In revision breast surgery a variety of techniques may be used to re-design or reshape the breasts. Some ladies have a less-than-ideal aesthetic outcome following cosmetic surgery or may have experienced changes in their results following fluctuations in weight. Occasionally some ladies experience symptoms such as tightness or pain following breast surgery. For those with breast reconstruction the results may have changed over time, particularly with implant reconstruction.
Correction of either cosmetic breast surgery or post-reconstruction problems requires experience, judgment and skill of the surgeon. As a female Plastic Surgeon I intimately understand how your feelings about your breasts can influence your self-image and femininity. My aim is to help you feel better and look better by giving you the results you are seeking. As a surgeon who performs complicated breast reconstruction surgery every week my skill and expertise is directly transferable to all types of breast revision, whether reconstructive or cosmetic.
Revision breast surgery may include a range of procedures including revision of breast implants, reshaping breasts that have previously been lifted or reduced, or correction of unsightly scars.
The results of breast reconstruction can change over time particularly with implant reconstruction and revision can involve a variety of techniques from fat grafting to taking down the reconstruction and starting again with a different type of reconstruction.
Breast revision surgery is always more difficult that primary surgery as we are working in an area that already has scars and tissue removed or altered. While there are no guarantees regarding the final outcome, my goal is to create the most aesthetic outcome from the tissue I have with the best possible symmetry and a natural result that is proportional to the rest of the body.
Who is a Good Candidate for Breast Revision?
Ladies who have previously had breast surgery, and now wish to rejuvenate their results following a change in shape, volume, size or symmetry.
Prior to breast revision you should be healthy and in good physical shape. You should be as close to your ideal weight as possible and your weight should be stable. It can take many months for the tissues to settle and the final results of any breast surgery to become apparent. Therefore if you have recently had breast surgery and are unhappy with the results I would always advocate waiting for at least six months and possible up to a year before embarking on correctional surgery. As well as allowing time for final results to be obvious it also allows time for the scarring (particularly internal scarring) to mature and soften so that the tissue is pliable and easier to work with. However, you may come in for a consultation at any time to learn about your options and plan for the future.
Who is not a good candidate for breast revision?
If you have pre-existing medical conditions it may preclude you from having further surgery. This procedure is not appropriate for women with unrealistic expectations or those who have been encouraged by others to change their appearance.
What Are The Different Types of Breast Revision?
The type of revisional surgery appropriate for you will depend upon what surgery you had in the past, your specific problems and your aspirations. Some ladies will have changed body shape since their original surgery and now simply wish to be adjusted to be more in keeping, in others complications of their previous surgery have led to the results have deteriorating over time and a very small sub-set of ladies were never really happy with the results of the original surgery. Whatever your circumstances the plan for revision will be tailored to your individual anatomy and desires. Your individual treatment plan may involve one or a combination of the following.
Removal and Replacement of Breast Implants
Breast implants are not like car tires, they do not need to be changed every few thousand miles. In the rare event breast implants have ruptured, they should be removed with or without replacement. If you remain happy with the results and there are no issues then there is no need to have further surgery at any specific time point. It is however, not uncommon for changes in your weight, your physique or capsular contracture around the implant, to alter the results and at this time you may wish to exchange your implants to improve your shape or proportions. This may involve a change in size or shape of the implant and at initial consultation I will go over in detail the various options for implant types, shapes and sizes that are most proportional and best suited to your body and your desired outcomes. I may suggest adjustments to the implant pocket to optimize results, or even sometimes a change of plane to above or below the muscle.
Removal of Implants with or without Mastopexy (breast lift)
Many women may wish to have their implants removed for a variety of reasons (personal preference, weight gain or increased age). Removal of breast implants is fairly straightforward, however in the same way that removing air from a balloon leaves the shell deflated, the breast shape can be somewhat flat and deflated when implants are removed. I therefore often recommend a mastopexy (breast lift) to reshape the breast tissue and leave a pleasing yet natural breast shape.
Capsulectomy
Capsular contracture occurs when the scar tissue around the implant has contracted and causes a change in shape or position of the implant, visible rippling, hardening of the implant or even pain. Surgical removal of the capsule around an implant is called a capsulectomy and is often done as part of breast implant revision.
Correction of Annimation Deformity of Sub-Muscular Implants
Some ladies that have previously had sub-pectoral breast implants are troubled significantly by animation deformity. This is often seen in ladies who do lots of upper body exercises such as gym work or other sporting activities. The result is that the breasts move or twitch with certain movements making the implants look quite obvious rather than natural. It is possible to replace the pectoralis major muscles back to their anatomical location on the chest and to place new implants on top of the muscle. This eliminates animation deformity and often reduces discomfort related to the muscle contracting over the implant. The breasts look and feel more natural and ladies are able to resume all upper body workouts without restrictions at 6 weeks post-op.
Re-do Mastopexy (Breast Lift)
If you had surgery at a younger age, or have previously had implants, changes in the body due to having children or significant weight change or simply as part of aging can result in a droopy appearance of the breast with the nipple and areola lying low. A mastopexy will reshape your breast tissue and raise the nipple to a more aesthetic position. A previous mastopexy will have done this but it only resets the clock it doesn’t stop it, therefore the impact of aging and body changes may have affected your results in the longer term.
Breast Scars
Some ladies request scar revision following previous surgery. The development of a poor scar is multifactorial but for the most part is genetically determined. Enlarged, stretched or unsightly scars resulting from prior breast surgery may be improved by revision. At consultation I will explore the history of your previous surgery, any delayed wound healing and any infections as well as examining any other scars that you have. Revision of unsightly scars may be part of a total breast revision or may be the primary goal of surgery. If you are someone who is prone to poor scars additional outpatient treatments will be discussed with you.
Conversion of Implant-Based Reconstructions to Flap Reconstructions
Many ladies choose implant breast reconstruction at the time of their cancer diagnosis as it is relatively quick, a shorter recovery and often at that stage they do not have tissue to allow reconstruction. Some ladies find an implant based reconstruction unsatisfactory either because it has not met their expectations or because it has changed post-radiotherapy. A few years down the line some ladies find that they have the time and energy to commit to a free flap reconstruction, or that they now have tissue to allow it. Conversion of implant to free flap reconstruction is relatively common in my practice. Further details on free flap reconstruction can be found on the relevant pages.
Fat Transfer
Occasionally both cosmetic breast surgery and breast reconstruction can be improved by minor touch-ups to improve contour. Fat transfer utilizes liposuction techniques but instead of throwing away the removed fat, it is processed and the fat cells extracted and re-injected into contour defects. This can improve contour, disguise rippling and may the results appear more natural.
What to Expect at Initial Consultation
At your initial consultation, I spend a great deal of time getting to know you personally and taking a full medical history. The success of any procedure relies on you being open with me at this stage. It is important for me to explore your reasons for seeking breast revision, what you like and dislike about your breasts and what you hope to achieve with revision surgery. I also need to know about your general health, lifestyle and medications, prescribed or otherwise. I specifically need to know about previous operations, any breast disease and any treatments for breast disease.
I will examine your breasts and overall body shape and skin quality. At the end of that consultation I will describe the surgical options to address your problems and devise your personal surgical plan. There may be more than one option for you and it will depend on what your priorities are at that time. I will also explain the risks and limitations of the options to you at this stage. I always have a second consultation to answer any questions before we book surgery.
As a female Plastic Surgeon I have an intimate understanding of how a ladies’ feelings about her breasts can affect self-image and femininity. I work with you to achieve the desired outcome whether that is to improve your self-confidence, have your pre-pregnancy breasts back or simply to feel more symmetrical.
Preparing for Breast Revision
You should be physically fit and at or close to your ideal weight which should be stable prior to embarking on surgery. Your health will be assessed pre-operatively and you may need some tests that will be arranged if required. You should stop aspirin, anti-inflammatory medications and any non-prescribed medication at least a week before surgery. If there is any change in your health prior to your surgery date you should let me know. Your health and general well being are my primary concern when I am treating you therefore if you are unwell for any reason it may be necessary to postpone surgery.
What to Expect on the Day of Surgery
This will depend on what your treatment is to entail. Please see relevant individual sections for further details.
What to Expect After Surgery
This will depend on what your treatment is to entail. Please see relevant individual sections for further details.
Potential Risks and Complications of Breast Revision
This will depend on what your treatment is to entail. Please see relevant individual sections for further details.