Breast Revision

Introduction

In spite of accurate preparation and correct execution of a breast implant surgery; there lies a possibility of changes in the expected results- leading to the consideration of breast revision surgery. A cosmetic surgeon should advise the patient seeking first-time breast implant surgery with the right choice of the implant and accurate surgical procedure. Otherwise, certain changes can be seen post-surgically like- implant related changes or changes due to natural causes (child-birth, breast feeding).

Inclusion criteria for breast revision:

Certain patients (with breast laxity or sagginess after pregnancy or losing weight) should have undergone a breast lift alone or with an implant at the time of their first implant surgery- instead of a breast augmentation alone.

One or more of the following criteria are to be met for breast revision surgery

• Loss of saline implant volume – implant deflation

• X-ray or MRI suggesting a silicone implant with a shell leak

• A desire to change implant/breast size

• Tightening of the scar tissue around the implant (capsular contracture)

• Breast implants shifted in position

• If breast tissue has changed in shape or volume from skin stretch or weight loss/gain

Assessment for breast revision surgery:

1. A detailed medical history is discussed with the patient, such as- the medical conditions, drug allergies, medical treatments received, previous surgeries including breast biopsies, and current medications. A patient will be asked if there is any family history of breast cancer.

2. Patient’s breasts are examined by the cosmetic surgeon and photographs are taken for medical records.

3. While planning for the surgery, the surgeon will judge the patient on factors like:

3. 1. The size and shape of the breasts

3. 2. The quality of Patient’s skin and breast tissue

3. 3. The position of the nipples and areolas

3. 4. All aspects of patient’s current breast implants.

3. 5. If patient’s breasts are sagging, the surgeon may recommend a breast lift surgery with breast implant revision surgery.

3. 6. In case of patient is willing to undergo a weight loss, the cosmetic surgeon will recommend the patient to stabilize the weight before breast revision.

3. 7. It is advised to discuss near future plans about pregnancy as well. Pregnancy can alter breast size in an unpredictable way and could affect the long-term results of the breast revision surgery. There is no evidence that breast implants will affect pregnancy or the ability to breast-feed, but patient is requested to get her doubts clear by discussing them with the cosmetic surgeon.

Need for breast revision surgery:

1. Breast implant deflation

2. A desire to change implant (size or type)

3. Capsular contracture

4. Implant malposition

5. Double-bubble deformity

6. Combined problems

7. Synmastia, so called uni-boob or bread-loafing

8. Implant coverage problems

9. Changes in the breast tissue

Preparation for breast revision surgery

• Breast revision is one the elective procedures and safety of the patient is the most important factor to be considered.

• Patients with a habit of smoking will be instructed to stop smoking well in advance of surgery and to avoid it for a period of time even after the surgery to minimize the chances of complications.

• Aspirin and certain anti-inflammatory drugs can cause increased bleeding and bruising, therefore patient undergoing breast revision is requested to avoid such medicines for a period of time before surgery.

Incision in the breast revision surgery:

• The number of incisions used will depend on how much change is required.

• The surgeon can use patient’s original scar of the previous surgery in case of straight forward implant or capsule surgery.

• There is a need for breast lift scars if there is a need to elevate the position of patient’s nipple and areola.

• One incision will be around the areola in the simpler cases where not much elevation is needed.

• For times when more lifting and tightening will help, another incision will run vertically from the bottom edge of the areola to the crease underneath the breast.

• The third incision is horizontal beneath the breast and follows the natural curve of the breast crease.

• If the nipples need to be lifted, the nipples and areolas remain attached to underlying mounds of tissue, and this usually allows for the preservation of sensation and the ability to breast-feed.