Breast Revision Surgery Sydney

Breast Augmentation Revision Surgery

Revision may be considered shortly after the initial operation due to complications or an unsatisfactory outcome, or many years later due to changes over time, capsular contracture, implant-related concerns or evolving patient preferences.

In all surgical procedures, the surgeon must discuss realistic potential outcomes, as well as the associated risks and possible complications. Despite careful planning and appropriate aftercare, outcomes can vary between individuals, and in some cases, further surgery may be required.

Reasons for Breast Augmentation Revision Surgery

Common reasons for breast augmentation revision surgery include:

• Implants settling in a poor position
• Implants ‘bottoming out’
• A ‘double bubble’
• Capsular contracture
• Changes in breast tissue
• Ruptured implant
• Inadequate cleavage or ‘sideboob’
• Implants that are too large or too small
• Changes in the patient’s aesthetic preference.

If the initial surgery also included a Breast Lift (Mastopexy), then the potential problems are magnified. We will discuss this further below.

Breast augmentation revision considerations

Whatever the reason for breast revision surgery, there are always numerous issues that your surgeon must take into account when planning revision surgery. More often than not, the revision surgery is far more difficult than performing a standard Breast Augmentation.

Your surgeon must understand your concerns and perform a careful assessment before creating your surgical plan. Below are some of the considerations.

IMPLANT EXCHANGE

Patients may request an implant exchange for various reasons, and the underlying cause will dictate the appropriate course of action. Issues to be considered include:

• • Implant pocket: Does the implant pocket need to be changed or significantly modified to accommodate the new implant and keep its position stable?
  • Internal bra: Is a formal internal bra (internal mesh) required?
  • Mastopexy: Should a Breast Lift (Mastopexy) be considered in conjunction with the breast augmentation?
  • Capsulectomy: Does the patient require a capsulectomy at the same time, and what are the potential issues associated with it?

EXPLANT SURGERY (IMPLANT REMOVAL)

Some individuals, for a variety of reasons, no longer want to have breast implants and, therefore, request removal. This is formally known as Explant Surgery. Before surgery, various considerations must be discussed with a patient, including:

• Degree of difficulty: Explant surgery, as with all types of revision surgery, is typically more difficult than the original breast augmentation surgery
• Capsulectomy: A total capsulectomy must be performed at the same time
• Chest wall: The ribs and surrounding muscles often change shape due to implants. This resultantly leaves a depression in the chest wall where the implants once were.
• Breast tissue envelope: This envelope has stretched due to the presence of the implants and will not shrink or tighten afterwards. Therefore, it will appear deflated.
• Combined surgeries: Is a Breast Lift (Mastopexy) required at the same time as the explant surgery? If so, there will be potential complications and issues to discuss.

Non-implant-related revisions

BREAST LIFT (Mastopexy) & REDUCTION SURGERY

In some cases, revision surgery is performed to address concerns relating to breast tissue position, shape or volume following previous surgery. For example, a patient with breast ptosis may have undergone implant surgery, yet residual drooping (ptosis) remains. In other situations, natural changes in breast tissue over time may result in further descent or an increase in breast volume.

In these circumstances, additional surgery may involve lifting the breast tissue and in some cases, reducing breast volume. Depending on the individual presentation, implant removal or replacement may also be considered during the procedure.

As with all surgery, these procedures carry specific risks, potential complications and limitations, which must be discussed thoroughly during consultation.

AREOLAR SURGERY

After breast surgery, some patients may be concerned about the size or shape of their areolae. In these instances, after the breasts have fully settled and softened, the surgeon may consider surgery to improve the size, shape and/or symmetry of the areolae to meet the patient’s expectations, provided they are realistic.

SCAR REVISION SURGERY

With any surgery, scars may not heal optimally. Some of the potential concerns include:

• Hypertrophic scars
• Keloid scars
• Tight/tethered scars
• Poorly placed scars

All surgery leaves scars. And, nothing can be done to make scars disappear. However, it is the surgeon’s job to ensure the scars are as neat as possible, placed in the ideal position and given the best opportunity to heal well. Sometimes, though, scars will not heal optimally no matter what is done, and this is particularly the case for patients who are genetically prone to develop keloid scars.

Combining Breast Augmentation & Mastopexy (a case of ‘further surgery’, not ‘revision surgery’)

Oftentimes, ‘further surgery’ does not mean ‘revision surgery’. The word ‘revision’ implies that there’s been a complication that requires further surgery to ‘fix’. While this is true in some cases, fortunately, it represents only a minority. This is best illustrated by discussing the types of breast surgeries.

If a patient undergoes a Breast Augmentation surgery, it typically takes around six months for the initial surgery results to settle fully. At this stage, the surgeon can critically assess the surgical results. And for the majority of patients, it’s highly unlikely they’ll need further surgery.

However, if a patient combines a Breast Augmentation with a Breast Lift (Mastopexy), it would not be unusual for the patient to be recommended further surgery to finesse the results. In this instance, it would not be classified as a complication of the original surgery, but rather, a reflection of the difficulty of the surgery and the unpredictability of how the implants and breast tissue settle into position.

Dr Dona often describes this process as being analogous to purchasing an expensive couture dress, where more than one fitting is required for an optimal fit. He will discuss these issues, including all risks and complications, with every patient before proceeding with any breast surgery.

Potential complications

Revision surgery may be attached to various breast surgeries, such as breast augmentation, breast lifts, breast reductions, implant capsulectomies, fat transfers and so on. Due to the extensive nature of the list, it’s not possible to provide a comprehensive list of all associated potential complications. Each of these procedures has its own specific issues, which are magnified with revision surgery. The specific complications for each of these procedures are listed on the relevant pages. However, all surgery carries general potential risks that you must be aware of.