Breast Revisions

Sometimes patients do not follow the advice of their surgeon and initially opt for breast implants that are too large or too small for their frame. After some consideration following their initial breast augmentation procedure, they may decide that they would like to pursue revision breast augmentation surgery to change the size of their implants.

When this is the case, Dr. Katherine Hein can typically use the original incision for the removal and replacement of implants. If the patient desires larger implants, the breast augmentation surgeon enlarges the breast implant pocket during surgery to accommodate the new implants. If the patient desires smaller implants, she may surgically reduce the size of the implant pocket to ensure a proper fit, using internally placed sutures.

Saline implants offer certain advantages. For instance, they are filled with a sterile saltwater solution that the body can safely absorb in case of an implant leak. They are also more economical than silicone implants. However, saline implants are also more likely to cause visible rippling underneath the surface of the skin, especially in women with thin skin and little body fat that does not properly cover and support the implants. When this occurs, women with saline implants may choose to undergo revision breast surgery to replace their saline implants with silicone ones, which are less likely to produce visible rippling beneath the skin’s surface. The saline implants also seem to have a higher chance of breakage because of a weakness in the manufacturing process (the filling valve through which the saline is placed during the operation).

Women may choose to switch implant types for various other reasons, too. For example, they may desire silicone implants instead of saline ones simply because silicone implants look and feel more like natural breasts than their saline counterparts.

Over time, some women decide to remove their breast implants altogether. Some women feel that as they have aged the size and shape of their natural breasts suffices. In other cases, the skin has stretched out due to the weight of the breast implants over time, the effect of gravity and the natural aging process, and the patient wants to remove the implants and undergo breast lift surgery.

Dr. Hein can perform revision breast surgery to remove breast implants altogether, no matter what the reason behind the patient’s decision is. Often, the plastic surgeon can use the initial incision site to remove the breast implants, and may also remove the capsule, or the lining around the implant, at the same time, to facilitate the healing process.

Several factors can cause the nipple-areola complex to migrate down the front of the breast, causing nipples to point toward the ground instead of straight ahead. These can include major rapid weight loss, breastfeeding or simply the natural aging process.

When the nipples start to point southward, Dr. Hein can surgically raise them to a higher, more central location on the breast. Accomplishing this surgical goal typically requires additional incisions, which may range from a periareolar incision pattern (an incision extending around the outer circumference of the areola, the darkly pigmented skin surrounding the nipple) to the most extensive incision pattern, which involves a periareolar incision plus a vertical incision extending down the front of the breast plus a horizontal incision running underneath the natural breast fold. During consultation, Dr. Hein reviews the patient’s anatomical needs and aesthetic goals before recommending the appropriate incision pattern to satisfy her needs. In any case, Dr. Hein typically keeps the nipple attached to the underlying tissue when adjusting the nipple position, to help preserve nipple sensation.

One of the possible complications that can occur with breast augmentation surgery is capsular contracture, which is the hardening of scar tissue around the breast implant. This can be a potentially painful condition that causes the breasts to feel unnaturally hard.

To correct the condition, Dr. Hein will most likely use an incision beneath the breast to remove the implant and the hardened capsule. She will remove the entire capsule in most cases. She can replace the implants with new ones during the procedure. The patient at this point can choose either a larger implant or a smaller one, depending on their preference. The staff at Accurate Aesthetics will discuss this with the patient at length prior to the operation.

Symmastia is a condition in which the breasts look joined in the middle, where the cleavage should be. The condition can develop following breast enhancement surgery if:

• The breast implant pocket is too large.
• The breast implants have migrated out of their initial position.
• The fibrous tissue that creates the medial fold (the fold between the breasts) becomes stretched out or weakened.

Symmastia can be difficult to correct, but Dr. Hein can perform revision breast surgery to recreate the medial fold, thereby improving the positioning of the implants and restoring the natural space between the breasts.

“Bottoming out” is a term used to describe breast implants that have descended too low on the chest wall, in turn causing the nipple to appear too high on the breasts. When the implants have bottomed out soon after the initial breast augmentation surgery, the cause is most likely an over-dissection of the implant pocket. If the problem occurs after a significant amount of time has passed since the initial enhancement procedure, it is likely due to the heavy weight of the implant or an increase in skin laxity over time.

To correct implants that have bottomed out, Dr. Hein typically rolls up the scar tissue at the bottom of the implant pocket, stopping where the new, higher breast crease will be. If necessary, the plastic surgeon will place internal sutures in other areas of the implant pocket as well, to help secure the implant in the proper place. The excess skin will then be removed from beneath the breast to help correct the drop, give extra support to the breast, and achieve a longer-lasting result.

Women pursuing revision breast surgery should visit Accurate Aesthetics for a consultation, so Dr. Hein can review their cosmetic concerns and anatomical needs and establish candidacy.

Generally, suitable candidates for the revision procedure include those who:

• Are in good overall health
• Do not smoke or are prepared to quit smoking for several weeks before and after surgery
• Perhaps wish to change the size of their breast implants
• Perhaps wish to correct implant malposition (in which the breasts are positioned too wide or too close together) or breast asymmetry
• Perhaps would like to address issues that have developed with the breast implants and / or the surrounding breast tissue.
• Perhaps wish to correct changes in the appearance of breast implants due to pregnancy and / or breastfeeding, major weight fluctuations or the natural aging process
• Perhaps wish to remove breast implants altogether
• Have a positive self-image and reasonable expectations for what revision breast surgery can accomplish

Dr. Katherine Hein is among the top cosmetic surgeons in the Boston, Newton, Wellesley, and MetroWest area. Dr. Hein is certified by the American Board of Plastic and Reconstructive Surgery and has specialized in breast and cosmetic surgery since 1999. She has performed thousands of cosmetic and reconstructive surgeries.

When you select Accurate Aesthetics Plastic Surgery for your breast reduction procedure you can be reassured of a close personal relationship with Dr. Hein and her professional staff.

Additional Reasons to Select Accurate Aesthetics

• One-on-one consultation with Dr. Hein follow-up appointments after surgery, and availability by telephone for your questions.
• Availability of a fully certified operating room in-office for your comfort and privacy.
• The use of a board-certified MD anesthesiologist or certified nurse anesthetist on each case.