Breast Implant Revision Surgery
What is Appropriate for You?

Michael C. Edwards, MD, FACS

Double-Bubble Deformity

This complication can occur when an attempt is made to lower the infra-mammary fold with a breast augmentation. The look is that the implant is there and the patient?s breast is almost stacked on top of it. This can also be seen when an implant is placed under the muscle in a patient who should have a breast lift as well. Treatment depends on the cause. It may involve releasing the muscle inside (referred to as a dual plane technique), moving the implant from below to above the muscle or performing a breast lift to tighten and elevate the breast over the implant.

After breast augmentation by another provider, this patient was unhappy with the shape of her left breast. Repair involved releasing the muscle internally.

Coverage problems (rippling)

If the breast tissue covering the implant is too thin you can see rippling of the implant through the skin. In the upper breast this is referred to as traction ripples. It can be seen in the well-performed surgery when the patient is a thin woman with little coverage.

This patient was unhappy with the visibility of the implant ripples.

This may be a very difficult cosmetic problem to correct. Some hope exists with pending approval of the more cohesive or firm silicone implants which effectively do not ripple. Other thought are to use a sheet of dermis (Alloderm or Strattice) to line the pocket and provide more tissue thickness. This is a costly option but may be the best alternative. A small handful of plastic surgeons are using fat grafting to try to cover this but this is not yet mainstream and the effects of this grafting on future mammograms needs to be addressed.

Complex Revisions

These cases are considered complex because they require a multi-dimensional approach. Many times this approach is taken when a patient wants to change the size of their implant and they are unhappy with the coverage of their implant. In this first patient she desired to be smaller and wanted to try to decrease the visibility of the implant ripples through her this tissue. The surgical plan involved removing the existing implant, repairing the capsule to make it tighter, changing to a partially sub-muscular position (site change) and tightening the breast tissue with a mastopexy.

This patient had firm capsular contracture and wanted not only to soften the feel of her breast but to improve the shape. The same approach was used as with the above patient except a slightly larger implant was used.

This brief discussion is meant to educate you about the options available to patients who have had breast surgery and want to investigate a possible change. Dr. Edwards enjoys seeing patients, going over their concerns and proposing and carrying out a plan to help you achieve the goal you desire. To schedule a consultation, please call Dr. Edwards? office at 702-248-8989 or e mail Dr. Edwards at info@medwardsmd.com.