Breast augmentation remains among the most common cosmetic surgeries performed each year. While commonly done, it is also commonly done “badly.” Revising breast augmentations is among the most difficult procedures that plastic surgeons perform. Unfortunately, revising breast augmentations from other surgeons remains common in my practice.
In order to understand how problems can be fixed, we must first understand where problems can occur. I like to categorize these problems into 4 major areas:
1. Problem with the implant itself
2. Problem with the size of the implant
3. Problem with the procedure choice
4. Problem with healing
Choosing the Right Implant
Choosing the implant is of crucial importance and I have written specifically about this in previous blog entries. The shape, texture, and size of implant must be carefully chosen to match your body. Many problems that can occur can be the direct result of choosing an implant that is too big for your body. This can result in implants touching each other in the center (synnmastia), implants appearing to “hang off” the sides, or augmented breasts that now appear “droopy”. Breast implants have a specific width, depending on the size. Your doctor should carefully measure the width of your chest (“base diameter”) so that the proper implant size can be chosen.
Implants must be placed within a carefully created implant pocket. If the implant pocket is too big, then the implant may move around in an unnatural position. If the pocket is not centered under your nipple, then the implant will be positioned too much to the center of your chest or the side. If the pocket is too small, then your implant may be “constricted” and take on an oval shape instead of the natural round shape.
There are also several variations in the type of breast augmentation that is performed. The implants can be placed above or below the muscle. Also, some women come to my office because they want “perkier” breasts and mistakenly think that breast implants will give them a lift. While breast implants do result in a slight lift of the breast tissue, breast augmentation primarily makes the breast larger and will not adequately correct a “drooping” breast. This would require a breast lift, possible with the simultaneous placement of implants. There is complex decision making that must occur, even before you get to the operating room.
New Breast Funnel Improves Breast Augmentation Results
Recently, I came across a new device to be used in breast augmentation. It is called the Keller Funnel, developed by a Texas Plastic Surgeon. The device resembles a pastry bag. A silicone breast implant is placed inside this bag and essentially squeezed into the surgical opening in the breast.
While very simplistic in its actual design, the concept is exceptional. It allows for a truly “no touch” implant technique. This device allows the surgeon to place the implant, without having it come in contact with his hands or the patient’s skin. This reduces potential bacterial contamination, reduces infection risk, and more importantly, may reduce capsular contracture. Capsular contracture is the development of abnormal scar tissue around the implant, resulting in an implant that looks distorted and feels hard. No one knows why capsular contracture develops in some people, but a leading theory is that a small amount of bacteria on the implant may lead to the development of this abnormal internal scar tissue. It may also be the result of the talc commonly found on a surgeon’s glove. The “no touch” technique is an important concept and until this funnel, was only possible through very large incisions.
In addition, a large amount of pressure is needed to force a large silicone implant through a small incision. This immense force may contribute to a weakened shell and a delayed rupture of the implant years later. The rupture rate has been estimated to be as high as 7% over the first 10 years. The breast funnel allows insertion of the implant with much less force, thereby potentially reducing the incidence of implant rupture.
Lastly, using the breast funnel, I am able to place the implants through a significantly smaller incision. This shorter incision means a shorter scar, and a happier patient. I have reduced the length of my incisions 1 cm.
Recovering from Breast Augmentation
Even if your surgeon chooses the right procedure, the correct implant size, and does everything perfectly in the operating room, your body still must heal. Not only must your body heal correctly on the outside (the incision), it must heal correctly on the inside. Abnormal scar formation on the inside may result in capsular contracture – or hardening around the implant. We now know that bacteria and blood can place you at increased risk of this abnormal scar formation, but there are some women who seem to be “predisposed” to capsular contracture. If it can be recognized early, there are some things that we can do to slow the progression.
So, “fixing” the problem relies on the surgeon’s ability to identify what the cause is. Revisional surgery may include exchanging implants to a sixe better suited for your body, enlarging or reducing the implant pocket, removing abnormal scar tissue, or performing a completely different operation than had been done originally (i.e. a breast lift). Some of these complications are avoidable by selecting a surgeon who understands the complexities of breast surgery. However, sometimes problems can occur that are not preventable, but revisional techniques are evolving and surgeons experienced in these complex revisional surgeries can improve things.
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Contact us if you have any further questions about fixing bad implants. We will be happy to help!