Revision Breast Surgery

Even if your breast implant surgery was perfectly planned and beautifully executed, changes in your breasts’ appearance can occur over time. A second breast procedure is sometimes necessary to optimize or revise the appearance of a prior breast surgery. In our office we regularly see patients who are disappointed in the outcomes of prior procedures, or who want revision breast surgery due to physical changes resulting from pregnancy and lactation or changes in body weight. Breast revision surgery or implant removal may also be necessary if the patient is undergoing unrelated health problems such as breast cancer, which may be more easily treated without the implant After a clear discussion and examination of your concerns and goals, Dr. Sabry will outline a plan to help you achieve and exceed them.

Breast implant revision surgery involves removal and/or replacement of saline or silicone breast implants.  In most cases, the original breast implants are removed and replaced with new ones that meet the new desires and expectations of the patient.

Some common reasons for seeking breast implant revision:

  • A increase or decrease size of  breast implants is desired
  • A different shape of breast implants is desired
  • Breast implant deflation has occurred
  • Breast implant rupture has occurred
  • Outcome  of prior surgery is asymmetrical
  • Outcome of prior surgery is malpositioning of the breast implants
  • Breast implants complications such as: capsular contracture, rippling, bottoming out, fold malposition, and/or symmastia (otherwise known as “uniboob”) has occured
  • The patient no longer want implants

Secondary 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 Plastic surgeon is now dealing with tissues that have been stretched, or other anatomical changes caused by previous implants.

Preparation
A first step in the process is a comprehensive consultation and evaluation with Dr. Sabry so that the reasons for revision surgery are well established, and you have a good understanding of realistic outcomes. Dr. Sabry will consult with you to clearly understand the size and shape implants you now wish to have, and will guide you to the best choice for your unique anatomy and desired outcome. Good communication is the key to achieving the results you want. If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.

As you approach the date of your surgery you will have a comprehensive preoperative visit in our office approximately two weeks before your breast surgery. A complete list of “dos and don’ts” will be reviewed as well as the pre and postoperative instructions and any questions that remain will be answered. You will be directed to avoid anything that has a blood-thinning effect (aspirin, ibuprofen, vitamin E etc.) for two weeks before surgery. If you are a smoker, you will be asked to quit smoking for 6-8 weeks prior to your procedure. You will be asked to minimize alcohol intake. Basic blood work for preoperative testing will be ordered, and any breast imaging studies that are required (age and past medical history appropriate) will be obtained.

Procedure
There are several approaches to revision breast surgery depending on the patient, their anatomy and the correction desired. The exact procedure Dr. Sabry will use for your breast implant removal and replacement will depend on the reason for your breast revision and the outcome you both decided on. Saline implant removal typically involves the deflation of the implant before removing it and eliminating any existing scar tissue. Silicone implant removal is usually more involved and may require some surrounding muscle and tissue to be removed as well. If you are undergoing a removal and replacement breast revision surgery, Dr. Sabry will generally place the new implants immediately after the original implants have been removed.

In some cases the pocket where the breast implants were placed previously (under the breast tissue or under the pectoralis major muscle) will need modification. The breast implant pocket may need to be recreated. The original incision used to insert the implant is almost always the same one used to remove it; however, if you decide to incorporate a breast lift, elevating the position of your nipple and areola will result in breast lift scars. To help reposition an implant, Dr. Sabry may create an “internal bra” utilizing an acellular dermal matrix product to add additional support. He will take the greatest care to ensure the results meet your expectations and look natural and symmetrical.

Recovery
The recovery process for breast revision procedures is dependent on which type of revision surgery you have undergone. Patients who have undergone implant replacement will go home in a comfortable surgery bra that has adjustable straps. You may feel tired and sore after surgery, but this is easily managed with medication. Soreness usually passes in a day or two and many patients return to work within the week. It is important to avoid all exercise, heavy lifting, and other more strenuous activities for the first three weeks. Expect to be more tired during the first week and sore by the end of the day. If your job involves a lot of moving of your upper body, take the entire first week off. Any post-operative pain, swelling and sensitivity will diminish over the first few weeks. Dr. Sabry will see you for post-operative visits during your recovery. He and our staff will answer any questions you may have about your recovery, as well as your overall health and well-being.  

Complications
Complications following breast surgery are uncommon and usually minimal. Under Dr. Sabry’s expert and meticulous care all measures are taken to minimize the potential.  They may include capsular contracture, swelling and pain, infection around the implant, a change in nipple sensation, asymmetry, implant migration, unfavorable scarring, and breakage or leakage of the implant (implant rupture) as a result of injury or the normal compression and movement of your breast.

If a saline implant ruptures, the implant will simply deflate in a few hours and your body will absorb the salt water. If a silicone implant leaks, you will need to see the doctor for replacement of the implant.