Expert Insights from a Board-Certified Plastic Surgeon
Breast augmentation is a popular choice for many women to enhance the appearance of their natural breasts with little to no visible incisions. However, in time some patients need a secondary procedure to correct issues, refine their results, or accommodate other changes in their body or personal preferences.
Revisional breast surgery can correct many of these issues and can provide solutions to address concerns ranging from drooping breasts, broken or leaking implants, or no longer desiring implants.
Dr. Stephen J. Ronan, MD, FACS, founder of Blackhawk Plastic Surgery in the San Francisco Bay Area town of Danville, California, provides insights into the intricacies of revisional breast surgery, including how to correct problems and achieve optimal, long-term results.
Understanding Revisional Breast Surgery
Revisional breast surgery, also known as a secondary or redo breast procedure, aims to correct complications or adapt to changes in the patient’s body after an initial surgery.
Common reasons for needing a revisional surgery include issues like incorrect implant positioning, complications with the implants themselves, or a need to replace aging implants. These surgeries are often a chance to improve upon past results and help patients achieve a look that aligns with their expectations.
The Importance of Proper Implant Placement
One of the most significant factors in achieving a successful breast augmentation is the correct placement of the implant. When implants are placed on breasts that are already beginning to droop, there is a greater likelihood that a revision surgery may be needed in the future as the implant may continue to droop and spread over time.
“The most critical thing is to put the implant in the right place on the chest. If the breast is not naturally positioned over the implant, a lift is often necessary to correct it,” says Dr. Ronan.
Augment Lift: When and Why It Is Necessary
An augment lift combines breast augmentation with a lifting procedure. Breast augment lifts are a very common procedures at the practice, especially in cases where the breast itself is drooping. If a patient’s nipple sits at or below the fold of the breast, simply adding an implant won’t suffice—a lift is crucial to achieve a balanced and aesthetic look. By lifting the breast, Dr. Ronan ensures that the breast tissue is properly supported, preventing further sagging and complications.
“If your nipple is at your fold or below, you can have an implant, but you also need to do a lift to bring the nipple back up into an appropriate place on top of the implant,” says Dr. Ronan.
This combined approach improves breast contour and firmness while tightening the skin around the breast pockets to a natural, more youthful look.
Actual revisional breast augmentation patient of Dr. Ronan
The Consequences of Cutting Muscle
Dr. Ronan also sheds light on the unintended consequences of cutting the chest muscle during surgery. Cutting the chest muscle can lead to upward muscle retraction and downward implant migration, known as “bottoming out.” Dr. Ronan details a case where a patient experienced significant downward migration of the implant, resulting in asymmetry and visible scars moving higher on the breast.
A corrective approach to repair the effects of a cut chest muscle often includes a technique which repositions the implant pocket higher on the chest, recreating a natural fold. In these corrective surgeries, the implant is not only repositioned, but the breast’s natural proportions are restored, which result in a more aesthetically pleasing outcome.
Capsuloraphy and Rebuilding the Pocket
One of the most effective techniques in revisional breast surgery is capsuloraphy. This procedure involves repairing the internal capsule around the implant, which helps stabilize its position on the chest.
By excising the old scar tissue, rebuilding the capsule higher on the chest, and placing a new implant, the patient was able to achieve better cleavage, symmetry, and a more proportionate look.
Rebuilding the implant pocket is particularly beneficial for patients who have experienced lateralization (the implants moving outward) or significant drooping. By adjusting the pocket and incorporating a lift when needed, the physical positioning of the implant is improved, but also the overall aesthetics of the breast are enhanced—creating a taller, narrower abdomen and improving the patient’s silhouette.
The Role of Strong Connective Tissue
Not all patients are the same, and Dr. Ronan notes that individual differences in connective tissue strength can significantly impact the results of breast surgery. He describes connective tissue as the “skeleton in the soft tissue,” which provides essential support to the breast and implant.
Patients with weaker connective tissue are more prone to implant migration, leading to complications like bottoming out or asymmetry.
To address this variability, Dr. Ronan tailors his surgical approach based on the tissue constitution of each patient. For those with softer tissues, he often makes the implant pocket smaller and higher than desired initially, knowing that natural tissue expansion will occur over time. This approach minimizes the chances of future migration and ensures long-lasting results.
Common Revisional Cases and Solutions
- Bottoming Out: This is a situation when implants migrate downwards, leading to an unnatural appearance. The solution often involves rebuilding the implant pocket using an approach like capsuloraphy, and repositioning the breast tissue through a lift.
- Lateralization: Lateralization occurs when implants move outward towards the sides of the chest. This can be corrected by narrowing the implant pocket, which helps bring the implants closer together, to enhance cleavage and improving the overall breast shape.
- Drooping After Augmentation: When patients experience drooping after an initial augmentation, it is often because a lift was not performed although it was needed. Revisional surgery in these cases typically involves adding a lift to better reposition the breast tissue over the implant, correct the position of the nipple, and tighten the breast pocket.
- Capsule Revisions: In some cases, the capsule surrounding the implant becomes too loose or misshapen, leading to issues with implant positioning. Revising or even removing part of this capsule can help recreate a stable pocket for the implant, ensuring better a long-term effect.
Consultation and Planning
Dr. Ronan emphasizes that a consultation is key to a successful revisional breast surgery. During the consultation, the patient’s surgical history is reviewed, the current condition of the implants and breast tissue is assessed, and the patient’s overall aesthetic goals are discussed.
This thorough assessment allows for a tailored surgical plan to be created that addresses the specific issues at hand, both patient and doctor concerns, and sets realistic expectations for the procedure to ensure a successful outcome.
“The key is to figure out where we are, and where we want to be,” says Dr. Ronan.
What to Expect on Surgery Day
For patients undergoing an augment lift or revisional surgery, Dr. Ronan outlines a typical surgical day.
- The procedure usually takes about an hour
- Patients are given a three-day numbing medication to assist with postoperative pain management
- The first 48 hours are often the most challenging with regards to pain management
- Post-surgery, patients are monitored in recovery and are able to return home the same day
Dr. Ronan recommends that patients should begin taking short walks once home. Aside from easy-paced walking, patients should take it easy for the first week to ensure optimal healing. Most patients can resume low-impact activities after two to three weeks. Although strenuous physical activities like lifting weights should be avoided for six to eight weeks.
Risks and Recovery
Like all surgeries, revisional breast procedures can come with some risks, however complications are rare. The following are a few common risks or side effects that can occur after breast surgery:
- Risks associated with anesthesia
- Procedure-specific risks, like implant deflation or asymmetry
- Changes in breast or nipple sensation
- Scar tissue
- Breast pain or tenderness
Correcting any of these complications may require additional surgery or other adjustments.
Enjoying A Second Chance
Revisional breast surgery offers a second chance for patients to achieve the look they desire, correcting issues from previous procedures and enhancing the appearance and longevity of their results.
Dr. Stephen J. Ronan at Blackhawk Plastic Surgery, focuses on personalized care—taking into consideration each patient’s unique anatomy, previous surgeries, and aesthetic goals to ensure the best possible outcomes.
For those considering revisional surgery, the key takeaways you should keep in mind are:
- Ensure proper implant placement
- Consider an augment lift when necessary
- Understand the role of connective tissue in the longevity of your results
With careful planning, revisional breast augmentation can provide you with beautiful, natural results.
If you’re experiencing issues with your breast implants or are considering a revision, click to schedule a consultation with Dr. Ronan.
Blackhawk Plastic Surgery can is equipped to provide personalized, high-quality care for all of your aesthetic needs.
Improve your self-confidence with a cosmetic surgical procedure at Blackhawk Plastic Surgery. Dedicated to using the highest standards of care for our patients, call today to discover how our Beautiful and Natural Results can enhance your looks!
