Many, many women have had breast surgery with implants, or with a breast lift. Unfortunately, the results may not be what that patient expected or problems have developed over time. Most of these conditions can be addressed with Revision Breast Surgery. Dr. Birchenough has a personal interest in (and spent his fellowship learning about) these types of breast surgeries.
Breast revision surgery commonly involves removal and replacement of saline or silicone breast implants, adjustments of the position of the implant on the chest, or correction of stretched out skin or drooping breasts. The overall goal is to restore a youthful breast contour and appearance.
There are many conditions that may be addressed with revisionary breast surgery, here are the more common ones:
- Bottoming Out (breast implant has slid down too low below the bottom of the breast)
- Side Displacement (breast implant slides off the chest and under the armpit when lying down)
- Breast crease (fold) is not even or in the wrong place (Inframammary fold malposition)
- Breast don’t separate or create cleavage between them (symmastia)
- Breast implants wrinkle or ripple (thinning skin and breast tissue allow implants to be seen, especially at the inner part of the breast when bending over)
- Breast and breast implants have gotten firm or painful, or have changed shape over time (Capsular contracture is thickening of the scar tissue around implant that may become severe enough to require surgery to correct)
- “Snoopy nose” (nipple and areola have started to droop off the breasts and implants, creating a particular type of ptosis or “sagginess”)
When to Consider Breast Revision
- Your breast no longer look as good as they did when you originally had breast surgery
- Your saline breast implants have deflated
- When an X-ray or MRI suggests your silicone implant has a leak
- If you want to change your implant and breast size or shape (perhaps the upper part of the breast is too big or too small and sunken in)
- If you have firmness of the scar tissue around the implant (capsular contracture) or your breast implants have shifted in position (too low, too high, or too far to the side or middle)
- If your breast tissue has changed as a result of skin stretching, natural breast aging, or weight loss or gain
What Can I Expect During Breast Revision Surgery?
Dr, Birchenough will determine the best procedures for each patient depending on their unique reasons, concerns, and expectations. The condition of the breast tissue, skin, and breast implant all factor in to what recommendation will be made.
Dr Birchenough has expertise and additional training in newer techniques using anatomically shaped (“gummy bear”) breast implants, acellular dermal matrix (ADM, or “skin slings” and “skin thickening”), and advanced fat grafting – liposuction of abdominal fat and reinjection to help fill in the the breast in particular areas.
Changing the implant size: If you decide to change your implant size, Dr. Birchenough may use the original incision for removal of the old implant and maybe even the scar tissue (capsule) around the implant.. If you want a larger implant, he may enlarge the “pocket,” or space in the breast, to accommodate a larger implant. If you want smaller implants, he may surgically reduce the size of the pocket with sutures to properly fit smaller sized implants. A breast lift (link) may be done at the same time.
With many new implant choices available in the past two to three years, a different shape or profile, texture or type of implant filling, may be a better choice for you. Ask Dr. Birchenough about his specific recommendations and why one may be better for you.
Capsular contracture (thickening of the scar capsule and implant): Dr. Birchenough may use the same incision used to insert the original implants to remove the capsule and replace the implant if possible. He will then insert a new implant.
Implant rippling: When the edges of breast implants are visible and able to be felt (like the way an underfilled plastic baggie with water feels!), Dr. Birchenough may use the same incision to remove or reposition the implants.
Other options include using a different type of implant or placing the new implant into a different breast pocket that either has better muscle coverage or uses other tissues to cover the implant edges. There is implantable material (acellular dermal matrix) that can be used if the patient does not have enough of their own tissue to cover and disguise the implant.
Implant malposition: Implant pockets can be created too far apart or too close together, resulting in poorly positioned breasts. This can also occur over time, as the implants slide too close together in the middle or too low or too far to the sides under the armpits. To correct this, Dr. Birchenough will manipulate the scar tissue from the capsule surrounding the implant and reconstruct the pocket in the appropriate position using suturing techniques or advanced implantable materials to hold the implant in place. Other tissues to reinforce this new implant pocket or using an acellular dermal matrix product can add additional support and maintain the proper implant location. New, advanced technology implants can be used to help maintain position as well.
Implant removal: If your implants are too large and your skin has stretched too much, Dr. Birchenough may recommend a masteopexy (breast lift) in addition to implant replacement. The lining around the implant, or “capsule,” is often surgically removed at the same time to facilitate rapid healing and incorporation of the new implant. Occasionally, removal of the implant and lifting the breast is sufficient.
Elevation of nipple and areola position: If it is necessary to elevate the position of your nipples and areolas (pigmented skin surrounding the nipples), you will require additional incisions, as discussed in the breast lift section (link). Incisions around the areola may be adequate in cases where a small amount of elevation is needed.
If your nipples need lifting, 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.
When more lifting and tightening of the breast and skin is necessary, an incision extending vertically down from the areola to the crease under the breast may be added. For cases where significant excess skin needs to be removed (such as in women who have had massive weight loss), the incision may be extended horizontally within the lower breast crease, following the natural curve of it to allow the breast to cover it when standing.
How Long Will It Take For Me to Recover?
There is a very wide variety of reasons to undergo Revision Breast Surgery, so surgery time and recovery time vary as well. Some surgeries may only last one and a half hours and require a minimal five to seven days without strenuous activity. Other, more extensive surgeries can last quite a bit longer if more correction is needed. Drains may be used in more extensive cases, and recovery time is longer.
What Questions Should I Ask Dr. Birchenough?
- “One of my implants / breasts has gotten more firm and started to get higher on my chest over the past two or three years. What is happening?”
- “How can you help prevent some of these problems if I am having my breast lift and implants for the first time?”
- “Can I just get bigger implants to help fix some of my problems? That’s what my last surgeon did.”