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Bad Breast Augmentation Can Be Corrected

Feb 4, 2008
Breast augmentation surgery is more popular than ever, with the vast majority of patients thrilled with their new proportions. There are however many patients that require additional surgery to correct problems with breast implants, to exchange outdated silicone gel implants, or simply to change to different size implants.

First, it is important to understand that every plastic surgeon will have, from time to time, a patient who has a complication or a result that is less than satisfactory which requires a touch up or revisional surgery. Don't be too quick to blame the surgeon. There are many factors and variables in surgery and in healing. It is important to realize that there is always some degree of unpredictability in the final outcome of the healing process.

It is usually beneficial and appropriate to follow-up and continue care with the plastic surgeon who performed the original surgery and work through any problems or complications. Obviously, anyone who experiences a complication or poor result wishes to have the problem resolved immediately. However, working through these problems may take extended periods and will require time and patience. Frequently, it is appropriate to wait any number of months after the problem or complication before moving ahead to correct the problem. Lack of confidence, obvious poor judgment, or failure after two or more procedures may encourage one to seek a second opinion or an alternate plastic surgeon.

Unsatisfactory results may be from one or more of several problems associated with breast augmentation including: capsular contracture (thickening, firmness and contraction of the layer of tissue around the implant), malpositioned or displaced breasts implants, poor or unnatural shape, asymmetry, obvious rippling or wrinkling, deflation, inappropriate size, poor scars or firmness from excessive overfilling of the breast implants.

Understanding that a large number of women have significantly asymmetric breasts, it is important to take into account the original shape and symmetry prior to any surgery. Many women do not realize their asymmetries until after breast augmentation surgery, when their inspections become more intense. Conscientious and meticulous surgeons will make every effort to make the breasts as symmetrical as possible; however, original asymmetries will prevent perfect symmetry. At times, asymmetry can even become more noticeable or obvious following breast augmentation.

If pre-operative asymmetry is significant, two different size breast implants may be used to accommodate two different size breasts, thereby improving the asymmetry. When asymmetry involves differences in shape or position of the nipple, it may be wise to choose smaller size breast implants, with a more conservative change in size so as not to accentuate the asymmetry. In those patients who have one nipple significantly lower than the other, or one breast hanging or drooping more than the other, some type of lift for that particular side may be considered along with the breast augmentation. Careful planning before the initial surgery best helps to produce optimal results.

It is also important to understand that complete healing and the final result after breast augmentation surgery truly takes several months approaching one year and what may be unsatisfactory to a patient after surgery may be something that will improve or resolve over time. Do not be too quick to insist that the surgeon correct a problem or concern when more time is recommended. For example, a patient happy with the left breast noted the right breast implant placement appeared too high and requested it to be corrected. However, at just under one year the high riding right implant ended up in perfect position and the left implant ended up a little too low! In reality, it was the left implant that needed to be raised rather than the right implant lowered. Patience in the healing process is very important.

Correcting implant problems may be relatively uncomplicated or they may require one or more surgical procedures. For some, it is possible that no satisfactory result can be obtained requiring living with and accepting the "best" that can be done or removing the breast implants altogether. If removed altogether, one should wait six months to one year allowing breast tissue recoil/contraction before deciding if any type of breast lift or any other procedure is desirable.

With breast augmentation, capsular contracture is one of the relatively common complications that has been significantly reduced with the use of saline breast implants. The capsule refers to the normal thin, soft, fibrous scar tissue layer that forms around every breast implant. Capsular contracture occurs when this capsule abnormally becomes thickened, firm, and contracts around the implant causing varying degrees of firmness, distortion, and sometimes pain. The greater the capsular contracture, the rounder and harder the breasts become.

The exact cause of capsular contracture is unknown. Capsular contracture may be caused by one or more contributing factors including: infection or "subclinical" infection, hematoma (collection of blood around the implant), talc powder on surgeons gloves, subglandular (over the muscle) placement, reaction from micro "bleed" of silicone gel from silicone gel implants or by other yet unknown causes.

Even with all aspects of the procedure performed correctly, the incidence of capsular contracture with firmness and hardening is approximately ten to twenty percent with silicone gel implants and three to four percent with saline implants.

Treatment for capsular contracture generally entails surgically incising, releasing and/or removing the thickened and firm capsule (scar tissue) from around the implant, and placing the implant under the muscle if not already. Also, a more appropriate and enlarged "pocket" or space to accommodate the implant is made. Breast implants may also be exchanged, depending on the original implants and any other associated problems. The off label use of Accolate, a medication used for asthma, has shown some success in treating capsular contracture.

It is important to understand that the possibility of capsular contracture exists each time breast implants are placed or changed or manipulated in any way regardless of the history of capsular contracture or not. Capsular contracture can occur with first time patients or in patients changing, revising, or repairing problems even if capsular contracture never occurred previously. For those who have capsular contracture, this problem may recur again after corrective surgery-there is no guarantee. If one attempt at correction fails, and contracture recurs, it maybe decided to try a different type of implant. The only other options would be to live with the firmness or remove the implants altogether.

Malpositioned or displaced breast implants can be corrected by adjusting the capsule around the implant. It is this capsule that forms the walls or boundaries of the "implant" pocket or space. If an implant is too low and/or too far out to the side, the capsule is repaired or closed down along the bottom and/or side to reposition the implant. Conversely, if the implant is too high or too close to the middle of the chest then the capsule would be opened at the base or side allow greater room and repositioning of the implant. Frequently, corrections call for both releasing the capsule in one or more areas and repairing the capsule in the other areas. It may also be desirable or necessary to change the size or type of implants used when both breasts are to be corrected.

Poor shape may be due to the above problems of capsular contracture and/or malpositioned implants. Poor shape may also come from poor choices in implant size or implant shape. Was too large an implant used or an "anatomical" or teardrop shaped implant used that doesn't look natural? Poor shape may also be due in part to original pre-operative natural problems in shape or symmetry that have been overly accentuated with breast augmentation. Maybe a more conservative size implant would not have made the original problems in shape or symmetry so obvious. For instance, if the "lower pole" of the breast, that area of breast below the nipple, is insufficient as compared to the upper portion of the breast, an implant will naturally tend to "ride" high. If too large an implant is used in this instance, the breast will be too full on top for a satisfactory result. Hence, there are certain shaped breasts that do not allow anything but conservative size breast implants.

The only alternative for a somewhat larger size would be to use the technique of "expansion breast augmentation" using expandable breast implants which expand the breasts over time using a multi-step procedure for expansion, thus allowing larger size breast implants. It is also possible that the original shape of the breast may also be improved at with this expansion breast augmentation procedure. For instance, "tuberous" breast deformity is a relatively common condition where the breast tissue herniates or bulges into the nipple area creating an overly full or protruding areola (pigmented area around the nipple). Breast implants in combination with this deformity or condition would tend to produce overly projected or pointed breasts. There are different procedures to correct this problem that can be done at the time of the original breast augmentation.

Poor shape may also be due to the wrong choice of procedures. Was only a breast augmentation performed when a breast lift was also needed producing a "double-bubble" or "snoopy-dog" appearance. In this case, some type of breast lift would need to be performed.

At times, especially in thinner patients, poor shape and a less natural appearance may be associated with implants placed on top of the muscle. Breast implants placed on top of the muscle are more likely to show waves or ripples made by the implant, especially textured implants. Smooth implants move inside the "pocket" or space under the muscle and slide to the most dependent area within he capsule which also more closely mimics natural breast movement. A textured implant, on the other hand, adheres to the overlying tissues and is much more likely to reveal noticeable rippling or waves on the breasts, especially in thinner patients. Implants placed over the muscle may tend to sag more over time due to the weight of the implants in the breasts.

The benefits of placing the implants under the muscle include a lower incidence of capsular contracture, a lower chance of obvious rippling or wrinkling, less ability to feel the implant, and a more natural slope to the breast because of the additional muscle coverage. Also, with the implants behind the muscle, mammograms are easier to review.

Other problems include deflation of saline implants, which has an incidence of approximately one percent in five years. Deflation can happen rapidly or slowly over weeks or months. The chances of deflation (leaking) can be increased by under-filling implants by the surgeon, which causes more creasing and eventual wear and tear overtime and premature deflation. The implant is warranted for life and will be replaced by manufacturer if deflation occurs. Manufacturers have programs available to help defer costs of replacement if or when deflation occurs.

Simple replacement of deflated saline implants can be performed through the previous scar and recovery time is very minimal compared to the original surgery.

There are times when simply too large of an implant was used to obtain a desirable result. Smaller implants may be all that is needed to improve overzealous attempts at breast augmentation. Conversely, some may wish to increase their breast size to improve body symmetry and proportions. This will generally entail exchange to larger, but appropriate size implants and further opening of the capsule to accommodate larger implants.

Attempting to improve or correct breast implant problems often involves many decisions and may require more than one procedure to obtain the desired improvement. It requires time and patience during the healing process as well. It is also important to understand that any attempt at corrective or revisional surgery will always carry with it some degree of unpredictability, as well as the associated risks and expense. This attempt at corrective surgery may result in no obvious correction of the problem or complication, unsatisfactory correction, worsening of the problem, or even additional complications.
About the Author
Dave Stringham is the President of LookingYourBest.com an online resource for breast augmentation Miami. Learn more about breast reduction and breast augmentation Miami procedures.
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