Breast Revision Introduction

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.

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

Rippling

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.

Breast Reconstruction Revision
Bilateral nipple sparing mastectomies followed by 2-stage expander/implant submuscular breast reconstruction, 640 cc textured shaped silicone gel implants, 8 months post op

Malposition

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.

Breast Augmentation Mastopexy Corrective
Breast Augmentation Mastopexy Corrective. Secondary Breast Revision (initial Augmentation Mastopexy done by another surgeon)

Asymmetry

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.

Breast Augmentation Patient with asymmetric breasts
Breast Augmentation Patient with asymmetric breasts. Breast augmentation and breast lift in patient with severe breast asymmetry
Breast Augmentation Revision
History of submuscular breast augmentation and significant asymmetry. Bilateral implant exchange with suture mesh, 325 cc moderate profile smooth round silicone gel implants, 4 months post op
Breast Augmentation Revision
History of submuscular breast augmentation and significant asymmetry. Bilateral implant exchange, bilateral capsulectomy, 350 cc moderate profile smooth round silicone gel implants, 1 week post op

Capsular Contracture

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.

Breast Augmentation Revision
History of submuscular breast augmentation with saline implants. Bilateral implant exchange with ADM, 450 cc moderate plus profile smooth round silicone gel implants, 9 months post op

Fat Injections

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.

FAQs

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.

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.