When a woman undergoes breast augmentation surgery, it’s likely that the last thing on her mind is having a second procedure, called breast revision surgery, on her breasts. However, it is important to understand that breast implants are not lifetime devices. Due to the nature of implants, some secondary surgery is essentially done at some point in the patient’s life.
Implant deflation or rupture is not the only reason one may seek secondary surgery after augmentation. Breast revision surgery is performed when a woman is unhappy with some aspect of how her breasts look and/or feel. According to Maryland board-certified plastic surgeon Adam Tattelbaum, MD, the most common reason for breast revision surgery can be summed up in one phrase: “Gee, I wish I was bigger.”,,
According to FDA statistics, switching to a larger implant size is estimated to account for approximately 37% of all breast revision surgeries in the United States.
Dr. Tattelbaum says that when women come to his office for a breast augmentation consultation, one of the biggest concerns is often that they don’t want their new breasts to be too big.,After the post-surgery swelling goes down and they get used to their new breasts, however, they often sing a different tune.
Common reasons for breast revision surgery
- Contraction of the capsule requires the release of scar tissue through capsulectomy or capsulotomy
- Switching from saline to silicone implants due to rippling issues or simply a desire for a softer, more natural feel
- Breast changes after pregnancy, weight gain or loss, or age-related changes
- Aesthetic concerns where the patient is dissatisfied with the result of previous surgery due to implant malposition or other problems such as double bubble, sympastia, or fundus depletion
Dr. Tattelbaum says he also occasionally sees women who had breast augmentation 20 to 30 years ago and are now at a different point in their lives, so they want implants removed. An ablation is then performed, usually in conjunction with a breast lift, although not always.,,
Challenges
Secondary surgery is always more difficult than primary breast augmentation, for several reasons. First, the presence of scar tissue makes it more difficult to predict a good outcome. In addition, the surgeon deals with tissue stretching or anatomical changes caused by previous implants. For these reasons, many surgeons may charge higher fees for breast revision than for initial breast augmentation.
Second, the breast revision patient may come to the surgeon’s office frustrated and more fearful than a primary breast augmentation patient. Often, the first surgeon has done nothing wrong to cause the problems that bother the patient.
However, sometimes a lack of effective surgeon-patient communication is responsible for the patient’s lack of understanding of the physiological risks associated with breast implant surgery. This can create unrealistic expectations, meaning the patient is more likely to be dissatisfied with the outcome of the initial or revision surgery.
Breast revision surgery success
According to Dr. Tattelbaum, the biggest predictor of breast revision surgery success is the quality of communication between the doctor and the patient before the surgery. Patients who receive a full and honest explanation of what to expect are likely to be much more satisfied in the end.
Another factor that determines the success of breast revision is the reason why the procedure is desired.
Some other types of revision are easier and therefore generally more successful due to the effects of gravity (and the action of the pectoral muscle, when the implant is placed under the muscle).
Some doctors also believe that the location of the incision is the key to success in breast revision, with many breast revision specialists leaning towards the periaqueduct approach (the incision follows the outer edge of the lower 1/3-1/2 of the nipple). If the patient has an IMF scar, surgeons will use the original scar to avoid adding a second breast scar.
This approach gives the surgeon a 360-degree view of the tissues inside the breast, allowing for greater precision in releasing scar tissue and creating or modifying the pouch. (Actually, this is a more difficult approach to solving many revision-related problems. The access point is smaller and causes more difficult visualization. It depends on the surgeon and does not necessarily allow for better visualization of an issue.)
Many surgeons believe that it can be much more difficult to judge what you are working with from incisions made in other locations.
In addition, Dr. Tattelbaum believes that breast revision can sometimes be more successful when the implant is placed at a different level than the first surgery (ie, from above the muscle to below the muscle, or vice versa).
This is because operating at a different level usually means there is less scar tissue and tissue distortion due to the first surgery. Of course, this is highly variable and the best course of action is always determined on an individual basis.
Questions you should ask
Don’t be afraid to ask your surgeon about his qualifications and experience. How many times has he had surgeries like yours? What is his complication rate with this procedure? Is he a board certified plastic surgeon?
Procedure
Which procedure will be done depends largely on the reason for the operation. Breast revision usually involves replacing the old implants with new ones, often with a change in size. It may also involve lifting the breast, releasing scar tissue, and changing the size, shape, and location of the “pocket” (the space inside the body where the implant is located).
With some cosmetic problems, additional surgery may be needed for the best and long-lasting results. Once proper healing and stabilization through the formation of new scar tissue has been achieved, the final surgery to replace the implants can be done.
How to minimize risk
Many cosmetic problems with implants (including double bubble, symmastia, and bottoming) are much more likely when very large implants are placed in very small bodies. Placing the implant in a higher position rather than too low usually results in the most pleasing appearance, as the effects of gravity will cause the implant to drop over time. By the same token, a too-aggressive approach to creating divisiveness is often partly responsible for complicity.
It is important to remember that stunning cleavage is created by push-up bras, not natural or enhanced breasts.
Since resizing is the number one reason for breast revision, it makes sense to want to be sure of the size you want before surgery. If you’re considering breast augmentation, it’s a good idea to ‘try before you buy’. The best way to accomplish this is to try several different sizes and shapes of implants in your surgeon’s office. With the range of implant shapes, types and sizes available today, this is the only way to accurately judge which implant will work best for your body.
Of course, your surgeon isn’t going to let you leave the office with a bunch of implants to wear in your bra at home. If you just want to judge what cup size you feel most comfortable with and want to spend some time getting used to a D cup before deciding if it’s right for you, there are commercially available sizing systems that allow you to try different sizes on your own time. However, if you want to try on multiple sizes, this can be expensive. A popular (and cheaper) way to try and get comfortable with different sizes is to do the rice test.
Ask lots of questions during your consultation with your surgeon and ask more on the day of your surgery. (It may be helpful to write down your questions in one place as you think of them, then bring your list with you each time you see your surgeon.)
Do your research and consult with more than one surgeon before making your decision. An educated patient is much less likely to end up needing a “reset”. And don’t let price be your main deciding factor when choosing a surgeon.
Finally, remember that it is of the utmost importance to go into your surgery with realistic expectations. Perfection does not exist in nature or in plastic surgery. Your body before surgery is not perfectly symmetrical and it will not be perfectly symmetrical afterwards either.
A word from Verywell
If you are having breast revision surgery, be aware that you may still be seeing some of the problems you worked on to correct. It is not always possible to completely remove all hints of a double bubble, for example. Always remember that the goal of plastic surgery is to improve, not perfect.
