Breast revision surgery can sometimes be requested for a variety of reasons. Even after proper planning and execution of breast surgery, limitations based on healing, the patient’s pre-operative anatomy, or changes over time can occur leading to the consideration of revisionary surgery. These changes can be implant-related or from natural changes in the breast tissue such as during childbirth and breast-feeding. The most common reasons for seeking revisionary breast surgery are implant deflation, a desire to change implant (size or type or position), or capsular contracture. A common example of this is a previous breast augmentation patient who had breast augmentation performed 10 years prior, and whose breasts have undergone changes due to pregnancy and childbirth. These cases need highly individualized evaluation.
Good candidates for this procedure:
Patients with differences in nipple position between the two sides
Patients that would like to change their implant size either bigger or smaller
Patients that would like to change their implant from saline to silicone
Patients with implants that have migrated over time -- dropped or risen over time
- Patients with capsular contracture
Patients who are unhappy with another facility’s breast augmentation results
What to expect: Consultation
All cosmetic consultations are complimentary and serve as a great opportunity to gain further insight by voicing your concerns and having questions answered. During the initial consultation, Dr. Hsu will ask some questions to get to know you and determine if you are a good candidate for breast revision surgery.
During the consultation, Dr. Hsu will first ask about the area in question, and determine what specific goals you have for your breasts after surgery. He will then make some careful measurements of your breasts, using multiple measures in order to plan the surgery and individualize it for you. The measurements during the consultation before surgery are a key part of the surgical planning. He will also ask about your medical history, including existing medical conditions, past surgeries, tobacco usage, daily medications, supplements, and allergies. After giving a thorough examination, Dr. Hsu will voice his opinions about going forth with the procedure. In order to reach your aesthetic goal, both you and Dr. Hsu will work together to decide all the necessary details that will ultimately give you the best results.
On the day of surgery, come in early to fill out paperwork, meet the anesthesiologist, and the staff will prep you for surgery. Dr. Hsu will meet you in the pre-operative area before surgery to make markings on the areas planned for surgery and answer any last questions you may have.
Breast revision highly varies depending on each patient’s problem. The majority of revisions revolve around symmetry. In general, the most common reason for breast revision is when patients would like to improve their symmetry in terms of the position of the implant or the position of the nipples. Depending on which is the case, Dr. Hsu will make a small revision to the “pocket” where the implants were placed and improve the symmetry of the implant position. Often times, Dr. Hsu will perform a capsulectomy procedure to remove any thickened capsule that is surrounding the implant, which may be responsible for the implant malposition. At the end of surgery, Dr. Hsu uses a special skin closure technique that involves multiple layers of stitches (all dissolvable) to help achieve the thinnest, most inconspicuous scar.
Recovery & Post-operative Instructions:
After the surgery, Dr. Hsu will wrap dressings around the surgical area which will remain there for the first week during healing. You will also need to wear a surgical bra for about a week to aid the healing process. It is not recommended to lift elbows above your shoulders, but you can still use your arms for different things. During the recovery period, walking is encouraged to help quicken the healing process and minimize clots. Dr. Hsu will be available 24 hours afterward for any immediate concerns.
It is crucial to keep the surgical area dry until Dr. Hsu gives his approval to shower. To clean the rest of your body, you can bathe from the chest down. Swelling & bruising will peak about 48 hours after surgery but will then decrease significantly in the first two weeks. Most patients can return to work after two weeks, but many patients return even sooner. The biggest limitation for post-operative patients is driving, which should be avoided while taking pain medication. Patients usually stop taking pain medication after five to seven days and plan their work schedules accordingly. Six weeks is usually an appropriate time to return to most types of exercise and activity.
Dr. Hsu likes to follow patients after surgery for an extended period of time to make sure the patient is satisfied and healing well. Most follow up appointments are scheduled immediately after surgery and for up to a year afterward.
Dr. Hsu's view on Breast Revision.
Breast revision surgery is a highly individualized procedure, and it depends very much on exactly what needs to be revised. Often times, there may be a variety of reasons why a revisional procedure needs to be performed. In my experience, the most common reasons patients come see me for revisional surgery is for breast asymmetry after they have healed from prior surgery.
Revisional surgery is challenging and requires experience with these types of procedures. I’ve found that my experience taking care of challenging breast reconstruction cases comes in very handy in making decisions on how to best revise the results from a prior operation. This is particularly true when the original operation was performed elsewhere and the patient does not have all the information available about their prior operation. Small differences in choice of procedure and technique utilized can make a significant difference in aesthetic outcome.
The good news is that in many cases, prior breast surgery can be revised and changes can be made to improve the outcome. The cases are very individualized and the surgical plan needs to be carefully tailored on a patient-by-patient basis.