Breast augmentation revision surgeries
Correcting implant-induced problems
Reviewing our clinical experience in breast augmentation surgeries since 1998, and in combination with the new Subfascial technique, no serious problems have occurred, such as the position of the implants in relation with the areola (bottoming out), dynamic breast (Dubble bubble), symmastia, capsule formation, internal bra technique, etc. However, due to our extensive experience in the field of breast augmentation (more than 2,000 surgeries conducted up to now) and the increased number of patients who were operated with another technique and visit our office, we managed to collect and classify the cases we treated. Breast augmentation surgery is not universally performed in women. It must be individualized according to the characteristics of each case and the patient’s desire. The implant size, technique, implant type, along with the plastic surgeon’s technical expertise, are of crucial importance. The goal of such a procedure is a natural-looking result with the least complications possible. Thus, choosing the right plastic surgeon is a major factor in the success of breast augmentation surgery.
Classification of breast augmentation revision surgeries:
- Problems with the surgical position of the implants
- 2. Problems with the woman’s skin
- 3. Problems with the implants
During the clinical examination on your first consultation, we must carefully examine you and deliver the accurate diagnosis. A lot of women don’t have a medical problem, yet a single problem may be combined with another. We must see the technique the previous plastic surgeon has applied and duly advise on the applicable solution.
Problems with the surgical position of the implants
Α.The position of the implants is asymmetric:one is higher than the other, or projects more/less compared to the other.
B.Bottoming out: The implants are placed either too high or too low in relation to the areola. This means that the previous plastic surgeon opened the pocket more, cutting the lowest part of the pectoralis major muscle. It may also happen when implants are placed under the gland, or when they are placed partially (dual plane) or totally under the muscle (total submascular plane)
C.Symmastia (aka Uniboob).It occurs when the two breasts join in the middle as a result of the previous surgeon’s eagerness to achieve a better result, i.e. he opened the pocket more than required towards the sternum.
D.Implants which are too high on the breast and remain there, not assuming their normal final position
E.Implants which are far apart
Problems related to the skin and tissue characteristics of every woman
A.Snoopy deformity:Projection of the nipple-areola. It is a breast tissue hernia under the areola. It is usually managed during the initial surgery, but it can also be repaired during a revision (second) surgery.
Β.Large areolawoman may or may not feel discomfort from it. It is easily managed.
C.Tuberous breasts: It refers to small-based breasts which widen up near the areola. They have insufficient hypomammary crease and are easily treated during the initial surgery.
D.Skin thinning: Skin becomes thinner with age, pregnancies, weight loss, and rippling occurs around the implant. It is manageable via several techniques.
Our extensive experience since 1998 shows us that up to now, no patient of ours has suffered an implant rupture. In fact, the “Mentor” implants we have been using until now have excellent properties and an overall good status. Many patients visiting our office have experienced implant ruptures from implants manufactured by other companies.
It is also known as capsular contracture. It is a thick scar around the breast implant. It may change the shape of the breast, cause discomfort to the patient, and create a hard to the touch breast. It is common among women who exhibited hematoma, not properly cleaned and treated by the previous plastic surgeon. The technique applied by the plastic surgeon and the implant type are also of great significance. On many occasions, hurried procedures using no drainage entail the aforementioned risk. Since 1998 and up to date, we have not operated a single patient of ours with exhibited capsule.
> The Baker Classification of capsular contracture
- Grade I Breast is soft and looks natural
- Grade II Breast is slightly firm but looks normal
- Grade III Breast feels and look firm (visible distortion)
- Grade IV Breast is hard, painful an looks abnormal (greater distortion)
Grade IV repair is performed mostly via capsulectomy, change of plane and implants. Capsulectomy usually restores limited capsules causing small problems, such as for breast improvement, and is performed with the internal bra technique which is based on capsulectomy.
Combination of problems
Double bubble-Dynamic breast
A groove forms on the breast and under the nipple, giving the impression that each breast is seated on the top of the implant. It occurs from the placement of the implant under the muscle, when the breast presents particularities, such as tuberous breasts, short submammary crease, short distance between the nipple and the areola, etc. However, it may also occur at the routine placement of the implant under the muscle, even when no particularities are present.
Watch Dr Kapositas on video presenting the result of a Double Bubble (dynamic breast) repair surgery
Initially the patient was treated by another plastic surgeon that performed breast lft with high profile implant placement under the muscle. During the revision surgery, we changed the implant plane to Subfascial and we also changed the implants to moderate plus cohesive I (Mentor, Inc, USA), with synchronous breast lift repair via orbital and vertical incisions.
Breast lift repair surgery with implants after dramatic weight loss.