The 3 Primary Types of Revision Breast Surgery

By Dr. David Sayah

Ideally, breast enhancement surgery will deliver beautiful results that perfectly match patient expectations every time. In the real world, however, all plastic surgeons recognize that this is not necessarily the case. Whether due to an unpredicted response from the body during healing after a well- executed surgery, a technical miscalculation during the surgery itself, or a change in patient breast surgery revision can create the desired outcome through a secondary surgery.

There are three basic categories for revision surgery: revision mammoplasty, revision mastopexy, and revision reconstruction.

1. Revision Mammoplasty

Revision mammoplasty is performed after an earlier augmentation procedure, and may be considered for a number of reasons:

• Size Adjustments – Exchanging implants for a larger or smaller size is a top reason why women pursue revision mammoplasty. In some cases, total explantation may be preferred instead.
• Aesthetic Concerns – Implants that show visible lateral displacement, synmastia, ride too high or too low, have rotated within the surgical pocket or that have significant asymmetry can be corrected with revision surgery.
• Capsular Contracture – The formation of a scar tissue capsule around an implant is part of the body’s normal healing response; however, if the tissue growth is overly aggressive, rigid to the touch, causes noticeable malformation or is painful, then revision surgery can be used to remove or release the capsule.
• Implant Replacement – Implants that have become damaged, deflated or ruptured need to be removed and replaced with new implants.

In many cases, these concerns may occur simultaneously; for example, more advanced grades of capsular contracture are often seen in reaction to a ruptured implant, or patients may opt for an increase or decrease in size if they are already pursuing revision surgery for an aesthetic concern.

2. Revision Mastopexy
Mastopexy, or a breast lift, raises and reshapes existing breast tissue to enhance the profile and placement of the breast without implants. In many cases, augmentation mastopexy is performed in women with ptotic breasts to combine the volume-additive properties of implants with the tissue redistribution benefits of a lift.

There are two primary factors that may necessitate revision mastopexy:

• Asymmetry – The breasts do not sit evenly on the body, the volume or shapes differ, or the nipples and/or areolae are not symmetrical.
• Aesthetic Concerns – Feeling dissatisfied with the appearance of the mastopexy scar, the nipples and areolae, or the overall breast shape and placement are all reasons that women pursue revision mastopexy.

3. Revision Reconstruction
Breast reconstruction is one of the most challenging surgeries due to numerous limitations such as the presence of mastectomy scarring, the absence of natural breast tissue and more delicate skin quality, not to mention the emotional impact of surgery and recovery. A number of women who look forward to their results following reconstructive surgery are disappointed by the outcome, and many women realize only after their reconstruction procedure that they could have achieved a better outcome from a plastic surgeon with extensive experience in breast reconstruction.

A board-certified plastic surgeon who specializes in revision breast reconstruction is essential for ensuring improvements through a secondary surgery. Women may choose revision surgery to change implant type or size, to replace or augment an implant-based reconstruction with flap reconstruction instead, or to improve the appearance of scars or asymmetry. Additional surgeries may be needed for the contralateral breast as well in order to ensure a very natural look and feel in both breasts. The end goal of revision reconstruction or any revision surgery is not to create the perfect breast, but instead to provide significant improvements following an earlier procedure.