Revisional Breast Surgery
Revisional surgery fixes various complications resulting from breast implants.
Revisional Breast Surgery
Revisional surgery fixes various complications resulting from breast implants. While implants can remain intact for decades in the body, all such devices will fail at some point. Leaks can be caused by degradation as well as external trauma. They can also cause a range of reactions that require follow-up surgery.
Leaks can be caused by degradation of the implant shell, chest trauma, damage during implantation and in rare cases from the pressure of mammograms. Saline implants have a failure rate of two percent per year while silicone gel implants have a lower failure rate of 0.5 percent per year. When saline implants break, they usually deflate quickly and noticeably and can be easily removed. When silicone gel implants break, they do not usually deflate but the silicone can leak and require implant removal.
Capsules of tightly woven fibroblasts can naturally form as the body's response to an implant. They can also be caused by contamination, rupture or leakage and bleeding. This complication can be painful and distort breast shape. Correction requires removing the implant and scar tissue, and re-inserting the implant. There is increased risk of capsular contracture with silicone gel implants as well as implant placement above the muscle (subglandular) or insertion of the implant via the nipple.
There are two types of double-bubble deformity, one in which the breast tissue hangs below the implant ("waterfall deformity"), and one in which the implant rides below the fold of the breast. Either deformity can occur shortly after breast augmentation, or result over time from pregnancy, weight loss or gravity. Surgical correction involves changing the position of the implant or lifting breast tissue or both.
Also known as "uniboob," this complication is uncommon. It occurs when an implant is placed too far medially and both implants meet at the midline. Symmastia can be corrected by changing the implant pocket location and reinforcement with an acellular dermal matrix (ADM) such as Strattice.
Bleeding leading to hematoma or bruising can occur after breast augmentation surgery and may require surgical correction to control or correct. Implant surgery can cause infection which can usually be treated with antibiotics alone. Though serious infections require removal of the breast implant and about a 90-day wait before re-implantation.
The chances of rippling can be lessened by using an implant with a smooth shell or silicone gel implant. Placement, either submuscular or subglandular, can also have an affect. However, ripping of implant capsule can still occur and require surgical removal and correction.
Breast sagging (ptosis)
After augmentation surgery, increased sag can sometimes occur. Correction may require mastopexy (breast lift) as implants alone are ineffective as a lifting mechanism.
Due lack of sufficient tissue coverage, downward migration of implants may occur over time, causing areolas and nipples to appear too high. The corrective procedure to bottoming out is called capsulorrhphy. Also known as an "internal bra" or pocket correction, it involves closure of a portion of the breast pocket using internal sutures to correct implant displacement. It's done after careful measurements are made from areola to the new mammary fold. Often an ADM is used to provide additional strength to the tissue to prevent recurrence.
A similar occurrence to bottoming out is when breast implants fall outward toward axilla (armpits). Likewise, correction involves capsulorrhaphy, using internal suturing to keep implants in the correct position on the chest wall.
Every skin type is different, and thus every implant patient bruises and scars differently. Scarring can be minimized through corrective follow-up surgery shortly after initial procedures. Post surgery, scars should be kept moist and out of sunlight.
Most revisional procedures are relatively simple and performed on an outpatient basis. Recovery time varies, however most patients can resume normal activities on one to two weeks. Specific post-operative regimes may apply to certain patients and procedures, and should be carefully detailed in pre-operative consultation.