Complex Secondary Breast Revision
Before + After Photo Gallery
This 38 year old woman had breast implants in place for approximately 15 years. She presents with firm, spherically-deformed breasts with a high-riding appearance. The nipple and areolar complex is hanging over the breast implant creating what is known as the “waterfall deformity.” The corrective surgery consisted of removal of her implants, capsulectomy to release scar tissue contracture, creation of a virgin subpectoral pocket for insertion of new implants, bilateral mastopexy (breast uplift) and insertion of a new pair of Moderate Profile Plus 325 cc smooth, round silicone gel filled breast implants. Her postoperative result, with excellent correction of the deformities, is shown one year after the corrective surgery.
Here is an example of a complex secondary breast revision. Patient had previous implants and uplift, had asymmetry, unsatisfactory breast contour. Dr. Handel performed implant removal and replacement and secondary mastopexy. She has dramatic improvement!
COMPLEX SECONDARY BREAST REVISION SURGERY
Breast augmentation or breast enlargement is one of the most popular cosmetic surgical procedures currently performed in the United States. It is estimated that about 300,000 American women undergo elective breast augmentation each year. We know that the overwhelming majority of patients who have breast augmentation have good results and are satisfied with their outcome. At the same time, it is acknowledged that there is a significant rate of complications and suboptimal outcomes following breast implant surgery, and substantial numbers of patients end up undergoing revisionary or corrective surgical procedures. Perhaps, the most common cause for secondary or revision breast surgery in patients who have had implants is capsular contracture. This refers to a condition in which the scar tissue membrane, which always forms around the breast implant, becomes thickened and contracts, creating an abnormally firm, spherically deformed breast. In most advanced cases, the breast can actually be painful and tender to the touch. There is effective surgical treatment for capsular contracture, and there are new techniques and new devices which appear to reduce the risk of recurrent capsular contracture. The treatment of capsular contracture is an area of great interest to Dr. Handel as he has performed clinical research on this subject and published numerous papers in medical journals about the treatment of capsular contracture. Other complications that can occur after breast implant surgery are conditions such as implant malposition, implants can be displaced superiorly, inferiorly, laterally or medially. When breast implants are malpositioned, there are a variety of different surgical techniques that can be employed to correct the problem. Other problems that occur after breast implant surgery include waviness and rippling of the breast which is usually most evident in patients who have a thin layer of tissue to camouflage the implant. There are innumerable techniques to reduce waviness and rippling, including new “form stable” highly cohesive silicone gel breast implants which have less propensity to cause waviness and rippling. In addition, there are products known as ADMs (acellular dermal matrix) which are sheets of collagen, either from animals or from human cadaver donors that can be used to reinforce thin tissues. Additionally, in recent years, autologous fat grafting or fat transfer has played an increasingly important role in helping to reduce waviness and rippling in patients. Certain patients have a problem known as “animation deformity” in which there is undesirable movement of the breast. This typically follows subpectoral or submuscular placement of the implant, and patients are bothered because of the excessive mobility of the breast every time they move their arms. Fortunately, there are new surgical techniques (such as the “dual plane” approach) that can lessen the symptoms of excessive animation of the breast. Frequently, patients who have problems as a result of prior breast implant surgery have multiple conditions that require attention. For example, a patient may have capsular contracture plus waviness and rippling, a patient may have contracture plus implant malposition, or may have undesirable breast scarring in conjunction with other suboptimal outcomes. Dr. Handel has extensive experience in correcting these complex secondary breast conditions. A large focus of his practice during the past 38 years has been to provide the best possible care to patients who have complications and suboptimal outcomes resulting from prior breast implant surgery. Dr. Handel recently co-edited a textbook on repair of deformities following previous breast surgery which is now a standard reference for plastic surgeons throughout the United States and around the world. Dr. Handel will exercise his best judgement in his years of clinical experience to design an approach that is custom tailored to meet each particular patient’s needs. Complex Secondary Breast Revision surgery in Beverly Hills, California by world-renowned plastic surgeon, Dr. Neal Handel.