Breast enlargement surgery revisions
Some women are poorly advised and have poor results from their breast enlargement. Getting it right first time requires the right surgeon, with the right expertise, spending time with the patient to assess and truly analyse the breast dimensions and tissue characteristics. Only after detailed assessment can a patient be advised on the best breast implant surgery techniques. If this is not done, or the surgery is carried out with out the best results from breast augmentation it can leave women with a poor result that is harder to correct.
The sagging breast
One of the commonest errors I see, is where patients with excessive breast sag are augmented without adequate consideration for the outcome. All too frequently patients get a sag of the new implant into the stretchy skin envelope. Although all women whose breasts have been bigger and then atrophied (deflated) and dropped after child birth are at some risk for excessive implant settling after breast augmentation, what I am referring to here, is where the sag is really excessive for a good result from implants alone. The breast assessment when conducted properly will look at the nipple position on the breast mound and in relation to the crease under the breast. A skin stretch test should be performed and tissue atrophy measured with tissue callipers. With over 14-years of experience in carrying out these assessments and performing this type of surgery, it has become very automatic in my practice and I have excellent judgement as to what works and work doesn’t!
Example of a Bad Outcome from prior Surgery
This patient recently came to see me and has given me permission to discuss her case and show her images. She had all of her previous surgery, which she explained had produced a bad outcome each time, at a well known national centre. Her first operation was with tear drop breast implants (style 410). Her high cohesive silicone implants were placed sub glandular (over the muscle). She had breast sag and the implants did not give her the result she expected. She quickly developed problems with the implants flipping and rotating but the revision they charged her for was for a breast lift. This was an anchor shape scar mastopexy (also know as the wise pattern mastopexy), but it was not done well either. She developed poor scars straightaway and the nipples were too high. Her implants had been changed to a high profile CUI implants in sub-pectoral (under the muscle) pockets. She was unhappy with he result and found the left implant to have dropped a bit lower given what we term a bottoming out appearance. This is where there is excess implant in the lower half of the breast below the level of the nipple and it leaves the nipple looking abnormally high on the breast, the upper breast looking relatively empty and can leave a constant ache in the breast. She had too much residual asymmetry between the two sides as well and disliked the way she looked and naturally this affected her confidence. She came to see me after she had put up with this unsatisfactory outcome for seven years. Now this is a difficult starting point to revise in anyone and the degree of additional surgery and the complexity is greater than with either of the original operations alone. I had discussed the option of doing staged surgery with her, which would include taking the implants out at stage-one and re-doing her mastopexy. This would have been a great way to more safely re-shape her breasts after the previous poor breast enlargement and revision result. I like the approach of staged surgery in this scenario as it reduces the risk to patients and safety is always my highest priority. However, she was able to accept some compromises, and because of her unique situation and difficult starting point she was prepared not to try to resolve everything with the revision, partly because of the additional expense. This decision is also normally always affected by cost as staged surgery is very expensive and understandably not everyone can afford to put things right. What I had to do in this situation was to careful manage expectations and take account of what her priorities were to improve her outcome. We met several times to accomplish this and I spent around an hour at each consultation and gave detailed advice and shared my knowledge and experience in carrying out this type of surgery to guide her. I find it very important to make this time commitment to my patients to adequately plan and inform them. I often use 3D surface imaging to capture a 3D image of their breasts, which helps with the analysis and discussion.
The Revision with BLite Lighter Weight Breast Implants
After taking account of what had been done incorrectly previously and the adverse outcome from the poor choices made we felt that a repair to her lower pole infra-mammary fold was required to reinforce the crease under the breast after restoring it to its correct position. The surgical technique for this is called an inferior (meaning at the lower edge of the breast) capsulorrhaphy. This is where the scar tissue and adjacent fascia in the lower breast is used to create a better layer of tissue to form a stronger scaffold to support the implant and define the lower breast in the correct place. I have used ADM (Acellular dermal matrix) for this before but it was not necessary not this occasion and would have added over £1000 to the cost. I carried out this inferior capsulorrhaphy on both sides as she had bottoming out to both breasts. The choice of implants to replace her old round CUI ones was equally important. She wanted her breasts to be fuller and firmer and a better shape and wanted larger implants. I was able to accomplish this using the premium BLite silicone breast implants. This is a super product that I use quite frequently for primary and revision breast implant surgery. The BLite implants are 30% lighter than conventional silicone implants. That means patients can feel more comfortable avoiding the extra weight that a larger implant would otherwise add to their breasts. 30% is actually a huge amount of weight to save and patients only need to hold a 500cc silicone implant in one hand that weighs 500gms and a 500cc Blite implant in the other hand that weighs 350gms to be amazed at the difference. So with my patient I was able to use a much larger BLite implant to reshape her breast and restore a proper balance between the upper and lower pole, with the nipple now being correctly and symmetrical placed on the breast mound. I was also able to balance her breast shape to her body, giving nice proportions that a really improved result. The outcome was a very straightforward recovery and a very happy patient. I have seen her since for follow-up several months later and the results have remained completely stable. She loves the shape of her breasts again and the BLite implants remain very comfortable and feel part of her.
What to do if you need breast implants
My advise is to see the best people. Choose a surgeon who is dedicated as a specialist in the area of surgery you are seeking. Do not go for surgery in places where you are not seeing the specialist at each appointment. Choose a hospital that is rated Outstanding by the Care Quality Commission who undertake independent reviews of all private hospitals and clinics in the UK. I see people form all over the UK, but I can’t see everyone so please do your home work before you commit to any surgery. I do offer second opinions and run clinics on Saturdays for one hour detailed assessments whether this is for your first breast enlargement surgery, an exchange, or for other cosmetic breast surgery whether primary or a revision. Contact me here.