La Jolla / San Diego Cosmetic Surgeon Dr. Tom Pousti Talks About Revision Breast Augmentation Surgery
Dr. Pousti is double board certified in plastic and reconstructive surgery and is well known for his vast experience with revisionary breast surgery. Dr. Pousti has patients that fly in from all over the world to have him revise their previous breast procedures. Revisionary Breast Surgery may involve complications such as:
Strattice is an acellular dermal matrix derived from donated human skin tissue. Since Strattice is regarded as minimally processed and not significantly changed in structure from the natural material, the FDA has classified it as banked human tissue. Strattice is frequently used in conjunction with symmastia repair, capsular conjunction, pocket correction and many other revisionary breast surgeries.
Adjustments can be made with the implants to try to achieve as much symmetry as possible after breast enhancement surgery. There are several ways to achieve breast symmetry; different types of implants may be used, different volumes may be used, or changes in the pocket dissection may be used to help achieve as much symmetry as possible.
- Bottoming Out
Bottoming out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the inframammary fold is too great. It is the loss of internal implant support can cause a slow downward migration of the implants. This is because support of the implant by the skin alone is not always enough to prevent downward migration of the implants. Also, over-dissection of implant pockets at the time of surgery may cause immediate bottoming out. This is corrected by “raising” the inframammary fold using internal sutures.
- Capsular Contracture
After breast augmentation surgery excessive scar tissue may form around the breast implant which causes the breast implants to harden (similar to what a contracted muscle feels like). There are different grades of capsular contracture ranging from mild to severe. Correction of capsular contracture can be handled surgically is necessary and in many severe cases surgery is necessary.
The capsulorrhaphy procedure, also known as pocket correction or use of internal sutures/bra, involves closing a portion of the breast pocket to correct displacement of the implant. This can also be necessary when breast implants fall toward the axilla (armpits) and therefore the pockets need to be internally sutured to keep the breast implant in the correct position on the chest wall.
- Change in Size/Type of Implant
Some patients choose to change their breast size after undergoing breast augmentation surgery. The most common “complaint” that patients have after breast augmentation surgery is that they “wish that they had gone bigger”. After a year or so, they may decide to remove their current implants and replace them with larger breast implants. Other patients may have gone larger when they were younger and are now ready to have a more natural look so they remove their larger implants and replace them with smaller implants. Patients frequently decided to change the type of their implant as well. The most common change is going from saline to silicone. These patient choose to go from saline to silicone because they have rippling, want more of a natural feel, or just as a personal choice. We also have patients that switch from silicone to saline, most of these patients are interested in XL implants, which involves overfilling saline implants.
- Deflation of Breast Implant
Breast implants are not known as lifetime devices. They may deflate or rupture for reasons such as trauma to the breast, injury from surgical instruments, normal wear and tear on the implant, and mechanical damage prior to or during surgery. If a deflation or rupture occurs, the treatment option would be to return to the operating room, remove the ruptured implant, and replace it with a new breast implant. If the ruptured implant is a silicone gel implant, then care needs to be taken to clean out the ruptured silicone gel from the pocket area before replacing the breast implant with a new silicone gel breast implant.
This is a cosmetically undesirable circumstance for patients with breast implants, which occurs when the breast fails to take on the shape of the implant, resulting in the appearance of a visible line showing a separation between the bottom edge of the implant and the bottom edge of the natural breast. This tends to happen more often in the case of a very tight or constricted pre-op breast or when there is significant droop present. Patients should also be educated toward tolerance of the imperfection, as this problem sometimes cannot be fully corrected.
This is when breast implants are too high on the chest wall and there is too much fullness superiorly.This displacement may cause the nipple-areola complex to appear low or pointing downward. In this case the pocket is lowered to allow the implants to settle into the pockets and have a nicer placement on the chest wall and more natural look.
When a patient doesn’t have much breast tissue or body fat, they may experience palpability of the breast implants and possibly rippling of the breast implants. Although the breast implants are placed under the muscle (sub-muscular), the outer edge and cleavage areas are not covered by the muscle and these are the most common places where rippling is experienced.
- Symmastia ‘Bread-loafing’
Symmastia- commonly referred to as bread-loafing or uni-boob, occurs when two implants touch one another in the center of the chest. If the breast implant pocket is over-dissected medially this cause the implants to migrate toward the middle of the chest causing symmastia.
Revision Breast Augmentation & Revision Tummy Tuck by Dr. Pousti
Prime Plastic Surgery Recommends Thongbra for Patients After Breast Revisionary Surgery
Visit http://www.thongbra.com for more information and to order.
The Thongbra® was designed to do what no other post surgery garment does; provide constant support to the cleavage area. Following surgery, Dr. Pousti recommends support to hold the surgical site securely while scar tissue forms and recommends using the Thongbra®. The Thongbra® provides the consistent pressure needed with high level of comfort. The Thongbra® is not really a bra at all but a post surgical compression garment which acts with a bow effect creating pressure from front to back and is worn between the breasts to keep constant pressure on the cleavage area during the healing process.