Before scheduling any revision to previous breast surgery, every Plastic Surgery patient should do her homework!

Breast revision surgery often is quite complex, and it is much more involved than simple primary cosmetic Plastic Surgery of the breasts. A “primary procedure” refers to a cosmetic breast augmentation, breast lift, or reduction where this operation is the very first surgery a woman has had on her breasts.

The goal is for this procedure to be the only one!  However, not all women are satisfied with their initial results in some cases, and time or other factors can create changes that cause women to seek a revision.

Revision breast surgery refers to any additional procedures after the primary surgery, where the goal is to improve upon the results and often to achieve better symmetry—or to correct other problems such as symmastia, capsular contracture, and/or bottoming-out.

When an implant and a breast lift are combined, this procedure is called a mastopexy-augmentation.  Not all Plastic Surgeons are comfortable combining these two procedures; experience and skill are key when success, symmetry and beauty are to be achieved.

On occasion, the revision will involve deflation (of saline implants) or removal of implants altogether in the office under local anesthesia (saline or silicone gel implants).  A breast lift may or may not be necessary after explantation.  Learn more about what happens to the breasts when implants are removed here.

Other breast revisions involve changing the plane of the implant from under the pectoralis muscle to on top of the muscle.  This is my most common revision procedure involving implants.  Learn all about this option for both cosmetic surgery and reconstruction in this blog post.

Many of these specific deformities are related to breast implants, and they can be difficult to correct. Seeing a Board-Certified Plastic Surgeon with experience in secondary/revision breast surgery is important.

Often, Plastic Surgeons who commonly specialize in breast revision are also experts in breast reconstruction.  Many of the principles and techniques used to correct these types of deformities are directly related to advanced breast reconstruction techniques.

The most common breast revision technique in 2016 has definitely been free fat grafting to the breasts, also known as lipo-filling.  I currently only recommend this procedure for reconstruction after a woman has undergone breast cancer treatment.  Learn all about fat grafting here.

It is important to keep in mind that breast revision is a challenging procedure, and it is not done (or done well) by most Plastic Surgeons!

There is a reason that the reality show “Botched” was created—there are many examples of bad Plastic Surgery out there, or cases where the patient is dissatisfied and is seeking correction. Some days, I feel like I could host my own “Botched Breasts in San Francisco” show, given the cases I see and am asked to “fix”!  See my post from the very first episode of “Botched” that I live-blogged, for interest.

Breast revision is always tailored specifically to each patient to achieve her particular goals for surgery.

When evaluating potential patients for breast revision, I ask myself the following questions:

1. What specifically is creating this patient’s deformity or complaint about her breasts?
2. What breast revision options are available to treat this problem(s)?
3. Can this patient’s complaints be adequately addressed by breast revision?
4. What is the likelihood that we will achieve her goals by performing surgery?
5. If this were my sister or my good friend, what would I recommend to her?

I treat each of my patients as if they were friends or family. And, sometimes, the best option is to say “NO,” or to not jump into surgery right away.

However, if I feel the patient is a good candidate for revision and she is fully informed about what to expect, the recovery period and what results she can reasonably anticipate, we can usually make things better!  

For more information about breast revision, or if you have any specific questions or concerns, I would be more than happy to speak with you one-on-one during a consultation. Just contact my practice today.

Complete our online consultation request form or call 415-923-3067 to learn more.

– Dr. Karen Horton, Board-Certified Plastic Surgeon