medicard patient financing

Breast Augmentation Revision

Dr. Michael J. Weinberg
B.Sc., M.Sc., M.D., F.R.C.S.C.


What Are the Reasons for Undergoing Repeat Breast Implant Surgery?

While the goal of breast augmentation is to achieve the desired breast enhancement with one procedure, a certain percentage of patients eventually wind up undergoing a second surgery. At my plastic surgery practice in Toronto, most of the revision surgeries are performed many years after the first. There are several reasons women undergo revision surgery, with the most common being:

• Development of a capsular contracture
Capsular contracture is the most common reason for revision surgery. It is the development of thickened scar tissue around a breast implant and can lead to discomfort and a stiff, less natural feel to the implant.

• Deflation of an implant
Deflation of an implant, which occurs because of rupture or leakage, is most obvious with saline implants because the implant shrinks rapidly – in just a few hours. In the case of silicone gel implants, MRI imaging might be required to detect a rupture.

• Development of sagging and elongation of the breast with time, often in association with placement of large implants
Sagging and elongation of the breast happens as part of aging. It’s exacerbated in individuals who have experienced significant weight fluctuations and in smokers. However, a primary contributing factor is the initial placement of overly large breast implants at the time of the first surgery. Large implants, over time, can cause thinning and laxity of the overlying skin, increasing the implant’s visibility and rippling. That’s why decisions about implant size are so important before the initial surgery. I tend to make more conservative recommendations with respect to size of implant in the first place. In the United States, FDA statistics suggest a full 37% of breast implant revisions are due to an initial large implant size.

Other reasons for breast implant revision surgery include patient dissatisfaction with implant size, i.e., some patients want larger or smaller implants. Other patients choose repeat surgery because of complications that produce an undesirable appearance. These include implants riding too high or too low, asymmetry, “double bubble,” or a “Snoopy” appearance to the breasts.

Choices When Planning Breast Revision Surgery
Regardless of the reason for undergoing a revision of breast augmentation in Toronto or elsewhere, a detailed consultation with your surgeon is the first step. This gives you the opportunity to discuss at length the reasons for the revision. It is important to tell your surgeon why you’re dissatisfied with the previous results and discuss what you wish to achieve with the second surgery. That includes the shape and size you’d like your breasts to be. After a physical examination, during which your surgeon will evaluate the previous implants, carry out measurements of your chest wall, and assess your skin quality, he or she will make recommendations as to how best to proceed.

Often, to achieve an improved result the second time around, it is advisable to opt for a different “pocket” for the implants in a revision surgery. This means that if you previously had placement of implants above the muscle, it may be recommended for you to go below the muscle in the second procedure, and vice versa.

It is also generally true that many surgeons prefer an inframammary approach. That involves an incision below the breast, in the crease, for revision surgery. This is because other approaches, such as periareolar, or through the axilla, will not give the surgeon sufficient visualization of the previous implant and the tissues.

There may also be specific considerations in revision surgery that could prompt your surgeon’s preference for a particular implant. For example, smooth implants are presently the most popular choice for first-time breast augmentations. However, in a woman who developed capsular contractures, the choice of a textured implant might be appropriate for the revision procedure. That’s especially true if one is going above the muscle. There is literature to suggest that textured implants in this location are less likely to be associated with contracture.

As mentioned, some women consider a second breast augmentation surgery because they are not happy with the size of their breasts after the initial procedure. Some women request placement of larger implants. This may be an option, but it is not always possible. The maximum size of implants for a given individual is limited by that person’s chest dimensions. If a larger implant size is not feasible, another option may be to replace the implants with ones of a higher “profile.” The projection from the chest wall is greater, giving the impression of a larger breast size, even though the overall breast volume remains the same.

It is also important to recognize that, the second time around, it may be necessary to undergo a breast lift. This is especially true in women who have developed drooping, pendulous breasts after undergoing previous placement of large implants. Even when drooping is not extreme, a lift may be necessary for women who want significantly smaller implants for their revision. Sometimes, implants that have been placed subglandular (above the muscle) may not sit high on the chest wall. A breast lift may be necessary to give the elevated appearance a patient is wanting.

For any breast surgery, it is important, of course, to choose a surgeon who has specific expertise. That’s doubly true for the unique challenges and increased complexity posed by breast augmentation revision surgery. As a plastic surgeon in Toronto with a lot of experience performing breast augmentation revision surgery, I like to have an extensive discussion with my patients, and lay out all of their options. The good news about revision surgery is that, as decades go by, newer, better implants and techniques are being developed, which will hopefully mean more options and improved outcomes as time goes by.