Revision Breast Surgery
One of the most challenging situations for a surgeon is to revise a procedure that has already been performed. By definition, this means there has been a problem, the patient is unhappy with the result, and a correction is being sought.
The type of revision in breast surgery depends completely on what procedure was done as the primary surgery – be it breast augmentation, mastopexy or breast reduction. Each of these procedures has its own list of complications which may have developed. The treatment for each must be individualized, and the patient needs to be thoroughly informed as to what is possible and what is not.
Revision surgery can be very satisfying for both the surgeon and patient, especially when a very difficult problem is solved. However, the results are also less predictable than with primary surgery, and in many cases patients need to be prepared for results which are less than ideal, despite having undergone a bigger operation than the initial one.
If you are considering surgery, you can request a consultation with Richard J. Warren, MD. A staff member will contact you to discuss the procedure, Dr. Warren's availability, and additional scheduling information.
Frequently Asked Questions
For revision breast surgery, the breast tissue has already been surgically altered. Therefore, the internal anatomy is not normal, there will be scar tissue, and some blood supply will have been permanently cut. Some of the normal surgical options will not be available and some surgical approaches will be more difficult to perform. As a result, difficult decisions need to be made and some objectives may not be possible. In the end, a customized approach is necessary for every individual case – each of which will present its own unique set of challenges.
The type of revision surgery will largely depend on the type of primary surgery performed in the first place. After a breast augmentation, common problems include capsular contracture (internal scarring around the implants), asymmetry, implants which have moved out of position, and distortions caused by contraction of the pectoralis muscle. After breast lift surgery, common problems are asymmetry, bottoming out of the lower portion of the breast, lack of upper pole fullness, unsightly scars, problems with nipple position, and a misshapen nipple/areola complex. After breast reduction surgery, problems are like those after a breast lift, with the added issues of size (breasts still too large, or too small), and partial or complete loss of the nipple/areola complex.
The surgery is performed at the Vancouver Plastic Surgery Center, under a light anesthetic. Every revision case will be different. Some may be minor, requiring only local anesthetic, but other cases may be complex requiring that new technologies be brought to the equation – including different planes for breast implants (in front or behind the pectoralis), the use of special sutures, or special materials such as acellular dermis, or fat grafting. Some of these procedures are less predictable than the original surgery, and are associated with other side effects and risks.
Revision breast procedures are usually performed under a light general anesthesia, although small procedures can be performed under local anesthetic with or without conscious sedation. Either way, the anesthesia is provided by an anesthesiologist who is certified by the Royal College of Physicians and Surgeons of Canada.
It is generally best if the patient returns to the original surgeon to discuss concerns with the results of a primary breast surgery. The original surgeon will have some advantages including an intimate knowledge of what was done during the primary surgery, and a feel for how that particular patient tends to heal. However, every situation will be unique in its own way, and it may be preferable for some patients, after further discussion with the original surgeon, to seek treatment elsewhere.
Comments made for primary augmentation and mastopexy also apply here. However, there is great variation in the magnitude of surgery required in any revision surgery. If a small revision is performed, recovery may be much faster and less involved than a primary procedure. Alternatively, revisional surgery may be of greater magnitude than the original, causing more bruising, swelling, and a longer recovery than the original surgery. Also, in some revision breast cases, specialized taping or undergarments are necessary for a prolonged period of time.