Revision Breast Surgery Houston
Individual results may vary
Revision breast surgery is a common procedure performed by Dr. Gill for patients in Houston, The Woodlands, and Conroe, Texas areas. Based on his extensive experience in aesthetic breast surgery, along with breast cancer reconstruction, Dr. Gill approaches revision surgery in a very conservative fashion as the risk of revision surgery is substantially higher than primary procedures. When assessing the breast in terms of revision, we look at the size discrepancy, shape discrepancy, and any asymmetries. Common causes for breast revision:
- Implant Rupture: Saline implants have a rupture rate of 1%, whereas silicone implants are around 0.6%. This is a very common cause for revision breast surgery. Women with saline implants typically notice a quick deflation. It is very uncommon for this to be a slow process. You will usually see the implant deflate over a period of 24 hours. Correction of this is optimally performed within two weeks because longer time frames can result in further scarring and difficulty in regaining the implant pocket dimensions. Silicone implant ruptures are usually detected by MRI or breast imaging. Depending on the age of the implant, associated scar tissue may be present also, known as capsular contracture. In these cases, Dr. Gill recommend removal of both the implant and the associated scar tissue with implant replacement.
- Capsular Contracture: This is another common cause of breast implant revision. It is caused by your body reacting against the implant and forming a thickened scar around the implant. Presenting symptoms include hardness of the implant, increased pain, restriction in motion, and a high riding implant with change in position. If the capsular contracture is mild, we will recommend aggressive massage physical therapy and the use of some medications. There are four grades of capsular contracture and once it obtains high-grade status, we recommend surgery to remove the capsular contracture/scar tissue and replace your implants.
- Implant Malposition: this can present in several different ways.
- Symmastia occurs when the medial muscle fibers are extensively divided and the breast implants fall too central, resulting in tenting of the skin. This must be repaired with suturing of the capsule along with reinforcement utilizing an allograft.
- Double Bubble Deformity: This occurs in patients who have a very narrow inframammary fold or breast crease. They have lowering or over dissection of this fold, resulting in the implant migrating below the inframammary fold. This results in a visible deformity. This can be corrected either by suturing the inframammary fold back down and utilizing a smaller implant, or by changing the implant from a sub muscular position to a sub glandular position.
- Bottoming Out: this occurs when the pectoralis major is hyperactive and displaces the implant down and out (laterally and inferiorly). This is more common in women who are very physically active and utilizer pectorals major muscle extensively. The correction of this typically involves switching the implant from under the muscle to on top of the muscle, or by suturing the capsule closed and attempting to reinforce this with an allograft.
- Discrepancy in breast size: This is another common reason for revision breast surgery and can often be corrected by utilizing implant sizer’s intra-operatively to help identify the optimal implant size to achieve better symmetry.
- Discrepancy in breast shape: This can often be corrected by a breast lift to either both breasts or one breast. It is important to discuss that secondary or tertiary breast lifts often carry a higher risk of sensation or blood supply change to the nipple.
- Natural causes: Common natural causes for revision breast surgery relate to the affects of aging, pregnancy, and weight loss. Women who have had previous aesthetic breast surgery and then undergo the effects of aging, weight-loss, and pregnancy may see changes to their breast that causes them to desire further aesthetic improvement. In most cases this is related to loose skin which can often be addressed by a breast lift or implant exchange.
Careful evaluation by Dr. Gill can help assess your current breast options and provide options to optimize your results in a safe and healthy fashion.