Breast Revision Overview
Revision breast surgery, or secondary breast surgery, can be carried out whether the initial surgery was cosmetic (breast lift, reduction, or augmentation) or reconstructive (breast cancer reconstruction). Chicago plastic surgery provider Dr. John Kim is an experienced breast revision surgeon, and he performs many breast surgeries to correct deformities. Patients who come to him for revisions may have had medical complications or a desire to improve their aesthetic outcome. Some complications that lead patients to seek out secondary surgeries include infection, seroma, implant rupture, or capsular contracture. Aesthetic considerations include improved implant positioning, recontouring, or implant replacement for a different size or shape. Secondary procedures may occur several years after the original surgery.
Reasons for Breast Implant Revision
Women may desire removal and replacement of their implants for any of the following reasons:
- Defect: both saline and silicone implants can rupture and leak
- Size: to increase or decrease the breast size
- Shape: to switch from round to anatomical or vice versa
- Type: there are a multitude of manufacturers, textures, and projections of implants to choose from
If your implant is not filled properly or is not covered by adequate breast tissue, a rippling pattern may appear. One corrective measure Dr. Kim employs is to use form-stable, cohesive gel implants (commonly known as “gummy bear” implants). Dr. Kim may also try to support the tissue covering the implant by reinforcing it with a material known as acellular dermal matrix (ADM), which acts as a sling or hammock. ADM increases the amount of available tissue to reconstruct the breast without overly stressing your native skin.
Implants may migrate after placement in the breast pocket. If the pocket created is too large for the implant, it may move around and shift to a position that appears unnatural. Implants may settle too low or too high on the chest, or too far inward or outward. Dr. Kim will typically utilize internal suturing of the capsule to fix this issue, or he may perform a breast lift. ADM may play a role in this corrective surgery as well.
Asymmetry is particularly prevalent when the initial breast surgery was unilateral (one-sided). It is very hard for plastic surgeons to match the two breasts when only one has been surgically altered. This issue is most common after unilateral (one-sided) breast cancer reconstruction surgery and is less prevalent with cosmetic surgeries, as those are typically bilateral (both sides). Interestingly, some women actually prefer a bit of asymmetry since natural breasts are slightly asymmetrical and they wish to retain some of that natural appearance. Dr. Kim typically addresses asymmetry with a change in implant size, shape, or position.
When an implant is placed in the breast pocket, the body’s natural immune response is to create a capsule around the foreign object. This scar tissue capsule is prone to harden and tighten over time. Capsular contracture is considered a complication of breast surgery. It may result in aesthetically displeasing breast appearance and discomfort or pain. Dr. John Kim performs revision surgery to remove the capsule (capsulectomy) or cut it open (capsulotomy) to relieve strain.
Sometimes Dr. Kim will employ fat injection (also known as a fat grafting) to help address thin breast envelopes or areas of contour deformity of the breast. There are a number of ways to harvest fat from varying areas of the body. Dr. Kim can discuss issues related to fat harvest and fat injection into the breast with you. There are studies that show that fat injections to the breast result in some loss of volume overtime and Dr. Kim can go over the time course and potential outcomes related to this.
Here is an original article on fat grafting written by Dr. Kim entitled “Long-term outcomes following fat grafting in prosthetic breast reconstruction: a comparative analysis.”
Secondary breast surgery, because it is revisionary in nature, is often more complex than the original surgery. Dr. Kim must manipulate tissue that has already experienced the trauma/stress of previous surgery, which may have left it compromised. Even when the original breast surgery is a success, changes occur in the breasts over time: women gain or lose weight, become pregnant, breastfeed, and age, which are all natural processes that affect prior breast surgery. Dr. Kim is well equipped to address your needs in this respect, and he encourages you to set up a consultation to discuss your multitude of options.
Breast Revision FAQ
How Long Will Recovery Be?
After breast revision surgery it is common to experience some swelling and soreness that should subside within a few weeks. The specific amount of time for recovery will vary depending on if your initial breast surgery had any complications and the technique used for the revision procedure. Dr. Kim will provide you with specific post-operative instructions at the time of your surgery.
When Can I Return To Work?
Most patients can return to work after about one week. However, this is dependent on the type of work performed and the specifics of your breast revision surgery. Dr. Kim will be happy to discuss this with you when going over your recovery instructions.
Can I Change My Implant Size or Type During Breast Revision Surgery?
A common reason that patients seek breast revision surgery is to change the implant size or type. Dr. Kim will discuss with you your desire to change your implant and will provide you with a recommendation on what options he believes will work best.
Should My Original Surgeon Perform My Breast Revision?
The surgeon who performed your initial breast surgery may not always be the best option for your revision surgery if they are not experienced with this procedure. It is important to choose an experienced breast revision surgeon, such as Dr. Kim, that has the skills to perform this corrective breast surgery.
What should I expect during a consultation for breast implant revision?
Dr. Kim will discuss your symptoms, concerns and surgical goals during your consultation at Northwestern Plastic & Reconstructive Surgery. Come prepared to discuss your medical conditions, drug allergies, medications, supplements and previous medical treatments and surgeries. Our plastic surgeon will evaluate your breast surgery results, outline your revision options and recommend a course of treatment to reduce your symptoms and achieve your desired results. Bring a list of questions to your consultation. If breast revision is recommended for your circumstances, Dr. Kim may take “before” photographs with your consent.
Dr. Kim is a board-certified plastic surgeon in Chicago, an Ivy League graduate (Harvard University) and a graduate of Stanford University. He is a nationally recognized leader in breast surgery with over 200 peer-reviewed articles in prestigious journals such as Plastic and Reconstructive Surgery, Journal of the American Medical Association, and Annals of Plastic Surgery. He has given over 100 international lectures on breast surgery as well.
What conditions and concerns can breast revision surgery improve?
Breast revision surgery with a secondary procedure or fat injections can resolve most issues with breast implants after breast augmentation. The revision may remove excess scar tissue (capsular contracture) and/or remove or replace the breast implants. The goal is to achieve a beautiful, natural-looking breast shape that addresses your cosmetic or medical concerns from the initial surgery and provides the desired bust size and shape.
Should I remove or replace my breast implants?
Removing or replacing breast implants is a personal choice, and Dr. Kim can discuss the benefits and drawbacks of both options during your consultation to help you make an informed decision. Many women choose to replace their breast implants during revision breast surgery, while others wish to return to their natural breast shape and size or utilize fat injections to augment the breasts.
How do I know if I need breast implant revision?
Women unhappy with their initial results may consider revision breast surgery for cosmetic reasons. Other patients may experience painful symptoms due to capsular contracture or significant asymmetry due to implant rupture or weight fluctuations. There are many reasons women may pursue breast implant revision. If you’re unsure if a secondary procedure is necessary for your breasts, schedule a consultation to discuss your concerns with Dr. Kim.
If you are in the Chicago area or beyond and interested in corrective breast surgery, please contact John Kim at his offices in on the Northwestern campus in downtown Chicago to set up your individualized consultation.