Breast Augmentation Revision and Correction: Advanced Art of Cosmetic Surgery

Advanced Art of Cosmetic Surgery Thomas M. DeWire, Sr., MD, FACS Specializing in Cosmetic Plastic Surgery 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 result. Although choosing an experienced and qualified Board Certified Plastic Surgeon is the best way to limit risks of various complications or problems down the road, occasional problems will occur in even the best of hands. The best test of a Plastic Surgeon's artistic and technical skills is demanded to identify, analyze, and then correct such problems, to improve, or salvage, an unsatisfactory result. Several such problems are identified below, followed by individual pages analyzing each problem, its cause, preventative strategies, and the surgical remedy.

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
Implant Displacement or Bottoming Out		See:	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)	See:	Symmastia Correction
Acellular Dermal grafts to 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: See:	Capsular Contracture and Implant firmness Post-op Implant Massage
Implant Deflation	Loss of integrity of the implant shell, causing implant deflation.	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