Breast Revision | Lisa Hwang, MD I Female Plastic Surgeon I Bay Area

Breast

Revision.

Fix It.

Have you had prior aesthetic breast surgery that you're dissatisfied with? Maybe the size of your implants were never exactly what you wanted. Maybe it's been twenty years since your augmentation, and now your breasts sag or your taste has changed. Maybe you've developed capsular contracture or the implant pocket has stretched out, leaving you with low breasts that fall to the sides.

If any of these problems sound familiar, you may be a good candidate for breast revision. Breast revision surgery covers a wide range of problems--surgery can be extensive and unpredictable, depending on intraoperative findings. Revision surgery can be quite difficult, as your anatomy is already distorted, and prior oversized implants can take a toll on your native breast tissue and ribs. Dr. Lisa Hwang's priority is to understand your vocabulary and your desires, as this is the key to defining the words, "bigger," "big," and "too big." She will figure out exactly what you're unhappy with and help you get the breasts you dream of!

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Problems.

SIZE Dissatisfaction.

It is not uncommon for patients to to be dissatisfied with the size of their implants, whether it's too big or too small. Some patients wake up from surgery, surprised by the size of their implants, as there was miscommunication with the surgeon regarding their expectations.

Dr. Lisa Hwang understands how subjective breast aesthetics can be. She delves into your lifestyle to fully understand your ideal size and look. In the office, she performs a detailed physical exam and makes specific implant recommendations based on your goals. You can try on sizers to simulate and experience that size prior to surgery. Finally, she uses sizers intraoperatively, along with her keen judgement, to make a game-time decision on the final size. All these measures ensure that you wake up from surgery with a result that is absolutely stunning, in a good way!

Capsular Contracture.

Scar tissue forms around all breast implants; however, some people can develop thickened scar, which can cause deformity and pain.

In symptomatic cases, revision surgery is indicated to remove the tight scar and to restore proper, aesthetic positioning of implants. Incision is made under the breast. Modifications are made within the implant pocket, and subglandular implants may need to be converted to a subpectoral position. Fat grafting, "no touch," and other reconstructive techniques may also be utilized. The medication, Singulair, serves as an adjunct to prevent recurrence.

Complications from capsular contracture can be difficult to fix, but you can entrust Dr. Lisa Hwang to make your breasts soft and more symmetrical again with her precise surgical technique.

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Implant Malposition.

Implant malposition refers to a variety of scenarios in which the implant is no longer seated in proper position under the breast. If the implant pocket is not dissected precisely at the time of initial surgery, the implant may not be centered under the native breast. Capsular contracture may tighten the implant pocket, lifting the implant higher on the chest. Larger implants may damage surrounding tissues, causing breasts to sag, "bottom out," and push out laterally over time. Selection of a suboptimal implant with inappropriate dimensions may also prevent the implant from being seated properly. In any case, revision surgery can correct the underlying problems.

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implant rupture.

Both saline and silicone implants can rupture. Saline implants generally deflate quickly and noticeably, as the salt water gets absorbed by your body; a deflated silicone implant shell is left behind. Silicone implants, on the other hand, often have "silent" rupture because the silicone gel may leak out of the shell, but does NOT get absorbed by the body. The shape of the breast may change very subtly, but the size doesn't.

Implant rupture is detected by MRI. Surgery can be a simple implant exchange or a more complex procedure involving implant pocket and capsule revision.

Surgery.

Breast revision is an outpatient procedure performed at a surgery center under general anesthesia. Revision surgery can take anywhere from one to five hours, depending how extensive the surgery is. During surgery, Dr. Hwang performs rib blocks for local anesthesia. Postoperatively, oral pain medication will further control your pain. An adult family member or friend should accompany you the day of surgery to take you home and to assist you for the first 24 hours.

Recovery.

Patients can expect some tightness, soreness, swelling, and bruising. Bruising usually resolves within 2 weeks, while swelling may take up to 3-4 weeks to resolve. After surgery, you will be placed in a supportive bra, which you should keep on for the first 2-3 weeks (except for showers). You can remove all dressings and shower the day after surgery. I encourage you to move your arms around slowly (i.e. out to the sides and over your head) to preserve the range of motion of your shoulders and back.

Avoid any heavy lifting over 10 pounds and avoid pushing anything (i.e. heavy doors, shopping carts, etc.). Patients with desk jobs can return to work within one week, but more strenuous physical activity should be avoided for 6 weeks. Initially, implants are generally larger, high-riding, and with swelling, but they will gradually settle into the bottom of the breast within 6 weeks. Please be patient!

Risks & Complications.

Risks of breast augmentation revision include bleeding, infection, capsular contracture, implant rupture, implant malposition, asymmetry, BIA-ALCL with textured implants, and possible need for future revision surgery.