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Revision Breast Surgery

Common reasons women undergo revision breast surgery include:

  • Implant replacement, exchange or removal.
  • Changing implant or breast size.
  • Re-lift breasts that have stretched.
  • Decrease of nipple or areola size.

Many women require revisionary breast procedures and as such this is a large part of my practice. Breast implants are not lifetime devices, yet the United States Food and Drug Administration does not specifically require replacement. Existing studies, however, indicate that 20-40% of breast augmentation patients and 40-70% of breast reconstruction patients undergo reoperation during the first 8-10 years after the placement of their implants. Many of these procedures are performed for non-implant related indications (i.e. needing a breast lift) but nevertheless create an opportunity for implant replacement.

Simple replacement is often combined with techniques designed to reposition the implant in a more ideal position. Implant malposition is common, especially after time has allowed the skin and surrounding tissue to stretch under the influence of gravity. This often results in implants that are too low, displaced into the armpits or on the side of the chest resulting in a loss of cleavage.

Capsular contracture can be an unfortunate byproduct of the body’s response to the implant. This causes a firm and tight breast(s) that can become quite uncomfortable and even painful. Correction requires removing the scar tissue from around the implant along with replacement of the implant if the patient desires.

Women who decide to not have their implants replaced may opt to also undergo breast re-shaping using various lift techniques to optimize the post-operative aesthetics. Breast implants not only augment existing breast tissue, but also stretch the breast tissue and skin over time. Once the implants are removed, the skin’s elasticity is rarely strong enough to return the breast to the pre-augmentation shape. As such, skin must be removed and the breast tissue re-contoured to optimize the post-operative appearance.

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Revision Breast Procedures

RESHAPE & REPOSITION

Patient preference and breast shape continue to evolve following surgery. As a result, nearly all patients will be interested in revision surgery at some point in their life to address breast size, shape or simply the age of their implants. It is important to know that you always have options. Beautiful breasts, according to you.

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What to Expect

All procedures are done in a balanced and natural esthetic.

Consultation

During the in-depth consultation, we will thoroughly review your goals and expectations. If your surgery was performed by another surgeon, please bring the operative report from any prior operations as well as the information on your current breast implants. This is extremely helpful in planning your successful implant exchange.

If you are electing to undergo implant removal without replacement, we will thoroughly review the anticipated post-operative appearance of the breasts. If indicated, we will discuss any re-shaping procedures that will enhance the aesthetics of the result.

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Surgery

Surgery is performed at an accredited surgery center in Newport Beach, California, USA and typically lasts 1-3 hours depending on the degree of shaping required to achieve your desired look. Under the care of a Board Certified Anesthesiologist, general anesthesia (fully asleep) is used to ensure maximal comfort and safety.

Use of the existing incisions is typically sufficient; however, may be modified depending on the extent of reshaping required.

Recovery

Patients are discharged home the same day and generally experience very minimal discomfort, often returning to light work within a week following surgery. Post-operatively, patients are advised to gradually resume their exercise regimen over a 4-week period in order to ensure proper healing. I ask that my patients wear a supportive bra without underwire for 6 weeks following surgery.

Results

The results are intended to be long lasting provided a healthy lifestyle is maintained. Skin gradually loses its innate elasticity as we age, which unavoidably compromises the robustness of the result in time. As such, patients may desire additional revisionary procedures to re-elevate and tighten the breasts.

Breast implants are not lifetime devices. As such, additional replacement/revision may be required in the future. It is a good idea to check in with your plastic surgeon at least every 10-12 years. The earlier the replacement is done, the easier the surgery and recovery.

FAQs

The risk of a recurrent capsular contracture is difficult to predict given the inciting factor for the first contracture is often hard to elucidate. Nevertheless, the best estimates in the literature point to a 20% risk of recurrence following revisionary surgery. Precise surgical technique that avoids bacterial contamination as well as post-operative administration of Leukotriene receptor antagonists are just a few of the strategies I use to further reduce the risk of recurrence.

I take implant choice very seriously as I believe that this is the key to a successful surgery. During your consultation we will spend time discussing your vision and how this can be achieved. I take several measurements of your breasts and chest during the consultation and we will discuss how these influence our implant choice. Finally, we will review pictures that are representative of the look you are trying to achieve. Using all of this information, we will decide on a range of implant shapes and sizes.

During your surgery, I have your pictures in the room and use them for reference as I try the different implant sizes we discussed until a match is determined. In this way, your wishes are my guide during surgery. Implant size and shape is a choice we make together. Some patients become fixated on achieving a specific bra cup size. I steer my patients away from this thinking because it is poorly standardized and has high inter-brand variability. A visual representation removes this ambiguity, allowing me to better understand what you want to achieve so that we can develop an accurate operative plan.

Typically, a couple of days off of work is sufficient. At three weeks you can begin light exercise., however I ask that you avoid any heaving lifting or stooping for 6 weeks. You may drive when you are no longer taking pain medication and you feel safe to do so.

During your consultation we will discuss your goals and expected result. The need for a lift is determined by your desired breast size, skin quality and the current position of your nipple with respect to your breast crease. For example, a breast with poor skin elasticity and a nipple that is below the crease typically require a lift at the same time as the augmentation.

Studies show that mammography is an effective means of screening for breast cancer in women who have breast implants. Special views are required so that the breast tissue can be completely imaged so it is important to make sure that your imaging center has experience with women who have breast implants.

The FDA recommends MRI screening for silicone implant integrity at 3 years and every other year thereafter. Studies show that the risk of silent rupture of silicone gel implants is approximately 15% at 12 years. This guideline is not meant to supersede the need for yearly mammography and breast examination as a part of formal breast cancer screening.

Maybe. If your implants are removed and not replaced, I typically use one drain per breast for a couple of days to assist with healing the area occupied by the implants. These drains require minimal maintenance and essentially no medical knowledge to care for post-operatively. This is often a concern expressed by patients; however, I can reassure you that this will be an easy and straightforward part of your recovery. Removal is simple, painless and done during your office visit.
Before & After

Stunning, natural results from patients.

Breast Augmentation

Breast Augmentation

Breast Revision Angle

Breast Revision

Breast Revision

breast reduction

Breast Reduction

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REVISION BREAST SURGERY

Receive an in-depth consultation where we will thoroughly review your goals to personalize a plan focused on a natural and aesthetic result. Dr. Donald S. Mowlds, MD is located in beautiful Newport Beach, CA but is also available via a virtual consultation for out-of-town patients.

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    Breast Procedures

    All procedures are done in a balanced and natural esthetic.

    Breast augmentation utilizes silicone or saline implants to enhance both breast volume and shape.

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    A breast lift, or mastopexy, involves repositioning the breast tissue and nipple on the chest wall, restoring a youthful appearance and feel.

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    Breast implants are not lifetime devices. As such, many women ultimately require revisionary breast procedures to replace their implants. Breast shape changes with time so revision breast surgery often includes additional procedures designed to create a natural, youthful breast.
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    Implant removal surgery involves removing existing breast implants and the surrounding scar tissue (capsule). The breasts are often re-shaped to optimize aesthetics.

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    During breast reduction surgery, breast tissue and skin are removed, contouring the breast into a smaller more aesthetically pleasing shape.

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    Restoration of form and function is one of the tenants of plastic surgery and breast reconstruction, specifically, epitomizes this mantra.

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