Advanced Art of Cosmetic Surgery     Thomas M. DeWire, Sr., MD, FACS    Specializing in Cosmetic Plastic Surgery     Richmond, Virginia, USA



       Advanced Art of Cosmetic Surgery:  Thomas M. DeWire, MD, FACS, Surgery Center and Spa,  3974 Springfield Road, Glen Allen, VA, 23260, Richmond, Virginia, USA

Breast Implant Procedures

Breast Augmentation Revision and Correction Surgery


Revision of Previous Breast Augmentation Surgery:  

In  some  instances, changes occur after breast  implant augmentation that  lead to  an unfavorable outcome. This may be due to factors like internal healing or stretch of support tissues, or stretch and later sag of the overlying skin.  In other instances, actions by the surgeon, or technique used, can be identified as the cause of  problems that occur.  This is especially true for deformities like symmastia, which is caused by active release of the medial pectoralis muscle origins, and some instances of early bottoming-out deformities, where release of the lower pectoralis muscles, coupled with over- release of the lower pole soft tissue leads to early downward implant migration to a position too low behind the nipple and breast tissue.  Even capsule contracture, which will be seen occasionally in the best of hands, has a relationship to the technique of the surgeon, and certain decisions, like placing the implants over versus under the muscle, or passing the implants through routes that may cause inflammatory contamination of the implant with germs or skin cells and debris.  The  best test of a  Plastic Surgeon's artistic and technical skills is demanded to identify, analyze, and then correct these problems, and thus improve,  or salvage, a complication situation or an unsatisfactory result.  Several such problems are identified below, followed by individual pages analyzing  each problem, the cause, preventative strategies, and  the surgical  remedy.  The best strategy of all it to accurately identify potential risk factors, or anatomical limitations, and to discuss them ahead of time, and then respect or avoid them at surgery.  One of the common causes of many of these problems is the placement of breast implants that simply too large for the given patient and  are thus outside of the anatomical and geometric  tolerance of the individual patient.  Such implant size limitations will be different for each patient, based  mainly on physical and structural relationships of body proportion and tissue support.


Common and Rare Post-op Implant Problems:
Implant Displacement or Bottoming Out Deformity of the  augmented breast with loss of breast mound proportion by Bottoming Out of  the  implant  below the original fold, and upward positioning of the nipples off the mound apex See: Case 1: Bottoming out with Capsule Contracture
Case 2:  Correction of Bottoming Out after Multiple Failed Tries
Symmastia or Synmastia Unnatural touching of implants across the breastbone with elevation  of  the pre-sternal skin (Kissing Implants, Breadloafing or Uniboob) See:   Symmastia Correction    
Acellular Dermal grafts to help repair various severe augmentation problems In certain situations complications like those described above cannot be repaired using just the local tissues of the breasts and chest muscles. In those instances donor acellular dermal grafts may be employed to bolster, thicken, or strengthen the local tissues so that they can hold sutures more effectively and better stabilize implant position.  See:  Acellular Dermis Grafts in complex augmentation revision, correction and reconstruction (Flex HD ®, Alloderm ®, Neoform , Strattice ™)
Capsule Contracture Unnatural  firmness  of  the breast implant augmentation result due to formation of a tense scar around the implant.    There is also usually  an  unnatural  appearance  of  the  breasts  in the instance  of  Capsule  Contracture  formation. See:


Capsular Contracture and Implant firmness  

Post-op Implant Massage


Implant Deflation or rupture Loss of integrity of  the implant shell,  causing saline implant deflation, or release of silicone gel. See: Correction of Implant Deflation
Lateral Implant Fallout or Displacement In certain situations, particularly in patients who have prominent breastbones and steep lateral chest walls, or after placement  of oversized implants, the lateral fibrous support tissues may gradually stretch, allowing implants to fall out to the sides or toward the armpits. Such situations merit repair by suturing of the internal scar capsule or capsulorrhaphy. Cases of lateral fallout are discussed with photo examples on the page linked at right. See: Correction of Lateral Implant Displacement or Fallout
Visible Implant Wrinkling Visible  implant   wrinkling  is  a  problem   more   often  seen   in women with thin skin and thin soft  tissue implant coverage, and especially with  textured implants,  or  implants placed  over the muscle.    The  problem  occurs  in  two  types:   Shell  Wrinkling seen at the outer and lower edges of the breasts, may be seen in any implant,  but  more  often  with  implants over  the muscle; and Traction Wrinkling,  seen  when  the  textured  implant shell actually  grabs  the  scar  tissue  surrounding  the  implant,  and pulls the overlying skin and tissues inward.   This can even pull the soft tissues away from the midline,  causing  less  apparent cleavage,  especially  with  heavily  textured  shaped  implants. See: Correction of Implant Rippling


Breast sag or Ptosis after augmentation Increased appearance or accentuation of sag is sometimes an unexpected  outcome  of   augmentation  if  pre-op  shape  and breast base dimensions are not taken into consideration when choosing the procedure,  implant  size  or positioning See: Augmentation Mastopexy 



Related  Breast Augmentation Links:   To Other photo Illustrated Procedures:

Important  Information  About  Implant  Breast  Enlargement

Trans-Axillary Breast Augmentation
Trans-Axillary Breast Incisions Scars
Breast Augmentation Shape Evolution
Breast Augmentation Shape Determination
Cleavage Determinants
Post-Op Implant Massage Technique
Implants Over versus Under the Muscle
Special Considerations in Augmentation
Breast Surgery in African American Women
Breast Augmentation FAQs
Breast Augmentation with Mastopexy or Breast Lift
Revision Surgery for Augmentation Problems
Important Information about Silicone Breast Implant Use
Nipple Reduction/Shaping
Mastopexy or Breast Lift

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Thomas M. DeWire, Sr., MD, FACS
Advanced Art of Cosmetic Surgery
3974 Springfield Road
Glen Allen, VA 23060
Richmond, Virginia, USA
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©Copyright 1997-2013  Advanced Art of Cosmetic Surgery:  Thomas M. DeWire, Sr, MD, FACS   Revised:   September 11, 2013 09:22 AM