Types of Breast Revision

• Anatomical Implants

  Anatomical implants are thicker or fuller at the bottom of the breast, and thinner or more tapered at the top of the breast. These implants can be helpful for some patients with excessive prominence or fullness in the upper pole of the breasts, resulting in a more natural appearance. Whereas anatomical saline implants have long been available in the U.S., anatomical silicone implants are now also available.

• Bottoming Out

  Bottoming out refers to stretching of the skin and tissues in the lower part of the breasts. The breast implants settle too low as a consequence, creating an unnatural appearance with the nipples and areolas seemingly too high, and a loss of upper breast fullness. Correction may require removing stretched skin as part of a breast lift, or tightening the lower breast tissues (capsulorrhaphy).

• Capsular Contracture

  Capsular contracture refers to excessive thickening and tightening of the tissue capsule that normally forms around all implants. This can make the breasts feel hard or look too round and unnatural. Capsular contracture can also cause implants to shift position, creating deformities and asymmetries, and can occasionally be painful. Surgery for capsular contracture involves a capsulectomy (removal of the thickened, hard tissue), sometimes with replacement of the implant and other measures designed to decrease the likelihood of a recurrent contracture.

• Double Bubble Deformity

  Double bubble deformity can occur for different reasons. Sometimes, the breast tissues sag and hang from the front of the implant, resulting in an upper bulge from the implant and a lower bulge from the hanging breast tissue. Treatment may involve repositioning the implant, combined with a breast lift to address the sagging tissues. In other patients, especially those who begin with a short distance from the areola to the fold beneath the breast, the original fold or crease persists and causes an indentation in the lower breast above the new, surgically lowered fold. Treatment may involve raising the inframammary fold once again with a capsulorrhaphy, possibly converting to slightly smaller implants and placing the implants above the pectoral muscle.

• Positioning: Implants

  Implants may be improperly positioned during the original surgery, or may move over time. This may result in one implant being higher than the other, or possibly in an excessively wide distance between the breasts (wide intermammary distance), with poor cleavage. Correction may require modifying the pectoralis muscle or breast implant capsule.

• Ruptured Implant

  Breast implants are not expected to last forever, and some will eventually leak or rupture. It is best to perform the revision breast augmentation surgery soon after the rupture, before the breast tissues shrink and tighten. For ruptured silicone implants, it may also be necessary to remove silicone gel or perform a capsulectomy to remove scar tissue around the implant. Often, the breast implant replacement procedure is less painful than the initial surgery, with a more rapid recovery.

• Size Change

  Some patients are dissatisfied with their implant size from the outset, while others are initially happy but later become dissatisfied as their skin stretches and breast tissues become thinner, making the breasts look too small or empty. An implant size exchange is often a very straightforward procedure. At times, a mastopexy may also be helpful to tighten loose skin and breast tissues as well. Dr. Taleisnik spends considerable time reviewing sizing with patients, and generally confirms the optimal implant size during surgery with trial sizer implants, resulting in an exceptionally low reoperation rate for size change of about 1-2%.

• Symmastia

  Symmastia occurs when the “pockets” or spaces for the right and left breast implants connect or lack sufficient separation and definition. Some patients refer to this problem as a “uniboob.” It is important to take measures to avoid this complication during the initial surgery. Treatment for symmastia often involves a capsulorrhaphy, or reinforcement of the tissues between the breasts to separate them.