enhanced breast. Please see our photo gallery to evaluate for yourself.
What is capsular contraction? How do I avoid it?
Capsular contracture is when the scar tissue that your body forms around the implant becomes thick and heavily scarred. This is not dangerous to you, but it can cause the breast to become tight, hard, and unattractive. Evidence supports that breast massage after surgery can help to decrease the tendency towards capsular contraction. Additionally, submuscular implant placement can reduce the incidence of contracture. It is very important to follow your surgeon’s instructions in the postoperative recovery period to minimize the chances of capsular contracture.
What about mammography?
Women with breast implants should follow the same mammography schedule as women without implants. Mammography technicians are well versed in compression and displacement techniques used to maximize the efficacy of mammograms on women with implants. Additional modalities such as ultrasound and MRI examinations may also be helpful in certain cases. It is recommended that all women 35 years of age or older have a baseline mammogram prior to undergoing any breast surgery.
Will breast implants increase my risk of breast cancer?
The breast implants themselves do not cause cancer. There is a slight decrease in mammographic breast tissue visualization after implants and additional modalities such as ultrasound or MRI may be used to aid in screening. Previously augmented women do not develop breast cancer at a higher rate than women without breast implants. Mortality from breast cancer is not increased in women with implants and there is no worse prognosis for augmented women who develop cancer versus nonaugmented women.
Does breast revision affect my nipple sensation?
Approximately 10-5% of women can have a decrease in nipple sensitivity after implant placement. Care is taken during surgery to avoid harming the nerves that provide sensation to the nipples, although it is not completely avoidable.
Where is the surgery performed?
Breast revision surgery is performed at accredited outpatient surgical facilities. Anesthesia is performed by board-certified anesthesiologists and your recovery is supervised by highly trained nurses. This ensures the highest degree of safety and the lowest infection rates.
What kind of anesthesia is used for the procedure?
General anesthesia is the preferred method of achieving adequate sedation and pain control. You will be entirely asleep for the duration of the procedure and awake in recovery before you know it. Board-certified anesthesiologists deliver the anesthesia and care for you before, during, and after surgery so that you have a comfortable and safe experience.
What is the recovery period?
The surgery is performed on an outpatient basis and you will able to go home after surgery. You will be walking around the day of surgery. The degree and duration of discomfort varies from patient to patient. Most women are able to stop taking pain medication after 2-3 days and are back to work and non-strenuous activity at 5-7 days. Low impact activity and exercise may begin at 4 weeks and unlimited activity at 6 weeks.
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