There are many reasons why women seek breast revision surgery
- Capsular Contraction
- Bottoming Out
- Rubtured Implants
- Double Bubble
Capsular contracture is the leading complication for breast augmentation patients. Although rare and a fully natural occurrence within the body, the capsule can cause the breast to become hard and produce visible distortion of the breast.
A capsule occurs with virtually every foreign object that is placed inside the body. It is a scar-like shell of collagen fibers that encases the object and under normal circumstances is completely harmless. In some cases the capsule grows very thick and tightens around the breast implant causing the breast to feel very dense and possibly painful and appears misshapen. It is still unknown why a capsule becomes so severe that it grows to this extent.
Capsular contracture is measured in four different levels (grades 1-4) with the fourth level being the most severe with the need for corrective surgery to remove the capsule
Possible factors that may increase the chance of capsular contracture are as follows
- Infections during or after surgery (dental work).
- Implant rupture (gel or silicone)
- Subglandular breast implant placement.
- Radiation (before or after breast augmentation surgery).
- Introduction of bacteria to the implant during or after surgery.
- Hematoma or seroma.
When breast implants are placed submuscular (under the muscle) there is a possibility that the pectoralis muscle will be cut allowing breast tissue and the breast implants to fall towards the sternum at the center of the chest. This happens when the breast pocket is overly dissected towards the center and releases the pectoralis muscle too much, resulting in the implants being too close to center, with unnatural looking cleavage and a uniboob or bread-loafing effect. A similar problem can also occur when implants are placed under the gland. When dissecting the pockets, the space between the pockets comes too close to the center
This is detected usually a few days after surgery whereas the post-operative swelling of the breasts lifts the breast tissue away letting the implants slide towards the cleavage area. There are many techniques to correct or repair symmastia. Our board certified surgeons use internal sutures to reattach and reinforce the cleavage area from the breast implants.
Patients with breast implants that have “bottomed out” have nipples that appear too high or have an inframammary fold that appears unnaturally low. Bottoming out has a higher occurrence in patients who have very thin breast tissue – the implant can pull the breast downward causing it to bottom out. It is also more common in subglandular breast implant placement as opposed to submuscular or partial submuscular placement.
The corrective surgery to repair bottoming out of breast implants consists of moving the inframammary fold higher. This is done by reinforcing the lower area of the breast pocket with internal sutures thus raising the breast implant and resulting in a more natural breast mound and inframammary crease.
Decreased breast size, uneven breasts, pain or swelling can indicate a ruptured breast implant (saline or silicone). There are may reasons why an implant may deflate or rupture. Underfilling or overfilling the implant beyond the manufacturer specifications is often the cause. (Note: all saline implants have a +/- threshold for underfilling or overfilling with saline.) Underfilling can cause the implant to have folds in it, and these folds over time rub together creating friction which weakens the implant. Overfilling the implant can cause the shell to stretch weakening the breast implant which can cause a rupture. An accidental trauma to the breast can sometimes cause an implant to rupture and slowly leak fluid or gel.
Please note that saline and gel/silicone implant leakage has NOT been proven to cause any harm to the patient. Extensive tests have linked no longterm health hazard due to breast implant leaks.
Some ruptures are covered by the implant manufacturer; surgical costs for replacing the damaged implant may be incurred.
A double bubble occurs when the implant drops below the natural fold of the breast. This can often occur when a breast lift is required.
When tissue hangs beneath an implant which has been placed submuscular, it is referred to as a double bubble or high-riding implant. This usually occurs with an individual who has sagging breasts before their breast augmentation surgery.
Factors that increase the risk of double bubble post operatively are pregnancy, breast feeding, weight loss and aging. In these situations the appropriate repair is either a breast lift to correct the sagging breast tissue, changing the placement of the implants, or possibly an inframammary fold revision.
Dr. Michael Cohen, a leader in breast enhancement surgery
Breast correction surgery requires a keen eye for aesthetics, a commitment to keeping informed of the new and innovative techniques as they become available, and the ability to develop problem-solving techniques – all key attributes of our board certified surgeon and breast revision specialist Dr. Michael Cohen.
Breast Revision Surgery is usually deemed cosmetic in nature. Certain circumstances may be covered by insurance; our staff will work with your insurance company to determine the scope of your benefits.
**NOTE: The specific risks and the suitability of this procedure for any given individual can only be determined through a consultation with the plastic surgeon.