Breast Reconstruction Revision
Breast reconstruction has become increasingly complex, with numerous reconstructive options—including immediate versus delayed, autologous versus expander/implant, or Direct to Implant (DTI)—and not all patients find themselves pleased with their final results. This may simply be due to a less-than-optimal outcome, complications following surgery (including poor healing), or both. Patients might also be unhappy due to asymmetry, discomfort, size, scarring, or some combination of all of the above. Additionally, women with implant-based reconstruction might experience tightness or discomfort, and even pain and distortion due to capsular contracture—a condition wherein scar tissue develops around their saline-filled or silicone gel-filled breast implant(s). Many different options are available to address any and all problems that a patient might be encountering after her breast reconstruction is complete.
Charleston plastic surgeons Craig Rowin, MD and Ram Kalus, MD have extensive experience in all aspects of breast reconstruction, as well as breast reconstruction revision surgery. After an in-depth evaluation of your medical history and a physical examination, Dr. Rowin and Dr. Kalus can determine the best options for improving a patient’s situation based on her unique concerns.
Why Revise a Previous Breast Reconstruction?
Although the majority of patients are satisfied with their newly constructed breast(s), the intricate nature of the breast reconstruction process can create aesthetic concerns for some individuals post-operatively. In some cases, the cosmetic outcome of breast reconstruction may appear favorably to a patient at first, but gradually become altered with the passage of time and age. Optimal results in breast reconstruction are generally achieved in multiple stages, and additional surgeries may be required to attain an ideal breast appearance.
There are a number of reasons why dissatisfaction from a previous breast reconstruction may arise and lead to consideration of a revisional procedure:
Asymmetry After Breast Reconstruction
Asymmetry between the breasts is commonly experienced when only one breast was reconstructed. Because the natural breast continues to undergo proportional changes from weight fluctuation, gravity, the aging process, and more, the aesthetic balance between the natural breast and the reconstructed breast can eventually become disrupted. In these cases, revisional surgery may be necessary to restore symmetry between the shape, positioning, or projection of both breasts.
Implant Adjustment After Breast Reconstruction
When implants were used to recreate the breast shape, the implant-related complications that are commonly associated with breast augmentation can also exist after breast reconstruction. As a result, reasons that may necessitate an additional procedure may include shifts in implant placement, leaks, ruptures, capsular contracture, or implant rippling, which occurs when the edges of an implant are clearly seen and felt. Women may also undergo revisional surgery because they simply desire an updated implant size, shape, or brand, as new technology has allowed the development of more advanced and natural-looking implant types.
Breast Reconstruction Revision For Scar Correction
Reconstructive surgery involving multiple operations can leave a significant amount of scarring. While these marks generally fade with time, individuals dissatisfied with how their mastectomy or initial reconstruction scars have healed may consider an additional procedure for scar correction. Cosmetic concerns commonly arise when mastectomy scars appear hypertrophic (raised), hyperpigmented (dark), or generally unfavorable. The scarring may also feel tight and uncomfortable, catalyzing the need for a correctional surgery to improve their appearance and alleviate any existing discomfort.
Complications Following Breast Reconstruction
Sometimes, additional surgery may simply be necessary to address complications that occur after breast reconstruction. Although these problems are generally uncommon, issues that can develop anywhere from months to years later may include the death (necrosis) of tissue flaps, loss of muscle strength at the donor site, or a diminished ability to heal due to radiation. Smokers are often at a greater risk of infection and other complications after breast reconstruction, as tobacco can lead to a longer recovery time, more noticeable scarring, and a poorer healing process.
How Can Breast Reconstruction Be Revised?
Many advanced techniques can be utilized to improve the outcome of a previous breast reconstruction. Following an open and honest consultation, Dr. Rowin and Dr. Kalus can develop a personalized treatment plan around your specific concerns and determine an optimal course of action to reach your surgical goals. In general, breast reconstruction can be revised using an array of surgical approaches, including but not limited to:
- Breast implant replacement
- Removal of scar tissue resulting from capsular contracture (a procedure termed a capsulectomy)
- Restoration of breast symmetry using a breast lift, breast augmentation, breast reduction, or liposuction
- Correction of implant rippling through fat grafting or other techniques
- Correction of breast shape and contour irregularities using fat injections
The goal of breast reconstruction revision is to resolve any practical or aesthetic issues concerning the breasts and dispel any existing complications. Our experienced plastic surgeon is committed to enhancing the results of your breast reconstruction surgery using the safest and most effective modalities possible.
To learn more about whether you are a candidate for breast reconstruction revision, or to schedule a consultation with Dr. Rowin or Dr. Kalus, please don’t hesitate to contact Plastic Surgery of the Carolinas today.