Breast Revision Surgery

Breast Revision Surgery

Breast Revision Surgery Overview

Breast revision surgery encompasses the surgical correction of a wide-array of conditions which can potentially develop in the breasts following implant and non-implant related cosmetic surgical procedures.

When considering breast enhancement surgery, it is worth noting that breast implants have a finite lifespan. In fact, most manufacturers offer warranties for implants no longer than 10 years. Hence, over the course of a patient’s lifetime, it is reasonable to expect that some sort of revision surgery will be needed – this may be as simple as requiring implant replacement due to aging implants or other mechanical problems such as implant rupture.

According to FDA statistics, the most common reason for breast revision surgery in the United States, at roughly 37 %, is the patient’s desire to switch to larger implants. Less commonly, other maladies of the breasts may develop secondary to breast augmentation surgery and other cosmetic breast procedures. These include hard breasts or capsular contractures, breast implant rupture and mal-position, double-bubble deformities, bottoming out and infra-mammary fold disruptions, symmastia, rippling and wrinkling, age-related changes, weight gain followed by weight loss, pregnancy-related issues, and combination issues.

Additionally, Dr. Vallecillos will occasionally see the patient with a long-standing history of a breast augmentation who – for various reasons – desires to have her implants permanently removed. In this patient population, the implants are generally removed and require a concomitant breast lift in order to create a more aesthetically pleasing breast mound.

Breast Revision Challenges and Achieving Success

Breast revision surgery is to be distinguished from primary breast enhancement surgery. Intrinsically, it is a much more technically difficult surgery to perform and there is often less predictability of outcome in contrast to primary breast surgery – This is primarily due to scar formation and soft-tissue changes ( such as stretching ) which come about as a result of the previous surgery(s). It is paramount that this be adequately communicated to the patient, and that she closely follow all post-operative recommendations by Dr. Vallecillos so that realistic expectations may be maintained ensuring the highest likelihood of a success and satisfaction.

Breast Revision Before & After Photos

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Before and after picture of a breast revision procedure

Breast Implant Removal

Breast Implant Removal

Implant Removal Overview

Breast implant removal may be required or desired for a variety of reasons, and involves the surgical removal of previously inserted implants. The FDA recommends that breast implant removal only be done when the risks of leaving them in outweigh the risks of removing them, which include:

  • Capsular contracture
  • Ruptured or damaged implant
  • Fears of future health consequences from silicone implants
  • Aesthetic concerns (such as changing implant size)

During this operation, the original incisions are reopened and the implant – along with any accompanying scar tissue – is removed. The implant is then either replaced or the breast is reconstructed with a breast lift to ensure that internal structure and shape of the breast are maintained.

Procedure Walk-Through

  1. Preparation: It is important that patients follow all of Dr. Vallecillos’ pre-operative instructions prior to breast implant removal. This might include limiting any medications, vitamins, or herbs that can cause thinning of the blood for two weeks before surgery. Depending on the individual, Dr. Vallecillos might also prescribe a round of antibiotics to be taken as a measure to prevent infection. If you smoke, you should abstain for at least two weeks before and after surgery, and if you are over the age of 45, you may need to obtain medical clearance by an independent physician prior to undergoing breast implant removal.
  2. Anesthesia: Breast implant removal is usually done under general anesthesia. A local anesthetic with IV sedation may also be an option.
  3. The Surgery: In most cases, Dr. Vallecillos will utilize the same incisions from the initial breast enhancement surgery. Once access to the breast pocket has been established, the implant and any accompanying tissue (such as scar tissue, in the case of capsular contracture) will be removed.
Implant Replacement

In cases such as capsular contracture and implant rupture, the implant will be replaced with a new implant. During your consultation, Dr. Vallecillos will discuss with you the option of replacing the implant with one made of a different material or make (silicone gel vs. saline, smooth shell vs. textured), or moving the placement of the implant (submuscular vs. subglandular).

Implant Removal

When the patient has elected not to replace the implant, Dr. Vallecillos will strive to reconstruct the breast’s original size and shape using a breast lift technique.

Once the surgery is complete, the incisions are closed and bandaged.

Breast Implant Removal FAQs

Who is a candidate for breast implant removal?

There are several reasons for undergoing breast implant removal. If you have developed capsular contracture, have suffered a ruptured or otherwise damaged implant, or have reason to suspect other health consequences, you may wish to consider breast implant removal and/or replacement. Breast implant removal may also be done for aesthetic reasons, such as changing the size of the implant or returning the breasts to a pre-operative state through implant removal and a breast lift.

What is the recovery time for breast implant removal?

Following breast implant removal, patients should allow themselves the same amount of recovery time as with breast augmentation surgery. Rest is vital during this period; strenuous exercise and heavy lifting should be avoided until otherwise indicated by Dr. Vallecillos. Bandages are usually removed during the first week after surgery, but you may be instructed to wear a special supportive bra thereafter. Soreness and swelling may persist for several weeks or months after surgery.

What are the risks and side effects with breast implant removal?

As with all surgeries, risks of breast implant removal include infection and bleeding. Breast implant removal also has a risk of excessive scarring, due to the reopening of original incisions or the creation of additional incisions. Rarely, implants may rupture during removal, which can cause problems later during mammography. Some patients report a loss of sensitivity in the breasts after breast implant removal. All risks and side effects should be discussed with Dr. Vallecillos prior to undergoing surgery.

How long do the results last?

Results from breast implant removal should be considered permanent, though the later development of complications such as capsular contracture, as well as the inevitable changes that occur as a result of aging, may render additional procedures necessary.

Breast Reconstruction

Breast-Reconstruction

Breast Reconstruction Overview

Breast reconstruction is performed to rebuild and reshape the breast. Following a mastectomy and depending on the individual patient’s circumstances, such as whether radiation therapy is required as a part of the treatment protocol, saline-filled or silicone gel implants or tissue from other areas of the body (also known as an “autologous reconstruction”) – and sometimes a combination of the two – may be used.

Nipple and Areola Reconstruction is often required as well and can be performed alongside or following breast reconstruction.

Procedure Walk-Through

  1. Preparation: To prepare for breast reconstruction, you should discontinue the use of blood-thinning vitamins, herbs, and medications for two weeks before the surgery. If you smoke cigarettes, you should quit for at least two weeks before and after surgery. If you are over the age of 45, medical clearance by an independent physician may be required before undergoing surgery.
  2. Anesthesia: General anesthesia will be administered.
  3. Several options for breast reconstruction exist, the most common being immediate reconstruction with placement of an implant. Dr. Vallecillos will discuss beforehand which options are best for you, given your specific diagnosis and circumstances. Some of the more commonly performed breast reconstruction procedures are as follows:

Autologous Reconstruction

The following flap techniques utilize a woman’s own tissue, notably muscle with overlying fat and skin, to re-create the breast mound.

In instances where a mastectomy leaves a woman’s breast with insufficient tissue needed to adequately provide coverage for an implant, a tissue flap or tissue expansion may be required.

A TRAM Flap

Also known as a “transverse rectus abdominus myocutaneous flap,” borrows donor muscle, fat, and skin from the patient’s abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and be tunneled up through the chest wall, or be completely detached, and formed into a breast mound.

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Alternatively, Dr. Vallecillos may choose the DIEP or SGAP flag techniques that do not use muscle but transport tissue to the chest from the abdomen or buttock.

Latissimus Dorsi Flap

Uses muscle, fat, and skin from the back tunneled to the mastectomy site and remains attached to its donor site, leaving bloody supply intact.

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Occasionally the flap can reconstruct a complete breast mound, but often provides the muscle and tissue necessary to cover and support a breast implant.

Flap and Implant

A breast implant can be an addition or alternative to the flap techniques. Saline and silicone implants are available for breast reconstruction, and your surgeon will help you decide what is best for you. Reconstruction with an implant alone usually requires tissue expansion.

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Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it is a more lengthy reconstruction process. This method requires many office visits over 4-6 months after placement of the expander to slowly fill the device through an internal valve to expand the skin.

A second surgical procedure will be needed to replace the expander if it is not designed to serve as a permanent implant.

Nipple and Areola Reconstruction is often performed alongside breast reconstruction. Liposuction may be performed alongside breast reconstruction if tissue grafts from other areas of the patient’s body are being used to rebuild the breasts.

Breast Reconstruction FAQs

Who is a candidate for breast reconstruction?

You should consider breast reconstruction if you’ve undergone, or are planning to undergo, a mastectomy, or have experienced a traumatic injury to the breast.

What is the recovery time for breast reconstruction?

Patients should arrange to have friends, family members, or other caregivers available to help during the first week after surgery. A drainage tube will remove fluids for several days and you may experience pain and discomfort during the first few weeks of recovery. You should avoid having sex or performing strenuous exercise and/or heavy lifting for at least 4-6 weeks after surgery.

Are there risks or side effects with breast reconstruction?

You should expect some temporary swelling, tenderness, bruising and possible numbness near the incision sites and throughout the breast area. As with all surgeries, there is also a small risk of infection. When the reconstruction involves the use of implants, capsular contraction (or a tightening of the skin and hardening of the breast) can occur. Patients with a history of radiation therapy are at higher risk for developing this condition. Carefully following Dr. Vallecillos’ post-procedure instructions can help minimize this risk.

How long do the results last?

Most breast reconstructions are permanent, though in rare cases additional procedures may be required to correct side effects.

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