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Secondary Breast Surgery
Secondary breast surgery or "revision breast surgery" is nearly as popular as primary breast surgery. I explain to primary augmentation patients that this is just the beginning, and maintenance surgery is an important and common part of this lifelong endeavor.
If you take 100 women with breast augmentation and follow them for 30 or 40 years, you will find most women have at least one additional surgery. It is highly likely that breast augmentation patients will need a secondary surgery during their lifetime.
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Who is a Candidate for Secondary Breast Surgery? Women who have had previous surgery and have issues with their breasts.
There are many reasons or conditions to have secondary breast surgery. The most common
ones are:
· Infection and bleeding in the postoperative period, while uncommon, may occur in about 1 to 2% of patients nationwide.
· Deflation of an implant
· Breast contracture (caused by scar tissue forming a capsule around the implant making it feel hard)
· Changes related to pregnancy such as breast-feeding
· Laxity of the skin over time.
In general, there is no reason to change implants unless there is a significant problem.
Secondary breast surgery often takes more skill, precision, and artistic ability than the primary surgery. The surgery is being performed to correct a problem and therefore requires significant surgical expertise. One advantage to a secondary procedure is that the patient has the option to choose saline or gel implants. Currently only patients having a secondary procedure, breast lift, or breast reconstruction are candidates for gel implants.
The various options for revision may be:
· Removal of the scar capsule and replacement of the implants, either the same size or larger.
· Breast lift with or without implants.
Each case requires individual needs and personalized attention for the best overall outcome.
Prior to Surgery A personal consultation is the first step for every patient considering surgery. Dr. Delgado will ask you to discuss your concerns about your appearance. During the meeting, he will discuss your current conditions and what goals you want to achieve. A physical examination will be made and your medical history reviewed to determine if surgery is your best option. If you are a good candidate, Dr. Delgado will explain:
· Various incision alternatives for breast lifts.
· Implant placement if implants are to be used.
· Explain the potential complications.
Dr. Delgado may require a complete work-up by your primary physician. Various lab work is required and possibly a pregnancy test and a mammogram.
Dr. Delgado will give a personalized preoperative instruction booklet that will explain your medications and any preparations that you need to make at home. This preoperative booklet will also give a concise list of all aspirin and aspirin containing compounds, including anti-inflammatory products that must be stopped two weeks before and two weeks after surgery. Tylenol may be taken during this time. You will also be given a list of vitamins and homeopathic drugs to take prior to and after surgery to reduce bruising and swelling.
Breast Implants There is no perfect breast implant. All implants have trade offs. There are essentially two implants used today; saline filled, and silicone filled implants. Both implants have an outer pliable envelop or shell which is made of silicone. The content of the shell is either saline (salt water) or silicone gel.
Saline filled implants are the most commonly used today. The silicone shell is filled with saline at the time of surgery. If there is a leak from the implant, the salt water is safely absorbed by the body.
Silicone filled breast implants are only available to certain patients that are participating in a mandatory adjunct study by the Federal Drug Administration.
Both types of breast implants come in many sizes, shapes and surface textures.
Anesthesia Breast implant surgery is performed under general anaesthesia. It is done in an outpatient surgery center or an accredited operatory. It can be combined with other procedures like facial surgery or body contouring.
Procedure Before general anaesthesia is given, your breasts and chest is carefully outlined using a surgical marking pen. This acts as a road map during surgery.
Breast implants can be placed through one of three incisions. The most common being the periareolar incision between the dark and light interface of the areola and paler breast skin. This incision gives an excellent cosmetic result. It can also be placed at the skin crease underneath the breasts itself, or lastly, it can be placed through the armpit region referred to as a transaxillary approach. The breast implant can be placed either on top of the pectoralis muscle or below it. For my patients, I usually use periareolar approach and place the implants below the muscle. During surgery, once the implants are in place, the patient is sat up to compare the size, position, and the symmetry. A multiple layer closure is performed for the closure of the incision and deeper tissues. A compression band and bra is then placed.
Some women have loose skin from childbirth, weight loss, or genetic reasons. In these cases we may place the implant partially under the muscle, above the nipple, and partially above the muscle below. This will insure that the loose skin is fully stretched. However, if the skin of the breast is very loose or ptotic, a lift in conjunction with the augmentation may give the best results. Some women do not want breast lifts due to the additional incisions, and will accept the trade-off of a lower breast mound.
After Surgery The first few hours after surgery will be spent in the recovery room. When you are fully alert, you will be able to go home with the assistance of a friend or a family member. At this time it is important to sleep with the head and back elevated to reduce the swelling in the area. Two days after surgery, you may take the dressings off and take a shower and then re-apply the band and bra. Instructions are given for suture care.
The discomfort after breast augmentation surgery is moderate. This discomfort is more noticeable if the patient has had the implants placed underneath the muscle. These patients will notice more tenderness and soreness around the chest region. Patients take medications during the first day or two in order to be comfortable during the recovery. By the third day, the patient shouldn’t need strong pain medications. However, some patients have a lower threshold and therefore, may take pain medications for up to five days.
The recovery period, is generally two weeks. Once the bruising and tenderness are gone, the patient can return to their normal activities. It is an absolute priority that patients avoid lifting of any kind for at least two weeks post operatively. Most patients may drive a car and return to work or social activities after one week. Strenuous exercise is avoided for three to four weeks following surgery.
Risks and Complications Each year, thousands of women undergo breast augmentation surgery and experience no complications. A highly-trained plastic surgery team which includes a board- certified anesthesiologist and nurses will reduce the frequency of complications. However, you must fully understand the risks as well as the benefits of this surgery. As with all surgery the risk of bleeding, infection, and risk of anesthesia exists. Additional complications specific to breast augmentation include deflation/rupture of the implant. Breast implants deflate when the saline solution leaks through an unfilled or damaged valve or through a break in the implant shell. The implant deflation can occur immediately or progressively over a period of days. Since salt water is naturally present in the body, the saline that has leaked from the implant will be absorbed safely in the body. Deflated implants necessitate additional surgery to remove and to replace the implant.
Capsular Contracture:
Natural scarring occurs around the breast implant. If the scar tightens around the implant, then it can become firm. This firmness is called capsular contracture. The symptoms range from firmness and mild discomfort to pain and distortion of the implant. If the symptoms are severe, additional surgery may be needed.
Infection:
Most infections resulting from surgery appear within a few days, to two weeks after the operation. All breast implant patients are treated during and after surgery with antibiotics.
Hematoma :
Hematoma is a collection of blood inside the body cavity. If a hematoma occurs, it usually occurs soon after the surgical procedure within the first 24 to 48 hours. Small hematomas are absorbed by the body but large ones need to be drained surgically in the operating room.
Changes in Nipple and Breast Sensation:
Feeling in the nipple and breast can increase or decrease after implant surgery. The range of change varies from intense sensitivity to reduced sensation of the nipple or breast following surgery. Changes in the feeling are usually temporary and return after swelling dissipates.
Cancer:
Public studies indicate that breast cancer is no more common in women with implants than those without implants.
Results Breast augmentation may be a way to achieve an enhanced appearance of the breasts. This often can boost a women’s self esteem and confidence.
The initial two weeks following surgery, the breasts are distorted with swelling and bruising, but it quickly dissipates. It takes approximately three or four months for the breasts to set into its new shape. Dr. Delgado will spend significant effort and time preoperatively to discuss your anatomy and to choose the proper implant shape and size that will accomplish a natural appearance to your new shape.