REVISION COSMETIC BREAST SURGERY
The multitude of cosmetic breast surgeries performed lately, often by inexperienced surgeons, may lead to complications and poor aesthetic results.
The normal failure rates in breast surgeries, combined with the large number of such surgeries performed in Greece lately, have cumulatively produced a large number of patients who seek revision surgery for their previous procedure. These procedures may be related to breast augmentation with silicone implants, breast lift or breast reduction.
Over the last few years, we have come across and treated many such cases at our private practice. We often wonder whether the large number of such cases reflects higher than globally accepted failure rates among plastic surgeons or simply our progressively growing reputation in this field.
Whatever the case, we must admit that there is a number of patients who require specialized care, giving rise to a special technique and frame of mind, which combine knowledge and experience in similar cases. Most of all, though, proper treatment requires accurate diagnosis of the cause of the problem and planning of the ensuing surgical technique.
The most common problems associated with breast augmentation are incorrect placement of the implant. For example, if the patient had adequate breast volume with slight ptosis, placing the implant under the muscles would potentially result in the implant staying high and the main volume of the breast sagging. In this case, the implant would have to be repositioned and the option of a simultaneous lift must also be assessed. Furthermore, if the pocket was opened more centrally, the nipples may point outward. If this has been done symmetrically, the problem may be ignored; however, if the pockets differ from one breast to the other, the nipples will point at different directions. In this case, revision surgery will focus on correcting the pockets. At other times, one may notice intervention in the inframammary fold, resulting in the implant ending up lower and the nipples higher than normal. In other cases, the reason for the deformity may the choice of silicone implant. The observed problems include wrinkling, palpable implants, or even crooked implants, with development of the well-known capsule, which cannot be easily predicted without prior hematoma or minor infection. In these cases, the implant must be replaced with a better quality one, or one with different features or shape. In any event, revision breast augmentation surgery requires experience so that the problems may be diagnosed properly. In other words, it is not a conventional procedure that one may be trained to perform.
In breast lift surgery, the problems may include asymmetrical, high nipples, empty upper pole, partial nipple necrosis and deformed dog-ear scars, which alter the round shape of the breast. If this technique, and especially breast reduction, is selected by a surgeon without the necessary experience, the aesthetic results may be poor, leading to anisomastia, flat non-protruding breasts, distortion of the normal inframammary fold, and distortion of the round shape of the lower-inner quadrant. As a result, an attractive cleavage may be forever ruined and however hard a woman may try to find the right bra to enhance it, she will not be able to. Any corrections of such deformities must be carefully studied each time, properly diagnosed and then restored. Some times, the cause of the deformity may be very simple and the problem may be corrected with local anesthesia and a minor procedure. At other times, though, a major procedure may be required, with complete modification of the technique and possibly placement of an implant in a breast that had previously undergone breast reduction surgery. In such cases, the surgeon may need to improvise, using a wide array of plastic surgery techniques and following the principles of revision surgery. Even the use of a local flap may be considered, always adhering to the principles of plastic surgery, so that the shape and function of the breast may be restored. In short, surgeons must have training on plastic surgery, long experience and, of course, creative imagination.