Dr Bruce K Smith discusses his BEWISE breast augmentation technique.

Because breast surgery has been one of the most desired types of aesthetic or cosmetic surgeries for
many years, it is not surprising that revisional surgery is commonly requested and sometimes medically
necessary. Breast implants do eventually wear out and need to be replaced. In addition, aging and
pregnancy may drastically change the shape, volume and symmetry of the breasts. Revisional surgery is
a significant part of Dr. Smith’s practice and very few practicing plastic surgeons have the experience
that he has acquired in this challenging area. There are 4 main reason that patients desire revisional
breast surgery.
1. Breast shape or volume change
2. Implant related capsular contracture
3. Implant failure
4. Patients’ dissatisfaction with initial procedure
1. Breast shape or volume changes can occur due to weight gain or loss, pregnancy, aging of
the breast or capsular contracture. After the age of 50, the breast primarily functions as an
organ for fat storage. Increases in the size of the aging breast may motivate women with
breast implants to have the devices removed or reduced in size. With saline implants, the
devices can be deflated with a simple procedure in the office to help patients with decision
making to remove or downsize their implants. Most of the time implant removal or
reduction requires a lift or mastopexy in order to youthfully reshape skin that has been
stretched and droops. Drooping of the breast is referred to as “ptosis.” Ptosis may also
occur in women with breast implants after pregnancy and breast feeding. Many of these
patients desire a mastopexy or lift to reverse the effects of pregnancy.
2. Capsule contracture is the most common late complication after breast implants and while a
great deal of research has been directed toward determining causes and treatments, this
complication still occurs in patients with the incidence increasing by approximately 1% every
year that the implants are in place. Capsular contracture is caused by excessive scar tissue
around the implant that can cause pain, firmness and malposition. Significant and
symptomatic contractures usually require removal of the excessive scar tissue and implant
replacement; often changing the position or “pocket” of the new implant.
3. Implants, like any mechanical or medical device, will eventually wear out and need to be
replaced. While most implant manufacturers replace worn out implants free of charge,
there are other costs not usually covered by insurance for surgery, the facility and
anesthesia. Implants should last at least 10 years and many last over 20. Many patients with
implant failure, use the opportunity to increase or decrease the size of their implants at the
time of replacement.
4. Unfortunately, not all patients are completely satisfied after one surgery on their breasts.
With patient satisfaction as the goal of every plastic surgery procedure; dissatisfaction can
occur related to an early complication, (i.e. infection, hematoma, fluid collection, wound
separation) or a miscommunication between patient and surgeon. Everyone has their own
unique desires and expectations when considering plastic surgery and it is important for
surgeons to have a clear understanding of these perceptions prior to performing surgery.