What are the surgical options for revision breast surgery?
There are almost always multiple options when considering revision breast surgery alt-hough occasionally considering implant replacement is not possible due to the significance of the current problem however, in general, there are 4 elements to consider.
• Breast volume:
◦ explant (breast implant removal only)
◦ breast implant removal and replacement
◦ substitute with fat grafting instead of an implant
• Breast ptosis/droop: a mastopexy may be worth considering for a nipple that is too low or the breast is overhanging onto the chest wall
• Capsule: neo-submuscular pocket, partial capsulectomy, total capsulectomy, en bloc capsulectomy
• Pocket stability: After dealing with the current problems will the current implant pocket be stable to hold the implant in position or does it need support with an “internal bra” using elements of the current capsule, excess breast skin, a tissue scaffold or acellular dermal matrix (ADM)
Many women have new implants inserted to maintain their current breast size (or perhaps increase it further).
Implants are not always replaced. Over time it is common for women to have gained a little weight and the breast has naturally increased in size compared to the breast size when implants were originally inserted and the additional volume of a breast implant may seem less important. The shape of the breast has frequently altered especially if there have been pregnancies or weight fluctuations and the nipple will frequently have dropped with the breast and the upper part of the breast will have become more empty.
A large number of women will choose to have their implants removed and not replaced (explant). Many women will want to have their implants removed and not replaced but will still consider additional elements of the surgery that can address shape change and preserve some volume. Mastopexy will address a low nipple position and a droopy breast which hangs onto the lower chest. Fat grafting can be used to address volume loss in the upper part of the breast, the cleavage and even provide a moderate enlargement of the breast without using breast implants. Fat grafting can’t generally replace the entire volume of a large implant in a single operative procedure but will occasionally be performed a second time for additional volume.
There are many surgical options combining the various technical elements of implant removal/replacement/fat grafting, mastopexy, “internal bra” and on top of this, the breast implant capsule is managed separately on its own merits.
The goal of Breast Implant Revision surgery is to return to beautiful, natural-looking results however sometimes the problems are so significant that explant alone is all that can be offered in the first instance with a possibility for further surgery at a later date. This occurs typically with severe extracapsular rupture, breast infections and rarely BIA-ALCL.
Whether you desire breast implant removal or replacement surgery a customised procedure is planned to best achieve your aesthetic goals and increase your physical comfort if there are associated symptoms.
The correct procedure for you will be an individualised for the problems that exist and your desired outcome.