Breast Augmentation Revision
Dr. Van Raalte has become a midwest expert in revision breast augmentation. He has 32 years of experience with breast augmentation and carefully measuring and recommending options, all of which are personalized for the individual patient.
We treat patients who have had surgery elsewhere and are unhappy with the size or the final appearance. Some patients may not have healed or turned out as they had hoped. This can include issues such as symmastia, implant malposition, size, or droop. Some are our own former patients and have had changes after pregnancy, aging, or had a deflation of an old saline implant. Breast implant revision can include a new implant type, size, correction of droop or malposition and use of grafting materials.
REASONS FOR SECONDARY SURGERY
Some patients will desire a larger size. Some have had deflation of an old saline implant or rupture of an old gel implant. We frequently see patients that will upgrade to the new cohesive gel implants (that are now available) after a saline implant deflation. There may be breast droop or further changes after pregnancy.
Problems that can occur after initial surgery that we have then corrected include… malposition, or one implant is too high or too low; or symmastia (referred to as uni-boob or wrinkling). Techniques we use include use of cohesive gel implants or material such as a silk mesh.
Patients seeking changes after the initial surgery are advised to wait at least three months after the initial augmentation before undergoing revision.
DIFFERENT IMPLANT SIZE
After the first breast augmentation, many women discover that they want their breast to be larger or smaller than the results achieved at the initial procedure. The numbers are low in our own practice, because of our comprehensive planning and sizing. We do see a number of women for re-augmentation. Some of these changes occur due to aging such as natural widening of the chest. A different implant size may be desired several years later when the natural breast volume has been affected with weight changes, pregnancy, breast-feeding, or aging. The implant may need to be wider or larger just to improve the cleavage or appearance.
IMPLANT LEAKS OR DEFLATIONS OR RUPTURES OR LEAKS
Saline implants that begin to leak or deflate are often very noticeable as the deflated breast will decrease in size. The patient with silicone implant ruptures may notice changes in the shape of the breast. The implant(s) are then replaced. Often saline implants will be replaced with the newer cohesive gel implants. Patients may decide to change size at the time of the new surgery.
Wrinkling or rippling occur most often in women with thin skin or a small amount of natural breast tissue and can be often felt when touching the breast or may occasionally be visible underneath the skin. This may be improved with a cohesive gel implant, fat grafting if possible, or use of a mesh or ADM to help cover.
Capsular contracture is when scar tissue forms around the implant and involves hardening of the breast as well and may result in a change of the shape of the breast. The capsule may be operated on and partially or almost totally removed.
Solutions that are available to help correct these complications include changing the size, shape, position, or type of implant.
Fat grafting to the breast can be done to help correct some abnormalities or give some correction to the shape of a breast. Fat grafting can be used to camouflage wrinkling but only if there is enough body available to cover.
Fat grafting the breast usually does not result in increase of more than one half cup size. Generally, about 50% to 80% of the grafted fat survives. In about 20% of the patients, new blood growth does not occur to the fat cells, and all the fat disappears. Luckily, this process is uniform, so one breast is not larger than the other. Fat can also be used for mildly tuberous breast to expand the skin and restore contours. It is good for tight breast folds, volume in the cleavage area, and to cover wrinkling. For reconstructive breast patients, it can be used to fill in after partial lumpectomy and is one of the best ways to restore the breast after radiation defects.
Sometimes a breast lift needs to be considered for shape improvement
Symmastia or implant malposition may be improved by various methods. These can include a new implant type, new positioning or use of a mesh or other material to add strength and support.