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Home > Services > Cosmetic Surgery > Breast Surgery > Revision Mammaplasty

Breast Augmentation

Revision Mammaplasty

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Revision Mammaplasty

Revision mammaplasty means performing breast augmentation surgery again. The causes why people will decide to receive another time of breast surgery are mostly due to capsular contracture from previous implant, unequal height of the breasts, deformation or even hardening of the breasts. These complications cause discomfort during patients daily life or even when facing their other half. In fact, every breast augmentation has its own risks for capsule formation. The incidence of capsular contracture will be increased if the past breast massages and recovery not doing well, inadequate pocket creating by last doctor, or even hematoma and infection due to previous surgery. All above can make the capsule become thickness and contraction.

Generally speaking, the breasts won’t be stabilized until 6 months after augmentation mammaplasty. During this period the patient can do frequently massages to improve the breast shape and 柔軟度if she dislike the result of the surgery. It is unnecessary to receive revision mammaplasty so hurry. Normally revision surgery is performed one year after the original breast augmentation, which is the best timing to treat the capsules. If you persistently have below problems, you could consider taking revision mammaplasty again.

I. Still not satisfied with the results one year after surgery.
II. Baker grade III and IV capsular contracture, or undesirable firmness of breasts.
III. Height difference between both inframammary fold is above 2 cm.
IV. Breast deformation or malposition of implant.
V . Breast sulcus can not be centered by hands.
VI. Implant foldings can easily be noticed.
VII. More than half cup size difference between both breasts.
VIII. Suspicion breast implant leak, bleed or deflated.

Revision mammaplasty is more complicated and takes more time than the first time surgery. The mainly problem is how to deal with the capsules. Currently there are three methods to perform this surgery:

I．Complete capsulectomy:

This procedure consists of completely resecting the whole capsule formed around the implant, which is the best way to treat sever capsular contraction. By this method we can reduce the recurrent rate to a very low status. However the operation time must be quite long. The incision must be placed around areolar margin or infra-mammary fold. Of course there will be an additional scar for the previously transaxillary cases.

II．Closed capsuloctomy:
This method consists of cutting the entire inner surface of the capsular contracture into small square pieces by electric cauterization or any other instruments. This also called capsularraphy procedure. This procedure will not resect the whole capsular like caopsulectomy, but just to rupture the scar tissue capsule partially. The advantage for this surgery is that surgeon can use endoscope from the original armpit wound to perform the procedure. The operation time is also shorter than capsulectomy procedure. However the disadvantages include incomplete dissection, rupturing the implant shell, herniation of the implant, and higher recurrent rate. The patient must pay much more caring and breast massage after surgery.

III．Conversional placement of the implant to different plane
The surgery consists of replacing the implant from the original pocket to another new space. Usually we should create a new pocket then place the implant from capsular contracture space, like conversion from the original sub-muscular to sub-fascial plane. In my own opinion, this procedure is not the first priority for the revision mammaplasty. This method is suitable for those who with repeated revision surgery which caused by severe capsular contracture or recurrence. The advantage is simple technique, quicker operation time, less bleeding but the disadvantage is limited case selection and indication. It should not be done for a skinny patient wanting a very large implant. Silicone gel implant is the best material choice for this method, but it will cost a lot.

	Complete capsulectomy	Closed capsuloctomy	Conversional placement of the implant to different plane
Indication	severe capsular contracture	partial capsular or scar contraction	repeated capsular contracture and surgery
Anesthesia	General anaesthesia	General anaesthesia	General anaesthesia
Incision	periareolar or inframammary fold	transaxillary or periareolar	periareolar or inframammary fold
Operation time	3 to 4 hours	2 to 3 hours	within 2 hours
Implant choice	saline or silicone gel	saline or silicone gel	best if silicone gel
Drainage tube	None	None	None
Re-contracture rate	Low	Higher	Low
Pain post surgery	Low	High	Low
Breast massage	as usual	more aggressive	It depends

Compared to the first time surgery, if to remove the capsule completely around breast implant, pain should be less in revision mammaplasty. Breast softness should also improve considerable. However, revision surgery is more susceptible for changes. Therefore, the patient must do post-operative breast massages consistently for over 6 months, and should also return to the doctor for periodical checkups by order. This is the only way to maintain the surgical result to its maximum.

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