Revision Breast Augmentation Manhattan, NY

Table of Contents

What is breast implant revision surgery?

A breast revision surgery is a plastic surgery procedure that is performed when complications occur or when a person who has had prior breast surgery is unsatisfied with the results. This is done following either breast augmentation or breast lift surgery, whether or not a person has experienced complications from the procedure.

Breast implant revision techniques can vary from something as simple as removing or exchanging one or both implants, to modifying the breast pocket, to removal or repair of the scar tissue that forms the capsule around an implant.

Who is a good candidate for breast implant revision?

A good candidate is a person who desires a change or improvement to the breast after their initial breast augmentation surgery and is otherwise healthy. If a person is deemed medically fit for prior breast surgery, they are almost always still well-qualified for revision procedures.

The qualifications and requirements of breast revision surgery will likely be very similar to the previous surgery to enhance the breasts, including avoiding certain medications and supplements for a given period prior to the treatment.

What should I expect during a consultation for breast revision surgery?

During the consultation with board-certified plastic surgeon Dr. Steven Wallach, you will spend a lot of time reviewing your breast revision surgery goals. An exam will then be performed and a plastic surgery plan to address your unique concerns revision surgery will be discussed with you at length.

You can also use this time to ask Dr. Wallach any questions you may have about the procedure and what results you can expect. For those disappointed with their initial results, it’s not uncommon to feel apprehensive about continuing to undergo plastic surgery, which is why we work hard to understand your motivations, expectations, and worries prior to committing to a surgery date.

What questions should I ask my plastic surgeon about breast revision surgery?

You should ask your New York plastic surgeon if they are board-certified first and foremost, as you should not entrust this procedure to someone who isn’t committed to the same ethical and professional standards that board-certified physicians are. You might want to review the various plastic surgery techniques as well and which breast revision surgery technique they feel will give you the best result with the least amount of scarring.

Patients may choose to change from saline implants to silicone implants, wish a change in the implant size, or want complete implant removal during their revision procedure. Your consultation with Dr. Wallach provides you the ability to discuss all your aesthetic goals and determine the best breast revision surgery technique that will help you achieve them.

What are the risks of breast implant revision?

The main risks of breast implant revision surgery are unfavorable scarring, asymmetry, infection, bleeding, nipple loss, skin loss, fat necrosis, fluid collections, implant issues, numbness or hypersensitivity, and the need for further breast revision surgery.

What should I expect during my breast implant revision recovery?

Most patients can go back to light-duty work within 3-5 days. Pain and discomfort are minimal depending on the technique used and goals achieved from surgery. Dr. Wallach has patients avoid strenuous activity for 3-4 weeks and then avoid exertion like heavy lifting for about 6-8 weeks to ensure everything heals correctly.

Patients may have many reasons for choosing to undergo revision breast procedures but the goal of the breast revision surgery in New York is to improve the appearance of your breasts and give you natural-looking results.

Common Reasons for Breast Revision:

There are many reasons both medical and aesthetic for choosing to pursue breast revision surgery. Common medical reasons include capsular contracture, implant rupture, or other conditions that cause pain. There are also legitimate aesthetic reasons to seek revision breast surgery, including rippling, unpleasing placement or deformity, and changes in appearance with movement.

Animation Deformities

When saline or silicone 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 seen 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 simply with wear and tear with thin soft tissue coverage.

The revision procedure for this may include moving the implant into a subglandular pocket, adding an ADM (Acellular Dermal Matrix) such as Strattice® (LifeCell) to the lower pole, releasing the muscle from the gland, or performing a split-muscle technique.

Bottoming Out

“Bottoming out” refers to the situation when a silicone or saline implant descends below the inframammary fold of the breast. This can happen as a result of over-dissection of the implant pocket, having a tuberous breast deformity, 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 implants may fall below the horizontal line of the nipple and around the areola. Revision procedure for this deformity will require possible implant removal for exchange with 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 new implants in the body, including breast implants. When this barrier gets tight around the implant causing deformity and pain, this is called a contracture. Clinically, patients may find the breast to be painful and the implant will not move freely in the pocket. When this happens, the silicone gel or saline implant tends to sit higher on the chest than intended. This is sometimes, but not always, caused by silicone or saline implant ruptures.

Breast revision treatment often requires removal and exchange of the implants, sometimes including a change in the pocket position from subglandular to submuscular or vice versa, removal of the capsule, and possibly inserting an ADM such as Strattice (LifeCell).


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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-looking breast, and from capsular contracture.

Correction of this problem is dependent on the cause. If the implant used during the initial breast augmentation 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 to expand around the implant. If the initial breast augmentation implant sits too high because of inadequate release of the pectoralis muscle, then the breast augmentation revision procedure will include releasing this muscle a bit more. If the breast is still “falling off” the implant, then plastic surgeons sometimes decide to perform a breast lift. If the breast is tuberous and the lower pole is tight, then radial cuts along the lower breast pole during breast revision can potentially improve this situation. If a contracture is causing the double bubble, then a capsule excision may help.

Of course, variations of all these breast augmentation revision techniques may be necessary to help you achieve the desired size, shape, and natural-looking results.

Lateralization of the Implants

When the pocket becomes too large either from over-dissection or over time with tissue expansion, the initial breast implants can fall off to the sides when the person 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).

All your breast augmentation revision procedures are performed under general anesthesia. During your consultation, NYC breast surgery Dr. Wallach will discuss the best options with you to help you get the breast enhancement you desire.

Symmastia

This is essentially the opposite of lateralization of the implants. This is when the inside portions of the breast pocket were either over-dissected during surgery or due to stretching over time. In this case, 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 a breast revision plastic surgery procedure that creates a submuscular pocket, or by 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 after breast augmentation is often a sign of rippling. This is a result of the skin being too thin to cover the implant most often due to the patient being very thin or having undergone many previous breast enhancement surgeries. The goal of the revision breast surgery 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. In the case of a saline implant, sometimes over-filling the implant will remove the ridging of the implant and therefore improve the rippling.

Usually the goal of the revision breast surgery 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.

Schedule a Breast Revision Consultation

If you would like more information about New York City plastic surgeon Dr. Wallach and his success with New York City breast revision procedures, we hope that you will not hesitate to contact our Manhattan offices at (212) 257-3263 or by using our contact form to request additional details. Whether your problem is medical or simply cosmetic, we’re here to help you get the care you need with a highly personalized breast revision surgery that gives you the naturally beautiful results you wanted in the first place.

Revision Breast Surgery Frequently Asked Questions

 

Can breast implants be reduced in size?

Yes implants can be reduced in size

Can breast implants last a lifetime?

Yes they can but most need to be replaced at least once in a lifetime.

Can breast implants be removed and not replaced?

Yes implants can be removed without replacing them

Can capsular contracture get worse?

Yes a capsular contracture can get worse

Can breast implants change shape over time?

Yes, breast implants can change in shape over time.

Can capsular contracture go away by itself?

A capsular contracture will not go away on its own.

Can breast implants last 30 years?

Yes breast implants can last 30 years

Can I have my breast implants removed?

Yes you can have breast implants removed.

Can you feel a ruptured breast implant?

Yes you can often feel a ruptured implant

How long do breast lifts last?

Breast lift results will depend upon the quality of the tissues and the patients overall genetics.

Does insurance cover breast revision?

Insurance does not cover breast revision surgery.

How long does it take to recover from breast revision surgery?

Often patients can go back to light duty within a few days of surgery.

Does insurance pay for breast implant revision?

Insurance does not cover breast revision surgery.

How much is a breast implant revision?

The fee will depend upon the extent of the revision surgery.

How do you fix capsular contracture?

Usually one has to exchange to a new implant and remove the capsule. Sometimes the pocket for the implant needs to be changed.

How often should breast implants be replaced?

Implants should only be replaced if there is a problem.

How soon after breast augmentation can I get a revision?

Depending upon what needs to be done, I will often tell patients to wait at least 6 months for a revision.

What is breast revision surgery?

Breast revision can be as simple as a scar revision, to more complex procedures as correcting an implant displacement, removing a capsule and/or performing a breast lift.

Is it dangerous to have breast implants removed?

No it is not dangerous to remove breast implants.

What is the most common breast implant size?

In my practice the average range is somewhere between 300-450 cc implants.

Is there an alternative to breast implants?

One alternative to breast implants is fat grafting.

Will NHS remove my breast implants?

What are the early signs of capsular contracture?

Early signs of capsular contracture include tightness, implant shape change, hardness, and pain.

I have rippling of my implants. What causes this?

Rippling is usually caused by the ability to see the natural folds of the breast implant through soft tissue coverage. It is more common in thin patients with thin soft tissue coverage over the implants. Therefore, rippling occurs more when implants are placed in a subglandular pocket than a submuscular pocket. Because a submuscular implant is not completely submuscular, most implants are palpable along the lower pole along the inframammary fold. Since rippling happens when the soft tissue envelope is thin, there are several potential solutions to the problem. If the implants are in a subglandular pocket, changing the pocket position under the muscle will usually cover them better. If the rippling is in the lower pole and the implants are in a submuscular pocket, then sometimes an acellular dermal matrix (ADM) like Strattice may add more coverage to eliminate the rippling. Some surgeons will also perform fat injection into the soft tissue over the implant to thicken the coverage. Additionally, if the implants used are saline filled, sometimes overfilling them may improve the rippling as well.

My breast implants cause pain. Does this mean I have a capsular contracture?

There are many different reasons why patients can have breast pain, and a capsular contracture is just one of the causes. If the cause is due to a capsular contracture, then performing a capsulectomy with implant exchange should improve the pain associated with the tight capsule.

What is a capsular contracture?

The body forms a natural barrier around any type of implant placed in the body. Commonly, this is a soft layer that surrounds the implant and allows the implant to move around easily in the pocket. When the implant pocket becomes tight due to the capsule constricting, the implant can appear tight in the pocket or lose its more natural appearance. Sometimes pain is associated with the capsular contracture. One popular theory of capsular contracture is related to biofilms, which may lead to a subclinical infection and inflammation causing the contracture to develop.

How does one treat a capsular contracture?

There are several techniques to treat a capsular contracture but general principles include performing a capsulectomy, which is a removal of the capsule, and exchanging the implants. Studies suggest that adding an acellular dermal matrix (ADM) like Strattice may reduce a capsular contracture recurrence.

Should my implants be placed above or below the muscle?

The two most common breast implant pocket positions are either submuscular or subglandular. There is a third pocket position that is considered subfascial. The subglandular pocket placement is a reasonable approach for women with a lot of soft tissue coverage over the implant. The advantage to subglandular placement is often less painful than a submuscular pocket placement. It also avoids animation deformities with pectoralis muscle flexion. However, studies suggest a higher risk of capsular contracture, symmastia, and rippling in this position. The advantage of a submuscular pocket is it provides more soft tissue coverage over the implants, less risk of rippling in the upper pole, and a lower rate of capsular contracture. Still, there is often more discomfort after surgery, and there is a higher risk of animation deformities with pectoralis muscle flexion. Both approaches have similar rates of implant palpability in the lower pole. A subfascial method, in my opinion, does not add any more soft tissue coverage than a subglandular approach, and has similar advantages and disadvantages as the subglandular approach.

What happens if I just remove my implants?

Removing breast implants or explantation results vary. If the patient does not have any significant capsule, then removing the implants is straightforward. If there is a tight painful capsule, often the capsule is removed as well. The breast will respond to the implant removal differently in different patients. This depends upon the ratio of natural breast tissue volume to implant, the quality of the soft tissue, and the extent of the surgery. In other words, the final shape is difficult to predict.

What happens if I want smaller implants because my implants are too big?

An implant exchange can be performed to reduce the overall size of the implants. However, the new implant size will affect what may need to be done to the breast gland or skin envelope. For patients with good quality skin and smaller volume changes, an implant exchange may be all that is necessary. For larger differences in volume, a mastopexy may have to be performed. This can be as little as a circumareola lift, which uses an incision around the border of the areola. If the smaller implant results in significantly looser tissues, then the mastopexy technique required may need to be more extensive. This might require using a lollipop incision or even an inverted T incision to adjust for the larger volume differences.

I am unhappy with the implants that were placed and I want bigger ones. When can I get a revision?

Exchanging implants for larger ones usually can be done about four months after the original surgery. It is best to wait for the swelling to dissipate and for the healing to be completed. Whether or not the patient’s anatomy can tolerate a larger implant needs to be evaluated in person during exam.

I have a double bubble. What causes this?

A double bubble is a breast deformity that occurs for several reasons. The first is when the implant drops below the natural inframammary fold or a lower breast crease. This can occur if the pocket was over dissected or by a natural progression of the implant descending into the pocket through a weak inframammary fold. Another cause may be due to placing too large of an implant for the natural breast diameter. In this case, the breast did not expand over the implant and sat on top of it like “the yolk sitting on top of the white of an egg”.

I have a double bubble. How does this get fixed?

A double bubble is exactly as the term states.The implant creates a ridge-like a bubble and the natural breast fold creates the second bubble or ridge. Correcting a double bubble usually requires fixing the implant pocket. If the implant descended below the breast fold, then recreating the breast fold with sutures (performing a capsulorrhaphy) may be sufficient. Some surgeons will add an acellular dermal matrix (ADM) such as Strattice to reinforce the repaired fold. If the implant was too big for the breast diameter, then either the breast gland needs to be scored to allow it to expand around the implant, or a smaller implant needs to be placed.

I think I have bottoming out of my implants. How does one get this fixed?

Bottoming out of an implant is similar to a double bubble in that the implant pocket has gotten larger and the implant has descended below the natural breast fold. If the gland has expanded over the descended implant, then one might not see a double bubble. To correct this problem, a capsulorrhaphy needs to be performed. The lower breast fold needs to be resuspended with sutures. Sometimes an acellular dermal matrix (ADM) like Strattice is used to reinforce the repair. Often a smaller implant is placed because the pocket itself is made smaller.

My implant seems to move into my armpit. What do I do?

An implant that moves into an armpit suggests that the pocket is too large for the implants. A capsulorrhaphy can be performed to repair the pocket and treat the malpositioned implant. This is typically performed with sutures and sometimes an acellular dermal matrix (ADM) like Strattice is used to reinforce the repair.

My implant shape looks funny. How is it fixed?

Unusual breast implant shapes can occur for several reasons. First, a patient can have a capsular contracture, which can distort the shape of the implant. Furthermore, the pectoralis muscle that is released during a submuscular pocket creation can cause the implant shape to change with flexion. Another cause for an odd shaped implant can be due to an implant rupture.

What is symmastia? And why does this happen?

Symmastia occurs when the sternal chest skin lifts up after breast augmentation and allows the implants to potentially move from one side of the chest to the other. This is more common when the implants are placed in a subglandular pocket and when the surgeon tries to produce more cleavage, resulting in an implant malposition.

I think my implant is moving toward the center of my chest and causing a symmastia. How can this be fixed?

Repairing a symmastia is like treating other forms of implant malposition. Commonly, a capsulorrhaphy has to be performed requiring suturing along the medial or sternal pocket. Some surgeons will add an acellular dermal matrix (ADM) such as Strattice to reinforce the repair. If the implants are subglandular, then changing to a submuscular pocket may be worthwhile.

 

External References:

Steven Wallach MD

Steven Wallach MD

Dr. Wallach is a board-certified plastic surgeon in New York City who specializes in performing cosmetic procedures of the face, breast and body. As one of the cutting edge experts in the field, Dr. Wallach consults on a regular basis with people in the beauty, media, and publishing worlds.

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