Breast Revision Bellevue
Dr. Parikh has trained with plastic surgeons that are world class pioneers in this area at Vanderbilt University. Namely, Dr. G. Patrick Maxwell, Dr. Jack Fisher and Dr. Bruce Shack. Breast correction surgery will most likely involve the removal and replacement of saline or silicone breast implants. It is usually done in the setting where larger or smaller implants are replaced. or due to any complications. A good contour and shape will be the goal. Fat grafting techniques can also be used to hide certain defects in the breasts or improve shape and size. Removal of an old capsule or creation of a new pocket may be needed. In addition, placement of mesh ie. (ADM) may be needed to correct certain deformities like rippling, thin skin, implant palpability or capsular contracture.
Candidates for Breast Correction Surgery:
There are multiple reasons to perform breast correction surgery.
- Chronic pain
- Implants are too high
- Nipple is too low
- Hard breast or Capsular Contracture
- Feeling of the implant through the skin or implant palpability
- Seeing the implant borders through skin
- Rippling of the skin
- Hypertrophic scarring
Candidates are generally healthy and nonsmokers. Breast correction surgery has already posed a higher level of difficulty and minimizing the risks of complication or recurrence is paramount. The more surgeries in the breast has undergone the most difficult to attain an ideal outcome.
Breast Correction Surgery Indications
Rupture can be spontaneous or traumatic. Both saline and silicone implants can rupture.
Silicone Implant Rupture: The newer generation implants have improved technology in the gel filler and barrier or shell of the implant. Ruptures may be subtle with no frank leak of gel to the surrounding breast. Some of the gels are more cohesive meaning they are more “sticky” like a “gummy bear” where even with severe rupture the gel still maintains a good shape and can minimize silicone leakage into the breast. Silicone implant ruptures can be silent or undetected clinically by the patient. These can be detected best by MRI where a “linguine sign” may be noted. If an implant shows evidence of rupture it should be replaced. The FDA recommends a MRI 3 years after silicone implant placement and every 2 years thereafter to monitor for silent ruptures.
Saline Implant Rupture: Saline implants can rupture. Usually these are clinically detectable by noticing a size difference on the ruptured side. The leaks can be slow or fast. The saline is absorbed by the body and generally has no adverse effect. If a saline implant has ruptured it should be replaced.
Capsular Contracture “scar tissue”. It is normal for the body to form scar tissue or fibrosis around foreign bodies placed in the tissues. The body reacts to the implant by forming a capsule around it. This is a normal response. However sometimes that capsules can contract or become constricting around the implant which pushes on the implant and can result in deformation of the breast or pain. Capsular contracture can be treated in different ways ranging from capsulotomy (cutting the capsule) to capsulectomy (removing the capsule). Capsular contracture may or may not recur after treatment.
There are 4 grades of capsular contracture (Baker Scale)
- Grade I — no visible or palpable changes, breast looks and feels normal
- Grade II — no visible changes, but the breast are mildly firm and the implant can be felt
- Grade III — visible changes deformity, moderately firm and the implant can be felt
- Grade IV — visible changes deformity worse, harder, tenderness and pain
The term “Rippling” in breast augmentation refers to lines or wrinkles seen on the breast mound. This is commonly due to lack of soft tissue coverage over the implant. It can occur with either saline or silicone gel implants. The capsule around the implant is adherent to the underlying soft tissue of the breast traction from the implant pulls on the capsule which pulls on the soft tissue and skin. This is different from stretch marks or striae which can be seen after breast augmentation from the excessive stretch on the skin envelope.
Malposition (Rotation of Implant)
Implants can move within the breast pocket created. Malposition is less common with round implants since the implant is circular in shape and equal in base dimension. Shaped (anatomic teardrop) implants on the other hand have different height vs width dimensions. Therefore if the implants rotate it will show deformity of the breast. Make sure that your plastic surgeon has experience with shaped implants because of the technical issues (pocket dissection) that can arise with these implants.
If you’re looking for a surgeon who is honest, has impeccable attention to detail, and very skilled, Dr. Parikh is your surgeon. He performed a breast implant replacement and breast lift, along with liposuction on my abdomen area. I’m very excited about the results. I didn’t have one second of anxiety or concern. He listened to my to all of my questions and desired outcomes. I was at ease the moment I chose him as my surgeon. I would recommend him to anyone and everyone, and I would definitely go to him again. He’s a class act.
Need for Revision or Reoperation Surgery
Revision or reoperation can occur with breast augmentation. The most common indication for revision surgery is a size change of the implant. Other reasons for revision include malposition, rotation or bottoming out of the implant. Revision surgery can involve lifting the breast tissue (mastopexy), treating asymmetry between the breasts, removal of the implants, or removal of the implants and exchange. Many techniques can be employed in revision surgery such as fat transfer or the use of mesh (acellular dermal matrix ADM)
With any surgical procedure complications can occur, but are generally low. We encourage that you ask about complications during your visit with Dr. Parikh. Dr. Parikh will ensure that your safety is first and discuss any concern in great detail that is tailored to your specific medical history.