Corrective Breast Surgery
Cosmetic surgery to the breast is not without risks and long-term implications. Corrective surgery to the breast can be required in patients who have long-term problems with breast implants. Most breast implants are expected to deteriorate overtime. In addition, with natural changes to the breast tissue associated with pregnancies, breastfeeding or aging, the effect of cosmetic surgery carried out in young age is also likely to change overtime. The other reason patients might request revision surgery is the fact that they have an unsatisfactory result.
Corrective surgery to the breast demands expertise in assessment, understanding of previous surgery, range of implants available and other surgical techniques which might be required to improve the problem. Such expertise is only gained from a combined cosmetic and reconstructive plastic surgery background.
Problems with implants
Although silicone is a biocompatible material, it is a foreign body. As a result, the body naturally forms a sack of scar tissue around it which is called capsule. With time the capsule might harden and in severe cases the hardening might distort the shape of the breast pushing the implant high (capsular contracture). Surgery might be required to release the tightness and replace the implant or consider alternatives. It is expected that 10-15% of women who had breast augmentation with silicone breast implants will develop capsular contracture within the first 5-15 years.
Silicone breast implants might rupture with time due to wear and tear. If the ultrasound scan or MRI scan show that the implant is ruptured, the implant might also need to be replaced.
Breast implant replacement procedures range from simple to extremely complex depending on the problem and individual desires. The capsule might need to be removed and sometimes, the pocket for the new implant might need to be relocated to under the muscle or behind the breast tissue depending on the circumstances in order to achieve satisfactory result.
Permanent removal of implants
Some patients might decide to have their implants permanently removed. For instance, women who had breast implants for a few decades might decide to have them removed to avoid any possible revision surgery in older age when they might be less medically fit to undergo such surgery. These decisions are usually very personal so are decisions about considering additional procedures to improve cosmetic result following removal of implants. These procedures would typically be reconstructive in nature and expertise in reconstructive plastic surgery is required in order to achieve satisfactory outcome.
Revisional breast uplift (mastopexy)
The effects of breast augmentation on the appearance of the breast are expected to change overtime. The breast tissue in front of the implant will go through natural changes associated with pregnancies, breastfeeding and aging. The breast tissue would loose supporting ligamentous structures which, in turn, can result in sagging. Some women develop waterfall deformity when the implant still sits high on the chest whereas the breast tissue and skin hang over the implant. Revisional breast uplift (with or without exchange of implant or alternatives) might be required to improve the appearance of the breast. Again, these procedures are reconstructive in nature and expertise in reconstructive plastic surgery is required in order to achieve satisfactory outcome.
What to expect from the consultation
During the consultation, you will be asked about your desired size and anything related to the appearance of the breast that you feel is important to you. This will help the doctor to understand your expectations and determine whether they can realistically be achieved. You will be asked about your medical history, current medications, drug allergies, smoking and history of breast disease including family history. You will also be examined and the doctor will consider factors such as size, shape, nipple position and skin quality. Measurements will be taken which are necessary for planning for the surgery. You might be asked to obtain old notes or give permission to the surgeon to request your records in order to understand more about the procedure you had.
Medical photographs might be taken as well. You will receive a letter summarizing the consultation along with surgery fees. Typically, minimum 2 consultations will be required in order to allow time to absorb information and have an opportunity to ask questions.
Clinical psychology consultation might be suggested in order to better assess your expectations and the degree the problem is affecting you. Joined effort from multidisciplinary team helps to improve the overall outcome of surgery. If you are are over 40 years old, you would be required to have a screening mammogram before surgery. There might be other investigations required as well such as breast ultrasound or MRI in order to assess the integrity of implants.
Risks and implications will be discussed in detail during the consultation.