Breast Implant Revision
Dr. Brooke R. Seckel
Most bad breast implant problems involve abnormal position of the implant, abnormal shape of the breast after augmentation, or visible depressions or irregularities on the breast. Breast implant problems that often can be successfully revised are discussed below.
Often when a patient requests a breast augmentation with an implant that is too large for their body the surgeon attempts to make room for the implant by dissecting a larger pocket into which the implant will be placed. If this dissection interrupts the inframammary fold, that is the fold beneath your breast, in time the implant can move downward and more breast volume is seen below the nipple than above the nipple. This appearance is called implant bottoming out. In some cases of bottoming out the inframammary fold or crease is visible above the bottom of the implant and creates a condition called double bubble breast implant deformity. These types of deformity can be corrected by removing the implant and suturing the implant pocket closed at the bottom of the pocket. This will raise the implant to a proper position.
If you have a sagging breast or breast ptosis and your surgeon recommends a breast lift in addition to breast implants you should heed the surgeon’s advice. If an implant is placed beneath a sagging breast in which the nipple is below the fold under the breast, the implant will not be able to fall into the sagging portion of the breast under the nipple. The result on the side view shows a mound created by the implant with the sagging breast and nipple hanging off of the breast mound. From the side this looks like the face and head of the cartoon character Snoopy. The only way to correct the Snoopy deformity is to do a breast lift.
Symmastia or uniboob occurs when the implants are too close together and appear to be connected. Usually this means that the connection of the skin between the breasts to the chest bone is not tight enough or has been violated. Symmastia is very difficult to correct and requires removal of the breast implants and an attempt to attach the cleavage skin back down to the sternum or breast plate. Implants may then be reinserted but reattachment of the skin is not always successful. Symmastia most often occurs when the patient focuses on and demands that the surgeon place her breast implants close together to promote cleavage.
Visible depressions on the breast after breast augmentation occur most commonly in patients who have sub muscular breast augmentation. An opening is always made at the bottom of the chest muscle during sub muscular breast augmentation. In time the force of muscle contraction can push the implant into and partially through the muscle incision which can cause a visible depression on the skin surface. Fortunately new fat injection techniques can be used to successfully conceal these depressions.
Visible ripples are almost impossible to avoid when using saline implants. Ripples occur in very thin women with very little breast tissue to cover the implant. Converting a breast augmentation to a sub muscular location can help conceal rippling.
Capsular contraction of a breast implant is scar tissue which causes the breast to feel hard and can occur 2.5-8.3% of cases. A severe capsular contraction requires removal of the implant and removal of the capsular tissue scar surrounding the implant. Best results are achieved by replacing the implant wrapped with a layer of dermal graft called Alloderm® or Flex–HD®. Fat grafting can reduce capsular contracture. We use a no touch technique which has reduced our capsular contraction rate to less than 1%.
If you previously had breast augmentation surgery and have experienced complications, or are unhappy with the results, Dr. Brooke R. Seckel and the professionals at Boston Plastic Surgery Specialists can help. Contact the practice today to learn more, or to schedule a consultation.
