Corrective Breast Surgery

When a woman undergoes breast augmentation it’s likely that the last thing on her mind is having a second surgery – called breast revision surgery. Revision surgery is always more difficult than primary breast augmentation, for several reasons. First, the presence of scar tissue makes it more difficult to predict a good result. In addition, the surgeon is dealing with the stretching of tissues or anatomical changes caused by previous implants. For these reasons, many surgeons may charge higher fees for breast revision than for primary breast augmentation.

Who is a Candidate

  • Switching from saline to silicone implants due to rippling problems, or just a desire for a more softer, more natural feel.
  • Breast changes after pregnancy, weight gain or weight loss, or age-related changes.
  • Cosmetic concerns where the patient is unhappy with result of previous surgery due to poor implant placement, or other problems such as double bubble – a cosmetically undesirable circumstance in patients with breast implants which occurs when the breast fails to take on the shape of the implant, resulting in the appearance of a visible line showing a separation between the bottom edge of the implant and the bottom edge of the natural breast. This tends to happen more often in the case of a very tight or constricted pre-op breast or when there is significant droop present.
  • Symmastia is a cosmetically undesirable circumstance in patients with breast implants which occurs when implants come too close to the midline of the chest. This results in a lifting of the skin from the chest wall and creates the dreaded “uniboob” appearance. This usually happens as a result of the overly-aggressive release of the chest muscle during implant surgery, extending the release to the mid-chest.
  • Bottoming Out is the non-technical name for when a breast implant drops over time into a position that is too low compared to the breast/nipple position. The result is cosmetically undesirable.

Intended Result

The biggest predictor of the success in breast revision surgery is the quality of communication between the doctor and the patient prior to the surgery. Patients who receive a full and honest explanation of what they can expect are likely to be much more satisfied in the end.

  • Breast revision can sometimes be more successful when the implant is placed on a different plane from the first surgery. (i.e., from over the muscle to under the muscle, or vice-versa). This is because operating on a different plane usually means there is less scar tissue and less tissue deformity due to the first surgery. Of course, this is highly variable, and the best course of action is always determined on an individual basis
  • The aim is to correct all the above complications
  • Remove old implants

Procedure Description

  • Double bubble: Correction of this condition via breast revision surgery usually involves a lift or tightening with aggressive release of the tissues of the lower breast in order to allow the breast to take on the shape of the implant. Patients should also be educated toward tolerance of the imperfection, as this problem sometimes cannot be fully corrected
  • Asymmetry: Correction of this condition via breast revision surgery usually involves removing the implants and closing the space in the middle of the chest with internal sutures. This approach works best when implants remain out of the body for a period of time after surgery and are then reinserted after approximately 12 weeks, or more, allowing the body time to heal. If the implants are replaced too soon following the corrective procedure the effects of gravity and pressure of daily activities may cause the problem to recur
  • Bottoming Out: Correction of this condition via breast revision surgery usually involves closing off the lower portion of the pocket (the space inside the breast where the implant resides) with internal sutures. This approach works best when implants remain out of the body for a period of time after surgery and are then reinserted after approximately 12 weeks, or more, allowing the body time to heal. If the implants are replaced too soon following the corrective procedure, the effects of gravity and pressure of daily activities may cause the problem to recur
  • Your breast revision surgery may be performed in a hospital, or office-based surgical suite
  • Like your previous breast surgery, medications are administered for your comfort during the surgical procedure
  • Occasionally, local anaesthesia and intravenous sedation may be used for patients undergoing some revision surgery, although general anaesthesia may be more desirable in most instances

Recuperation and Healing

  • When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. Your breasts will be wrapped in gauze dressings or a surgical bra depending on your plastic surgeon’s preference
  • Your plastic surgeon may determine that you will stay in the hospital or surgical facility overnight
  • You should be up and walking on the day of surgery. Depending on your plastic surgeon’s preference, your dressings will be removed within a few days after surgery
  • You may be instructed to wear a support bra during your early healing period
  • Your plastic surgeon will probably permit you to shower between one to three days following surgery but you should not immerse your breasts underwater for at least four weeks after surgery as long as you are healing well
  • Stitches that don’t dissolve on their own will be removed in about a week
  • Some discoloration and swelling may occur initially, but this will resolve as you heal. Most residual swelling will resolve within a month. Healing in revision surgery will take a little longer that your first breast surgery
  • It is important to follow all patient care instructions as directed and stay in close touch with your plastic surgeon’s office as you heal
  • While it will take several days to return to more normal activities after your breast revision surgery, it is important to your recovery that you get up and move around
  • After breast revision surgery, it is often possible to return to work within 7 to 10 days, depending on the type of activities that are required at your job
  • Heavy physical activity should be avoided for at least the first couple of weeks following surgery. After that, care must be taken to be gentle with your breasts for at least the next month
  • Your plastic surgeon will give you specific instructions and restrictions in terms of physical activity

Note

The specific risks and suitability of this procedure for a given individual can only be fully determined at the time of consultation with your cosmetic surgeon. All surgical procedures have some degree of risk. Minor complications which do not affect the overall cosmetic results occur occasionally. Major complications are rare.