Breast Revision Surgery

What is breast revision surgery?

Sometimes when women undergo breast surgery for reconstructive or cosmetic purposes, complications and less than desirable results may occur.  Some of these problems include breast capsular contracture, bad implant position, ruptured implant, breast asymmetry, malpositioned nipples and areolas, bad scarring, or loss of the nipple or part of the breast skin due to circulation issues.  The result is severe asymmetry and misshapen breasts.  Revisional surgery for these problems can be quite complex and require an understanding of breast anatomy and circulation.  These are NOT beginner cases to do for the plastic surgeon.

 

How is breast revision surgery performed?

There are many techniques employed by the seasoned plastic surgeon when it comes to fixing complications from previous breast surgery.  Techniques include excision of tight deforming (sometimes painful) capsules that can form around breast implants, breast lift or mastopexy, repositioning and/or exchange of old, ruptured, or suboptimally sized implants.  Preparation for revisional breast surgery takes knowledge and expertise of the previously performed surgery, a thorough patient history including treatment for breast cancer and radiation therapy, assessment of vascularity of the breast, and other factors.  Each surgical plan is specific and detailed to each patient.  Surgical procedures usually take longer than the initial breast surgery to reshape a natural appearing breast and to accurately correct symmetry problems.

 

What is the recovery?

Recovery from revision breast surgery is similar to other breast procedures.  These procedures are typically done as an outpatient.  The recovery is similar to other breast procedures.  A family member or friend is required to care for you on the day of surgery and for at least 24 hours following surgery.

The breasts are covered with gauze dressing and an elastic bandage. General discomfort may last a day or two but can be relieved with pain medications. In some cases, a surgical drain may be required. A nurse will provide instructions on how to care for the drain and record the amount that comes out.  This is then removed in Dr. Panossian’s office in the first week.  In a few days, the operative dressings will be replaced with a soft bra. This bra is worn continuously for up to four weeks over a thin layer of gauze. Stitches are usually removed within one week following surgery.

It is critical to reduce activities substantially during the first week after surgery. Having a family member or friend to help during this time with daily activities is essential. This first week is critical for the healing process and in the avoidance of postoperative complications. Approximately two weeks after surgery, light walking and similar activities is allowed, but strict avoidance of upper body workouts, heavy lifting, running, aggressive exercise, or sports is advised.

There is usually some loss of sensation in the nipples and breast skin after surgery. This numbness will improve over the next six weeks. Sometimes, the nipples will undergo a period of increased sensitivity as well. In some patients, these sensory changes may last a year or more, and can be permanent.

 

What are the risks and complications?

Breast revision surgery is more complex than other types of breast surgery.  Previous scarring and vascularity issues can complicate the procedure, but it is usually safe when performed by an experienced board-certified plastic surgeon. Bleeding, infection, and problems with anesthesia are risks inherent to virtually all surgical procedures. These risks can be drastically reduced with strict adherence to Dr. Panossian’s pre-and postoperative instructions.

Breast scars are usually covered within the bra line. An individual’s tendency for keloid or thick scarring is sometimes unpredictable and genetically predetermined. These scars can be treated with either steroid injections or surgical revision, if they should occur. 

Slight asymmetry between the breasts can also occur in relation to breast shape, nipple position, or differences in sensation. In the worst case scenario, the vascularity of the nipple and areola may be compromised and a portion of the nipple-areola complex may die. This is a treatable problem but surgical correction may be necessary. 

Dr. Panossian’s staff is available 24 hours a day to answer your concerns and questions regarding pre- and postoperative instructions in order to avoid complications. Patients are encouraged to call immediately in the event of a suspected problem.