Revisional Breast Surgery
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.
- Breast shape or volume change
- Implant related capsular contracture
- Implant failure
- Patients’ dissatisfaction with initial procedure
- 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.
- 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.
- 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.
- 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.