Breast augmentation revision can be performed for a wide range of reasons, but it all comes down to the patient’s unhappiness with their initial breast augmentation results. This can be due to the following manifestations:
1. Capsular Contracture
This occurs when the body detects a foreign intruder. It responds by creating a sac, or capsule of scar tissue around it, to seal it off. This can be beneficial to the implant. However, problems arise when this sac starts to thicken or contracts. This squeezes the implant and this is what makes the implant shift in location, harden, or distort in size. Capsular contraction can also cause considerable pain and discomfort. Until recently, capsular contracture was a difficult problem to combat, but with the use of Strattice, there appears to be a good solution to this difficult problem.
2. Implant or Nipple-Areola Asymmetry
This has many different variations and often occurs because of problems with the implant. If the breast have an unnatural fullness at the upper half of the breast. The implant may not have descended properly or have risen up too much. If there is unnatural fullness at the bottom of the breasts, the implants may have been placed too low or has settled over time. Nipple-areola asymmetry can be due to either too low or too high of placement when a breast lift was previously performed. These are both difficult problems to address however, with breast revision surgery a more cosmetically pleasing appearance can be obtained.
3. Double Bubble
There are two different types of this deformity. One type occurs when the breast tissue itself descends past the inframammary fold and the implant stays in its location. This can occur with age, loss of weight, pregnancy or when a smaller lift is done and patient needed a larger lift. The breast tissue falls and the implant now gives more fullness in the superior part of the breast. From the side one sees the convexity of the implant then the convexity of the breast below it. The other type of double bubble is when the implant drops past the inframammary crease and now you can visualize the implant below and beyond the breast tissue. Revision surgery can be performed to lift the breast tissue back on to the implant in cases when the breast tissue has fallen off the implant. In cases when the implant has fallen too low, a capsulorrhaphy (suturing of the capsule) can be formed with the use of dermal matrix (Strattice) to bring the implant back up.
4. Ptosis
Ptosis refers to sagging in the breasts. In patients who experience sagging after a breast augmentation, this may be due to not performing a lift when a lift was indicated. Patients who have breast tissue to begin with are more at risk for ptosis after breast augmentation. This may happen after pregnancy and breast feeding, after weight loss and with aging. The solution is to simply perform a lift with or without changing the breast implant.
5. Synmastia
When the breast implants are not placed correctly or when too large of implant are used, complications occur. The breasts turn into what is known as the “uni-boob†or symmastia. This is where the line differentiating between the two breasts is erased and the two implants pretty much flow into each other. The solution is to place slightly smaller or narrower implants as well as performing a capsulorrhaphy with the placement of acellular dermal matrix (Strattice).
6. Deflated Implants
This most commonly occurs to saline filled implants and can occur at any time after the initial breast augmentation. This can happen for several reasons such as: when the implants are filled over or under capacity, wear and tear on the shells of the implants, or a defect in the implant shell. The simple solution is to replace the implant.
