In the Media

REVISION BREAST SURGERY

Steven Bloch, M.D.

Breast augmentation surgery is one of the most common elective procedures performed in the United States and has been available for approximately 50 years. Over time, the implants have changed as well as their placement. It was initially thought to be a one-time procedure, but we know better now, and women are advised that in all probability they will need revision breast surgery later in life.

It is important to realize that implants are used to make the breast larger. The implants alone may not adequately lift the breast or correct the effects of pregnancy, weight loss, or skin stretching. The body heals by forming scar tissue around the implant. The scar tissue holds the implant in place, but over time the scars might also contract and distort the implant, making them feel firmer than you or I may want. This is referred to as a breast capsular contracture.

Breast augmentation does not stop the aging process. An augmentation that looked good when you were young may not always age gracefully. The overlying breast tissue may continue to sag with time and create an unpleasant appearance much like an "orange in a sock,"-not a pretty visual. Likewise, the body's own tissue may not be strong enough to support the implant, and you may get a "bottoming out" of the implant over time.

Minor asymmetries of the breast may become more exaggerated due to weight loss, gain, pregnancies, or menopause. The implants haven't changed, but the overlying breast tissue has, which may create distortions.

Finally, patients' desires change as to what is an appropriate size. Younger women often want larger breasts. What might have looked attractive when we were young may not be our desire when we are older, especially if one has gained some weight over the years.

Revision breast surgery is complex and challenging. Often, to get the optimal result, more than one surgery may be required. In the case of capsular contracture, removal and release of the scar tissue is in order as well as changing the plane that the implants are in. If the implants are above the muscle, then placing them behind the muscle may solve the problem. The use of cadaver tissue to line the pocket may also be of benefit. In the case of "bottoming out" of the implant, I prefer to use some internal mesh to support the breast tissue and prevent a recurrence.

If the overlying breast tissue has dropped in relation to the underlying breast implant, then a mastopexy, or breast lift, may be in order. There are various types of breast lifts with different types of scars. As to which is best, it all depends on your anatomy and how much lift and or reshaping of your breast tissue is needed.

Revision breast augmentation is usually more difficult and complex than your original augmentation but well worth the effort. If you had your augmentation to enhance your self-esteem and over time things have changed or you are having problems, you owe it to yourself to seek out the help of an experienced plastic surgeon.