Breast Implant Revision

Common Problems & Complications Corrected by Breast Revision Surgery

Bottoming Out

Bottoming out describes breasts with implants that have either stretched out the skin below the nipple-areola or migrated below the inframammary fold. In both cases, the distance between the nipple areolar and inframammary fold is greater than it should be, implants. It can also occur when the pocket surrounding the implant has enlarged or stretched.

To correct the “bottoming out” of implants due to an enlarged pocket, Dr. Tauber and Dr. Yan use sutures to tighten up the breast pocket (aka capsulorrhaphy) that will support the implants in their new and proper position. In addition, a mesh internal surgical scaffold by Galaflex can be sutured into the pocket to reinforce the patient’s natural tissue envelope.

Breast Asymmetry

Implant Asymmetry results when one implant is placed higher or lower when compared to the other implant. Breast Asymmetry Correction is performed through implant exchange and repositioning the implants.

Implant Malposition

Revision surgery can correct a number of abnormalities that result from a previous augmentation surgery, including:

• Implants may remain too high and never drop into the correct position.
• Implants may remain too far apart as a result of placement.

Symmastia

Symmastia is commonly known as “uni-boob.” It is when one or both implants are positioned too close to the mid-line over the breastbone or sternum. Symmastia Repair may require surgical correction of the pockets as needed and a reduction of scar tissue.

Other problems are often caused by the implants used in an augmentation rupturing or changing over time.

Breast Implant Replacement (of deflated and/or ruptured silicone or saline implants)

A surgically implanted saline prosthesis that has lost its size and volume rather noticeably over the course of one or two days has likely ruptured or deflated. An implant exchange should be performed within a few weeks to keep the pocket from shrinking. Sometimes, the deflation of an implant is less noticeable – in these cases, either ultrasound or MRI testing will determine whether or not any leakage has occurred.

Double Bubble Deformity

There are two types of “double bubble” deformity, which can occur immediately following implant surgery, or over time due to weight loss, pregnancy, or natural gravity. The double bubble look occurs when there is a groove along with the breast below the nipple giving the impression that the breast is sitting on top of the implant.

The double bubble deformity can usually be corrected with a breast lift (mastopexy) or pocket correction. There are 4 indicators of the double bubble deformity:

• The breast implants were placed sub-muscularly and the natural breast tissue has sagged downward off the breast implant
• The natural breast has sagged or drooped downward while the breast implants are submammary
• The breast tissue or breast pocket is not sutured
• There is capsular contracture which is distorting the breast shape

Implant Rippling

Rippling occurs when there are irregularities of the implant surface that can be felt or seen through the skin. This could be a result of skin tissue covering the implants thinning, a saline implant leaking, the placement of the implant above the muscle, or a combination of any of these. To correct rippling, a possible solution is a Pocket Correction revision using a silicone implant, which is less palpable than saline. Removal of the breast implant from the pocket above the muscle to the pocket below the muscle could decrease the rippling effect.

Capsular Contracture

Capsular Contracture occurs when tightly woven collagen fibers form around the implant, thus the body forms a thick scar. This condition tightens or squeezes the breast implant, causing pain and discomfort. There are four grades of capsular contracture based on the baker scale:

• Grade I – The breast appears natural in size and shape and is normally soft
• Grade II – The breast looks normal but is a little firm
• Grade III – The breast appears abnormal and is firm
• Grade IV – The breast appears abnormal, is hard and painful to the touch

Depending on the severity, solutions for correcting Capsular Contracture include Capsulectomy and Capsulotomy revisions. A Capsulectomy involves the reduction of the capsule (scar tissue) that is surrounding the implant. Lower-grade Capsular Contracture can be corrected with Capsulotomy when the scar tissue or capsule is adjusted or partially reduced through incisions in the breast.

These procedures are just some of the options Dr. Tauber and Dr. Yan offer for breast revision. These different solutions can be combined to help work toward your desired breast look. During your consultation, Dr. DeLuca will address your specific aesthetic needs and recommend a surgical plan that is tailored to your goals.