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Revisional Cosmetic Breast Surgery
As cosmetic breast surgery becomes more common in our country, the number of women seeking revisions and improvements from previous cosmetic breast surgery is increasing.
There are a variety of reasons why someone might seek revisional cosmetic breast surgery. For example, you may have had a breast augmentation done with an older style of silicone breast implant, and are now interested in a change to the newest generation of silicone implants. Or perhaps you had a breast augmentation years ago, and are now dissatisfied with breast sagginess that might have resulted from pregnancy or weight-loss.
Most augmented women are happy with the size, shape and appearance of their breasts. On the other hand, some women do experience problems related to their implants, or the way their breast tissues interact with an implant. Two problematic, long-term issues with breast implants are implant failure, and capsular contracture.
Breast implant failure represents a crack or tear of the breast implant shell. This can occur for a number of reasons, but probably the most common reason is a long-term fold in the implant, which weakens the shell. For saline implants, an implant leak typically presents with a dramatically reduced breast size on one side. For silicone implants, there may be no change in breast shape, or a very significant change, depending on the type of silicone implant and the breast tissue's response to the leak. An ultrasound or MRI scan is often used to confirm a failure in a silicone implant.
A leaking or ruptured implant can be removed and replaced with a new implant of similar type and size. Often, scar tissue also needs to be removed around the implant. This procedure sometimes requires placing the implant in a new breast pocket away from scar tissue.
Capsular contracture is another long-term problem with breast implants. The body forms a capsule around any foreign object, like a breast implant, in order to isolate that object. The thickness of the capsule is determined by one's own scar-forming biology, the amount of inflammation around the implant, and the position it was placed. Some patients develop a thickened implant capsule that actually changes the shape and position of the implant. This phenomenon is referred to as a capsular contracture. The problem can usually be treated with implant removal, implant capsule removal, and replacement of a new implant in a different implant pocket. Sometimes the implants need to be removed, and not replaced.
Reasons why patients are interested in revisional cosmetic breast surgery include:
- visible wrinkling of the implant
- capsular contracture (scarring) around a breast implant
- rupture or leakage of a breast implant
- improper position of a breast implant (bottoming out)
- desire larger or smaller breast implant
- exchange of saline implants for newer cohesive silicone breast implants
- desire for breast implants to be removed and not replaced
- revision of previous breast lift or breast reduction
- desire for a breast lift after breast augmentation
- fat grafting to conceal visible edge of breast implant
- fat grafting to improve cleavage
Implant replacement for silicone breast implants is a very common procedure. The current generation of silicone breast implants was FDA approved in November 2006 for cosmetic use in female patients aged 22 years and older. Now that silicone implants are available for cosmetic breast surgery, many women want their saline implants exchanged for newer generation silicone implants, which have improved shape and tactile qualities. In the upcoming months, the FDA will likely approve 'fifth-generation' form-stable silicone implants from Mentor® and Allergan®. These new devices have a pre-formed shape, and a more cohesive silicone formulation. They appear to outperform the current generation of breast implants in terms of rate of implant failure and capsular contracture. It is anticipated that many patients will want these new breast implants when released for use by the FDA.
When considering a breast augmentation in the first place, patients should recognize that a substantial number of women will require a revisional breast surgery to maintain their desired look, at some point in life. Estimations for the number of women who seek revisional cosmetic breast surgery vary, but a good rule of thumb is that close to 30% of women who have breast implants longer than 15 years will seek revisional cosmetic breast surgery for the reasons described earlier.
Dr. Gottlieb has experience with the complex issues that women seek revisional cosmetic breast surgery for. In general, these procedures are not covered by health insurance policies. The type of breast implant, and how long ago it was placed will determine if the implant manufacturer has any warranty against implant leak or failure. In some cases, the implant manufacturer will provide some coverage for new implants and will pay part of the fee to replace them. Our clinic is happy to go over your breast implant manufacturer warranty information with you and help you determine if you are eligible for implant replacement under warranty. Please have your implant information and past medical and surgical records in hand when you meet Dr. Gottlieb.
Breast Revision Photo Gallery
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I am interested! What do I do next?
If you are considering this procedure we encourage you to schedule a consultation with Dr. Gottlieb. During this visit he will listen to your concerns and discuss your options. He will tell you whether you are a suitable candidate for a breast revision procedure and inform you of the potential risks of the procedure. Each breast revision procedure must be custom tailored for the patient to get the best possible result. You will also have a chance to view before and after photo albums of his patients who have undergone procedures similar to what you are considering.
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