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Revision Breast Augmentation Typical Patients

 

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Revision Breast Augmentation Typical Patients

 

Am I a good candidate for Revision Breast Augmentation Surgery?


There are several aesthetic, emotional, and medical reasons why women may consider breast augmentation revision or secondary breast augmentation. The best candidates for secondary breast augmentation are women who are in good health, not pregnant or nursing, and are dissatisfied with their current breast implants. The need for breast augmentation revisions stem from a number of sources but fall into several broad categories:

 

Problems with Implant Position or Surgical Dissection

  • Implant asymmetry with one implant higher than the other, or one implant more central (medial) or more lateral with respect to the other. These asymmetries can result from use of different size implants, pockets that are dissected unevenly, or significant breast asymmetry in terms of shape and position. Correction of high-riding implants requires revision surgery to lower the implant and center it under the nipple-areola complex. Correction of implants that are too medial or too lateral involves accurate recreation of the pocket.

 

breast-implant-revision-01-before

 

This is a patient who had asymmetrical implants with the right one higher than the left. Dr. Agha performed a revision procedure lowering the right implant, releasing the lowering aspect of the implant capsule and the inframammary fold.

  • Bottoming out of implants. This occurs when implants are positioned too low on the chest wall with respect to the nipple. Over time the implants shift into an unsightly position due to aggressive distortion of the inframammary fold.

 

breast-implant-revision-02-before

This patient presented to Dr. Agha for corrective breast augmentation. Her primary breast augmentation was performed by a non-plastic surgeon 18 months prior. Both of her breast implants are too low due to excessive dissection of the inframammary fold.

 

The implants move down onto the upper abdominal region, resulting in distortion of the breast shape and nipple-areola complexes that point up. This complication occurs more often with subglandular implant placement, over-sized implants in relation to the patient size, and inaccurate implant pocket dissection. The implants may hang too low, appearing unattractive, and prevent you from being comfortable when bra-less.

 

The patient below presented herself to Dr. Agha for corrective breast augmentation. Her primary breast augmentation was performed by a non-plastic surgeon three years prior. Both of her saline breast implants were placed in a subglandular plane and were too low due to excessive dissection of the inframammary fold. Implant positions are asymmetrical. The right implant is lower than the left. She also had rippling of her right implant.

 

breast-implant-revision-03a-before

 

The patient underwent a corrective secondary breast augmentation procedure performed by Dr. Agha as well as a tummy tuck. Her breast revision surgery involved removal of the implants, reconstruction of the lower inframammary fold, and placement of silicone implants in a submuscular plane.

 

  • Synmastia. This represents implants that touch one another centrally. It represents over-dissection in the medial region of the breasts over the sternum or release of the medial attachment of the pectoralis major muscle from the central sternum bone in an attempt to create better cleavage.

    • Implants that remain too high post-operatively (and do not “drop” or “settle” into the correct position)

    • Implants that are placed too widely apart, lacking desirable cleavage

 

Problems with the Implant Selection

  • Over-sized implants for the patient’s size and weight. This can result in stretching out the breast tissue and skin.

  • Over time, the breast tissue thins out and the breast droops and sags over the upper abdomen.

 

breast-implant-revision-05a-before

 

This patient presented to Dr. Agha for corrective breast augmentation. Her primary breast augmentation was performed by non-plastic surgeon four years prior. After the second year of her breast augmentation, she returned to her surgeon for implant drooping. According to the patient, the surgeon placed additional saline in her implants during an office procedure. When presenting to Dr. Agha four years after her primary procedure, the patient had 450 cc saline implants in a subglandular plane, despite weighing 90 Ibs only. Her large saline implants in a subglandular plane had resulted in significant thinning of her breast tissue, skin damage, and stretching of her nipple-areola complex. The patient underwent a corrective breast augmentation procedure that involved removal of her implants, reconstruction of the lower inframammary fold, and placement of silicone implants (275 cc chosen by patient) in a submuscular plane, and peri-areolar mastopexy to remove stretched out skin.

 

Problems with Neglecting Patient’s Tissue Characteristics

  • Over-looked patient’s breast tissue sagging or attempting to correct breast drooping through breast augmentation.

 

breast-27

 

This patient had a breast augmentation by a non-plastic surgeon after her pregnancy using saline implants in a subglandular plane. The correct procedure would have been to combine a breast augmentation with a breast lift.
  • Over-looked Tuberous Breast Deformity. Correction of this condition should be addressed during the initial operation but occasionally only becomes apparent post-operatively.

 

breast-implant-revision-08a-before1

 

This patient presented to Dr. Agha for Breast augmentation. The patient had tuberous breasts which were corrected appropriately.

  • Over-looked pre-existing natural asymmetry. Most breasts differ from one another, sometimes greatly. This may be a difference in size, shape, form, or position and is rarely perfectly corrected during surgery. However, asymmetries should be properly diagnosed and documented pre-operatively in an attempt to correct the asymmetry as much as possible during surgery.

 

breast-implant-revision-07a-before

 

This patient presented to Dr. Agha for Breast augmentation. The patient had subtle breast asymmetry with the right breast being smaller and than the left. This was appropriately corrected with use of different size implants.

 

Combination Problems

  • Double Bubble Deformity. Double bubble deformity may occur soon or years after a breast augmentation procedure on one or both sides. It represents breast tissue that is sitting on top of a round breast implant rather than over the implant. Double bubble deformity typically results from implants that are placed low on the chest or have dropped low due to gravity. It represents a mismatch between position of a well-formed breast and an implant. It is best treated during the primary augmentation by choosing the appropriate implant and pocket position in reference to the patient’s breast size and tissue characteristics.

    • Rippling characterizes irregularities of the implant surface that can be felt or seen through the skin. It may develop as a result of a thinning of the tissue covering the implant, from an implant that is under-filled or leaking, or an implant that is placed above the muscle in a thin person. Rippling is also more common with the saline implants.

    • Implant visibility (being able to see the outline of the implants through the skin)-see rippling explanation.


 

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