Breast Augmentation Revision Surgery, has become an important area of specialization in my Walnut Creek plastic surgery practice. As many as 25% of women undergoing breast augmentation, will require a second surgery in the ten years after surgery.
Breast augmentation revision surgery may be elective, and may be performed to increase or decrease the size of your breast implants. Increasing breast implant size is one of the most common, and simplest forms of breast implant revision.
Breast implant revision surgery may be needed to replace a deflated implant or to revise the scar around the implant (capsular contracture). The major US breast implant manufacturers offer lifetime replacement of their breast implants if a breast implant deflation occurs. They also provide financial support if the breast implant leaks occur within ten years of the primary breast augmentation.
You will find videos on breast augmentation and breast augmentation revision surgery posted on the San Francisco Plastic Surgery Blog. They can be viewed here or on my YouTube channel. Please remember, the 800 number appearing on the video was only for the live show, to contact my office for additional information or to schedule a private consultation appointment, call (925) 943-6353.
This video comes from a segment of KRON’s Body Beautiful. You can hear:
What is Breast Augmentation Revision surgery?
Who needs Breast Implant Revision surgery?
Do your silicone breast implants or saline breast implants come with a warranty?
Is there an expiration date on my breast implants?
Before and after pictures of Breast Implant Deflation Replacement Surgery?
Can breast implant asymmetry be improved?
How does Capsular Contracture present?
Can breast surgery be performed for a diabetic (a person with diabetes)?
If you are considering Breast Implant Revision Surgery in the San Francisco Bay Area, a Board Certified Plastic Surgeon can help. This first step is a consultation appointment so that existing problems can be defined and achievable goals can be set.
Breast Augmentation Revision Surgery, has become a specialty unto itself. While most women will never require breast augmentation revision, a large minority will. The exact number is difficult to pin down; however, studies have indicated that in the ten years after breast augmentation, as many as 25%, will undergo a second breast augmentation related surgery.
Many times there is no complication, and the primary motivation for breast augmentation revision surgery is to change the size of the implants. Perhaps the most common breast implant revision surgery is to replace breast implants with a larger pair. This is the reason I place so much emphasis on defining the goal size for breast augmentation before surgery. Even so, minds and goals can change with time.
Other times breast implant revision surgery is less volitional, and may be due to gravity (requiring a breast lift), breast implant failure (breast implant deflation or breast implant rupture) or capsular contracture (tightening of the nature scar that surrounds the implant causing movement or firmness of the breast implants).
Other videos on this subject have been posted on the San Francisco Plastic Surgery Blog and they can be viewed here (see bottom of article for links) or on my YouTube channel. When you are watching this video, please note, the 800 number on the video was for the live show, to contact my office for additional information or to schedule a private consultation appointment, call (925) 943-6353.
On this episode of KRON’s Body Beautiful you can learn:
What are the main reasons for Breast Augmentation Revision surgery
Do breast implants wear out?
What is the capsule around the breast implants?
What is Capsular Contracture?
How long is the Breast Implant Warranty?
How many Breast Augmentations are performed each year?
How is Breast Implant Revision Surgery performed?
What is the recovery like after Breast Augmentation Revision?
Breast Augmentation Revision Surgery requires a careful analysis of the existing problem, a thoughtful discussion about the good (and bad) aspects of all available treatments, the ability to adapt the plan to any new findings found during surgery, and a careful recovery, to speed you return to daily life. The first step is a private consultation with a Board Certified Plastic Surgeon.
The base width diameter (BWD) of the breast is an import measurement for selecting the best breast implant. For my San Francisco Bay Area breast augmentation patients to achieve the best breast augmentation, the width of the breast must correlate with the width of the implant.
I am often asked what is the best breast implant profile or best breast implant volume for a certain bra size. The answer depends on many specifics, but the base width diameter (BWD) of the breast is one of the most important measurements used to determine the optimal breast implant diameter.
This patient desired restoration of her lost breast volume. Note the patient's left breast is higher than her right breast prior to breast augmentation.
After breast augmentation. Breast implant diameter was selected to enhance cleavage without overly enhancing width.
There is more to choosing the best breast implant than just picking an implant with a diameter that matches the chest, but it is a great place to start. While no implant is the perfect breast implant, choosing one that is proportional to the body is the best way to get a full and natural result.
It’s like Goldilocks. If the beast implants are to wide, they will hang over the sides and you will be bumping into them with your upper arm. If the breast implants are too narrow, they will tend to fill the outside of the breast and leave a space between the beasts. If the implants are just right, the breast can be filled over the entire base width and create a naturally full cup.
After choosing the appropriate beast implant diameter, the volume can be adjusted by choosing the appropriate profile. Low profile breast implants are flatter than high profile breast implants. The larger the volume desired, the higher profile selected and the more projection obtained.
Prior to breast augmentation. The breast maintains a low projection but more volume is desired.
After breast augmentation. Enhanced projection is obtained by using a higher profile implant.
When I trained as a Plastic Surgery fellow at Saint Francis Memorial Hospital in San Francisco, California, only moderate profile saline breast implants were available for breast enlargement. Today, saline breast implants come in three different profiles: Low, Moderate and High. The variation in projections is even greater for silicone breast implants with five profiles available. When the form-stable gummy-bear beast implants are finally approved, even more choices will be available.
Choice is good. When you are choosing, be certain to pick a Board Certified Plastic Surgeon who can help you make the most of your options.
For more information on how to choose the correct breast implants see these links:
The previous example of scar revision was a keloid scar revision. Keloid scars tend to be raised and larger than the original injury. The following scar revision is for an irregular, hypopigmented and wide-spread scar. It may have been more hypertrophic in the past, but was mature, soft, flat and pale prior to revision. This patient presented over a year after breast implant placement. The implants were inserted through an incision normally placed around the lower edge of the areola (the pigmented skin around the nipple). In this case, the scar was too high, and did not heal well.
Wide spread periareolar scars below the nipples after breast augmentaion.
This is noticeable because the scar is white, wide and irregular within the tan skin of the areola. This incision was not placed at the edge of the areola, making the white scar even more noticeable. This is also a poor scar. It is very wide for this location. This scar not a fine line, it’s not a line at all, but rather, an irregular blotch.
The periareolar incision is one of my favorite incisions for breast augmentation because a nice, fine, discrete scar is the normal result. The original scar was not of my making. Since I’ve done hundreds, if not thousands of breast augmentations using this approach, I felt very confident that this particular scar could be improved.
The plan was to excise the previous scar, and obtain a narrow scar that follows the contour of the areola. With the new scar placed at the junction between the areola and the normal skin, the scar’s location is disguised.
After scar revision the periareolar scars are thin, fine and follow the natural contours.
This scar revision was performed in the office, under local anesthesia, without complications. The resultant scar is narrow and follows the natural contour of the areolas. Close up views are included below for comparison.
Before scar revision - Right breast with wide white irregular misplaced scar.
Before scar revision - Left breast with wide spread hypopigmented scar.
After scar revision - Right breast with thin soft pale scar following the natural curve of the areaola.
After scar revision - Left breast with less noticeable and improved scar.
Scar revision can be a very rewarding procedure. The scars cannot be completely erased, but by making scars less noticeable, they can be forgotten.
Whether you are considering breast enhancement, or already have breast implants, this video discusses the most frequent reasons why corrective surgery is needed and includes before and after pictures and live viewer questions.
This is part two of two from an episode of KRON 4’s Body Beautiful with Vicki Liviakis that aired last month. This video discusses breast augmentation revision surgery, including before and after pictures and viewer questions.
Specific examples are shown. The first patient (shown below) had breast augmentation in her twenties. Years later, she had children and was not happy with the changes in her breast resulting from pregnancy and breast feeding. Before and after breast augmentation revision surgery pictures are shown. In her case a breast implant exchange and breast lift and were performed to adjust for lost volume and improve the shape of the sagging breasts.
A different patient had breast implant bottoming out. In her case the implants had fallen below the inframammary fold leaving the nipples high and flattening out the normal curve beneath the breast. Corrective beast augmentation surgery included breast implant implant exchange to adjust the volume, and the inframammary fold was reconstructed internally to raise the implant and form a distinct curve beneath the breast.
The caller in this video had a question about ruptured silicone gel implants that were placed in the 1970’s. If any breast implant has ruptured, it needs to be removed. Most frequently, a ruptured breast implant is replaced at the same operation. Silicone gel implants in particular should be removed sooner than later. A ruptured silicone gel implant, over time, can cause increased scarring and hardening of the breasts, as the body tries to wall off the free gel. If not treated promptly, this type of scarring can lead to further problems than may not be correctable.
Silicone gel filled implants placed before 1985 seem to have a higher deflation rate than the new silicone breast implants. In fact, the outer shell of silicone breast implants has changed twice since the 70’s. The first change, in the mid 80’s, was to decrease the rupture rate. The second change, in the mid 90’s, was to reduce gel bleed (the ability of the silicone gel to leak through outer shell without a rupture). Both US FDA approved breast implant manufactures, Allergan and Mentor, offer lifetime replacement of their implants should they fail, and often provide financial support should this occur within ten years of your breast augmentation procedure. For details of the Mentor and Allergan (Natrelle) Breast Implant Warranties click on the manufactures names. It is best to get the information direct from the manufacturer; however, the Mentor site has been going through some changes, perhaps with the merger with Johnson & Johnson, so if you can’t link there, JustBreastImplants.com also has information on breast implant warranties.
Breast Augmentation is currently the most frequently performed cosmetic plastic surgery procedure. Whether you are considering breast enhancement, or already have breast implants, this video discusses the most frequent reasons why corrective surgery is needed.
Breast augmentation revision surgery is sometimes necessary even in the best of hands. Revision surgery can range from simple, like changing breast implants after deflation or changing sizes, to more complicated, like when treating breast ptosis (sagging) or capsular contracture. The best way to reduce your risk of needing breast revision surgery is to choose a qualified Board Certified Plastic Surgeon.
If you need breast revision surgery, choosing a well trained Board Certified Plastic Surgeon with a broad experience in breast enhancement surgery is the best way to get a satisfying result. By choosing a Board Certified Plastic Surgeon who specializes on cosmetic surgery, you get a doctor who is well trained and well rehearsed in a wide range of treatment options.
Breast implant revision in San Francisco is no different than in other areas of the United States. Sometimes the results of the breast augmentation where just not what was expected. Other times, the result were great and either the breasts change, the implants change or the desires change. When these situations arise, breast augmentation revision surgery could be your best option to get back into the shape you want.
This is part one of two from an episode of KRON 4’s Body Beautiful with Vicki Liviakis that aired last month. This video discusses breast augmentation revision surgery. Part two will include more discussion, before and after pictures and viewer questions.
The best way to be certain your plastic surgeon is appropriately trained to perform breast augmentation surgery is to make sure that he or she is a Board Certified Plastic Surgeon. By choosing a Plastic Surgeon who is a member of the American Society of Plastic Surgeons (ASPS), you can be certain that their credentials have been verified. ASPS members are held to higher standards in ethical care of patients and continuing medical education requirements. ASPS standards are above and beyond those required by State licensing boards and hospital credentialing committees.
A small percentage of ASPS members are also members of the American Society for Aesthetic Plastic Surgery (ASAPS). ASAPS members are ASPS members who specialize in the cosmetic side of Plastic Surgery. ASAPS members must meet the standards of ASPS, apply independently for membership to ASAPS and demonstrate a commitment to cosmetic plastic surgery both in education and in patient care.
ASPS is the largest plastic surgery specialty organization in the world. Founded in 1931, the society is composed of board-certified plastic surgeons who perform cosmetic and reconstructive surgery. ASAPS is the leading organization of board-certified plastic surgeons specializing in cosmetic surgery of the face and body, and I am proud to be an active member of both.
Next time I will talk more about the reasons for breast augmentation revision surgery and how a qualified Plastic Surgeon can help.
Yesterday I was on NBC Bay Area, KNTV, Living Well with host Peggy Pico. We discussed the Mommy Makeover San Francisco, focussing on breast augmentation, tummy tuck, mini tummy tuck and liposuction. I will be posting several excerpts of the show on the San Francisco Plastic Surgery Blog. This video discusses breast enhancement and the future postings will discuss the belly enhancement, tummy tucks and liposuction. The full episode is also available on line. To view the entire segment, just click on the NBC Bay Area logo above.
Breast augmentation is one component of the Mommy Makeover. It has become the most frequently performed cosmetic plastic surgery procedure in the United States with 400,000 breast enlargement surgeries performed last year. That’s 800,000 breast implants.
This segment discusses the types of breast implants available: saline breast implants, silicone breast implants and even the soon to be available gummy bear solid gel implants. Comparisons area made between smooth round breast implants and textured shaped breast implants. The importance of body proportions is stressed, and before and after pictures are reviewed.
I will add additional video from the show about tummy tucks, mini tummy tucks and liposuction in the near future so stay tuned. If you would like more information on Breast Augmentation San Francisco, click here to visit the Breast Augmentation page on DrMele.com.
Walnut Creek Plastic Surgeon (San Francisco Bay Area, East Bay) Joseph A. Mele, III, MD, FACS, will be appearing on KRON channel 4’s, Body Beautiful this Monday, September 14, 2009, at 11:00 AM.
KRON4’s Body Beautiful, is a weekly news show hosted by News Anchor Vivki Liviakis. It originates right here in San Francisco and is know through out the Bay Area for its coverage of the lastest trends in cosmetic plastic surgery.
This week’s topic will be breast augmentation, specifically breast implant revision surgery. Information about breast augmentation and the most common reasons for breast implant revision will be presented. Topics will include, choosing the best breast implant size, breast implant deflation, capsular contracture, dealing with breast asymmetry, and how to decrease your risk of needing breast augmentation revision surgery.
If you have questions that you would like me to answer on air, please send them via the contact form on this page. Please do mention that you would like me to answer your question on Body Beautiful, otherwise all inquiries are kept confidential. Alternatively, you can send your questions directly to KRON4 via the Body Beautiful web page. You can also phone into the studio while we are on the air, and get your questions answered live.
Previous shows discussing breast augmentation, tummy tucks, liposuction, eyelids surgery and many other cosmetic plastic surgery procedures can be found on my website in the DrMele.com Video Gallery
A unique aspect of Body Beautiful is it live broadcast live. Broadcasting live allows for more a more dynamic and interactive presentation. A segment of the show will be dedicated to viewer questions. So be sure to call in.
Breast augmentation has become the most frequently performed cosmetic plastic surgery procedure. As a result, breast augmentation revision has also increased. This topic has been discussed previously under breast asymmetry and capuslar contracture. There are many reasons for breast implant revision surgery San Francisco; they can be divided into three main groups.
Breast implant size – Perhaps the most common reason for breast implant revision surgery. The breast implant and pocket may both be fine, but there is a desire to change the size of the breast augmentation. By far, the most common change is to place larger breast implants, but reducing breast implant size and correcting asymmetry for size also are included in this category.
Breast implant leak – Failure of the implant, and loss of the filling volume is another common reason for breast implant revision. Saline filled breast implants rapidly lose volume and it is clear that there is a problem. Silicone gel filled breast implants may require an MRI to determine if there is a leak. Regardless of the type of implant, if there is a leak, it needs to be replaced.
Pocket problems – The pocket around the implant is normally lined with a thin soft scar. When the scar becomes too thick or too tight this is called capsular contracture. In its advanced stages, capsular contracture can lead to a firm, tight, immobile breast, which in severe cases becomes painful. On the other hand, if the scar is too soft and loose, the implants can move too much. This can lead to implants that are bottoming out (too low) or the implants may fall to the side when laying down (like natural large breast do).
Here is another example of breast augmentation revision surgery bay area. This patient presented to my Walnut Creek plastic surgery office. Overall, she was happy that she had breast implants, but she had several aspects that she wanted improved.
Her bra would ride up onto the lower pole of her breast with exercise.
Her implants had bottomed out.
Her breast implants were asymmetric (more bottoming on the right).
Her implants were a little small still.
Her nipples were too prominent, noticed more after her primary breast augmentation.
Her nipples were asymmetric.
The following procedures were discussed:
Capsulorrhaphy – literally means capsule tightening. The lower pole of the capsule is closed to lift the implant higher on the chest. Capsulorrhaphy is also performed to move implants out of the armpits. Larger implants and weaker soft tissues increase the risk of implant malposition, and recurrence of the problem.
Creation of an New Inframammary Fold (IMF) – This is a difficult procedure to get right, and it is worth finding a Board Certified Plastic Surgeon who has experience with this type of correction. The IMF is purposefully formed slightly higher than the desired result as there is almost always some stretching again after surgery. This procedure and capsulorrhaphy can both improve asymmetry. A defined IMF is important to keep the bra in the correct position and to allow the bra to support the breast properly.
Breast Implant Exchange – Whenever breast augmentation revision is performed, it is worth considering whether to replace the implants. Implant volumes are most commonly increased during breast revision surgery. Sometimes the volumes are reduced and sometimes the volumes are adjusted to help compensate for asymmetry. The implants can also be exchanged between saline and silicone gel. As is often the case, a slightly larger implant was desired. Larger implants can increase the risk of bottoming out. Smaller implants will increase the reliability of the capsulorrhaphy and IMF repairs. Smaller implants are lighter, and less weight means a better chance for long term correction.
Nipple Reduction – Generous nipples can be reduced in size. The scar lies in the crease at the base of the nipple and is very difficult to see.
Periareaolar Breast Lift – The periareolar scar can be used to move the nipple/areaolar complex (nipple and the dark skin around it) in any direction. As with a breast lift, the scar goes around the areola. In this case, the right nipple is significantly higher than the left; however, since the patient was not really bothered by her nipple position, it was not fixed.
Breast Augmentation Revision with Nipple Reduction - Before (left) and After (right)
The previous implants were removed, a capsulorraphy was performed, additional work was done internally to form a new IMF, and new implants where placed via a periareolar scar (from 4 to 8 o’clock). The volume was increased from 300 to 350 cc’s using saline filled implants. In addition, the nipples were reduced with an incision that runs around its base. The nipple is still high on the right, and could be improved by further raising the breast implants. However, for the sake of the left breast, it is better to keep the implants in their current position. While this leaves the right nipple high, it avoids creating a low (sagging looking) nipple on the left.
Notice the improvement of the angle at the bottom of the breasts. It is no surprise that the bra was ridding up onto the breasts before surgery. After recreation of the IMF, it is higher, smooth and well defined.
Breast asymmetry is more the rule than the exception, and there are many ways in which breasts can be uneven. Size, shape and location all come into play. Asymmetry may effect the entire breast mound (see previous post) or just the nipples. Normally, the differences are small; however, as the magnitude of breast asymmetry increases, so does the desire for correction.
In my San Francisco Bay Area (Walnut Creek) cosmetic plastic surgery practice, I measure the differences between the breasts both subjectively and objectively every day. Small differences frequently go unnoticed. Often, asymmetry is first noted in the consultation for breast augmentation. When the difference is obvious, however, breast asymmetry can be the driving force toward seeking consultation with a Board Certified Plastic Surgeon.
This post is focussed primarily on areola asymmetry (the darker skin around the nipple) and nipple asymmetry (the raised part in the middle). Look for a post on breast asymmetry (the breast mound itself), including breast implant asymmetry, in the very near future.
One of the most common nipple asymmetries is caused by inversion (retraction) of the nipples. Inverted nipples can occur on one or both sides. Inverted nipples and even bifid (split or duplicated) nipples can be treated with minor surgery.
Before correction the nipple and part of the areola are hidden.
Inverted nipples are caused by short mammary ducts that pull the nipple inside the breast tissue. In the most pronounced forms even the areola maybe hidden. The scar for inverted nipple correction is normally hidden in the fold beneath the nipple. Since correction involves releasing the tight ducts, correction may interfere with the ability to breast feed, and this should be discussed with your plastic surgeon prior to surgery.
After correction the relatively large nipple can now be seen.
The size and shape of the nipple can also be adjusted.
Close-up of breast showing appearance of nipple enlargement after pregnancy.
Overly large nipples can be reduced in length and girth. In general, it is easier to reduce a large nipple than to enlarge a small one. Nipple reconstruction is performed after a mastectomy when the nipple is absent. With nipple reconstruction, especially when the breast has received radiation, the most difficult aspect is creating and maintaining nipple projection.
Close-up of breast showing appearance of nipple after nipple reduction.
There are times when the nipples are normally formed, but their location on the breast is asymmetric or they are just too low. Modest changes in nipple location can be improved with a periareolar approach. Several centimeters of motion can be safely accomplished with this method. The same periareolar technique can also be used for areolar reduction or to correct the overly full areola, as seen with a tubular breast deformity.
Larger asymmetries may require surgery similar to a breast lift. Formal breast lifts allow the larger movement of the nipples, and reshaping of the entire breast mound. See the previous San Francisco Plastic Surgery Blog posting by clicking here Breast Mound Asymmetry San Francisco: Breast Mound, Breast Implants. There are many types of lifts, and each has its own pros and cons. The art of Plastic Surgery is choosing the best approach for each individual San Francisco breast asymmetry patient. This will be the topic of a future posting.
