Revisional Breast Augmentation – Breast Revision

Serving New York City, Manhattan

 

Techniques:

Animation Deformities

When implants are placed in a submuscular pocket, sometimes patients have animation deformities of the breasts. The implant can appear to move upward and toward the axilla, and a ridge can sometimes be appreciated at the juncture between the lower muscle border and the breast tissue.  This can be the result of over release of the medial muscle fibers along the sternum, or overtime with thin soft tissue coverage.  This deformity can be treated by moving the implant into a subglandular pocket, adding an ADM such as Strattice® (LifeCell) to the lower pole, releasing the muscle from the gland, or performing a split-muscle technique.

Bottoming Out

Refers to the situation when an implant descends below the breast inframammary fold. This can happen as a result of over dissection of the implant pocket, or over time as the implant pushes below the fold. In this situation the nipple may be pointing upward, and usually the majority of the implant will fall below the horizontal plane situated at the nipple. Correction of this deformity will require possible exchange for a smaller implant, a capsulorrhaphy (capsule repair), and/or inserting an ADM for further support along the lower pole.

Capsular Contracture

The body forms a natural barrier of tissue around all implants. When this barrier gets tight around the implant, then this is called a contracture. Clinically, the breast may be painful and the implant will not move freely in the pocket. When this happens the breast implant tends to sit high on the chest. The current theory is that a subclinical infection may develop over time, perhaps with bacteria migrating through the nipple leading to a biofilm of bacteria, potentially irritating the pocket and causing the contracture. It is thought that blood in the pocket at the time of surgery may exacerbate this situation if it happens early.  Treatment often requires removal and exchange of  the implants, sometimes including a change in the pocket position from subglandular to submuscular or vice a versa, removal of the capsule, and possibly inserting an ADM such as Strattice® (LifeCell).


“Beauty is the internal light that emanates from within. To me, the true form of beauty is one’s personality that shines through.”


Double Bubble Deformity

A double bubble can be the result of several different scenarios, each requiring a different surgical technique to repair it.  Common causes of a double bubble include: an implant that is too large for the breast, an implant that sits too high on the chest with the gland “falling off” the implant, a tight breast in the lower pole often seen with tuberous deformities, and from a capsular contracture.  Correction of this problem is dependent on the cause.  If the implant is too large for the base diameter of the breast, a smaller implant can be used or the lower breast pole can be released by making radial cuts in the gland. If the implant sits too high because of inadequate release of the pectoralis muscle, then the muscle can be released a bit more.  If the breast is still “falling off” the implant, then a breast lift may be necessary.  If the breast is tuberous and the lower pole is tight then radial cuts along the lower breast pole can potentially improve this situation.  If a capsular contracture is causing the double bubble, then a capsule excision may help.  Of course, variations of all these techniques may be necessary in certain scenarios.

Lateralization of The Implants

When the pocket becomes too large either from over dissection or over time with expansion, the implants can fall off to the sides when the patient is lying down.  Treatment of this deformity can be accomplished by performing a capsulorrhaphy (capsule tightening procedure) along the lateral chest wall. This may include the use of permanent or slowly resorbable sutures, reinforcing part of the capsule to itself, or reinforcing the repair with ADM such as Strattice® (LifeCell).

Symmastia

This is almost the opposite to lateralization of the implants. This is when the medial or sternal  area of the pocket is either over dissected during surgery or over time stretches.  The implant migrates toward the sternum and the cleavage becomes crowded or lost.  This is more common with subglandular implant placement.  Correction of this deformity can be accomplished by creating a submuscular pocket, or performing a capsulorrhaphy, which can include reinforcing the capsule and/or inserting an ADM such as Strattice® (LifeCell).

Rippling

Visibility of the implant through the skin is often a sign of rippling.  This is a result of the thin soft tissue covering the implant most often due to the patient being very thin or having undergone many previous breast surgeries.  The goal is to provide better soft tissue coverage over the implant if possible. If the implant is in a subglandular pocket, placing it in a submuscular pocket may help. If the implant is saline filled, sometimes over-filling the implant will remove the ridging of the implant and therefore improve the rippling. Usually the goal is to provide more soft tissue coverage so fat grafting can sometimes be helpful, as well as inserting an ADM such as Strattice® (LifeCell) over the implant in the  rippling areas.

If you would like more information about New York Plastic Surgeon Dr. Wallach and his success with New York City Revision Breast Augmentation procedures, we hope that you will not hesitate to contact our Manhattan offices at (212) 257-3263 or by mail at 1049 5th Avenue, Suite 2D in New York, NY 10028; or using our contact form to request additional details.

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