Revisionary Breast Surgery: Where to Begin

As the desire of breast enlargement increases, so does the need for revisionary breast surgery.  Breast Augmentation surgery is one of the most sought after “cosmetic procedures” performed today.  Revisionary surgery is often times more complicated than the original surgery and it requires a surgeon with expertise in the area and excellent skill to achieve the patients desired results.

Some of the most common revisionary breast surgery are because of deflation of a breast implant, capsular contracture formed around one or both implants, double bubble formation, etc.  Below you will learn about the most common revisionary breast surgeries performed and what to expect if you become a candidate for this surgery.

Symmastia

One of the more common problems that patients are seeking Dr. Pousti's help for is symmastia.  Symmastia more commonly referred to as bread-loafing or uni-boob, occurs when two implants touch one another in the center of the chest. If the horizontal muscle that is connected to the sternum and goes across the implant is cut during surgery, then the implant can move toward the middle of the chest.  A possible consequence of unopposed muscle action with overzealous medial release causing aesthetic disfigurement and additional issues with discomfort and apparel problems, symmastia is a difficult surgical complication to address.

Who is Susceptible to Developing Symmastia?

            Patients with multiple breast operations, excessively large implants or overaggressive medial dissection are susceptible to developing symmastia.  Symmastia seems to be more prevalent among thin women mainly due to the fact that thin women usually have less tissue or fat covering the sternum.  Also, patients with pectus excavatum, a depressed breastbone, are more prone to symmastia.  Attempts to increase cleavage by releasing the soft tissues or inner origins of the pectoralis muscles lead to symmastia by surgically interrupting the natural barriers of tissue and muscle at the medial location of the breasts where the cleavage is normally defined. 

How is Symmastia Treated?

            Symmastia is difficult to treat and recurrence is common.  Correction requires combined restoration of the initial presternal subcutaneous integrity and medial closure of the pocket.  In order to repair symmastia, the space between the 2 implants must be securely closed off.  The combination of medial closure of the breast implant pockets and suturing of the preseternal soft tissue to the sternum periosteum provides one satisfactory option to the surgical reconstruction of symmastia.  Often, it is necessary to “open” the breast implant pocket laterally (to the sides) to decrease pressure along the cleavage area.  There are several methods used to correct the deformity, such as allogenic dermal grafting, fibrin-based tissue glue, and delayed filling of an adjustable implant.

What to Expect after Revisionary Surgery?

            After corrective surgery, the patient is instructed to wear a t-back sports bra or “thong bra” for at least two months.  This brassiere is utilized to help apply pressure and assists in keeping the area stable allowing the area to heal and aiding in recovery.  After this specific surgery, patients are extremely careful to allow for full recovery.  Dr. Pousti is careful to follow up with patients and remain close by their side to ensure a full recovery.

Implant Mal-Position

One of the most common complications after breast augmentation surgery is implant mal-position. This occurs when the implant is in an incorrect position on the chest wall.  This may include incorrect position of the implant superiorly (“riding high”), inferiorly (“bottoming out”), medially (“symmastia or uni-boob”) or laterally (falling outward into the axilla). Dr. Pousti, at Pousti Plastic Surgery, has corrected these problems for many patients.

Bottoming Out

Bottoming out involves inferior migration of the implants.  This causes the nipple areola complex to appear too high on the breasts.  Also, the distance from the areola to the inframammary fold is too great.  This is corrected by “raising” the inframammary fold using internal sutures.  This is done after careful measurements are made from the areola to the “new” inframammary fold.

Tuberous Breasts

Tuberous Breasts have a very narrow base and usually a long skin envelope. Sometimes people refer to "Tuberous Breast" shape as the shape similar to "snoopy's nose". In the most severe cases of Tuberous Breast, a breast lift can be done through an incision around the areola, making the breast into a more rounded shape that the patient will be happy with. In many cases however, a lift is not necessary. The patient should be aware that the final result will take months to see and that they will need to be patient.

Lateral Displacement

Some post operative breast augmentation patients present with lateral (outwardly) displacement of the breast implants.  This can be corrected using an internal suture technique decreasing the size of the pockets and moving the implants toward the midline.

New Inframammary Fold

Some patients present with a short distance from the areola to their inframammary fold. Many of these patients wish to increase this distance and the “fullness” of the lower pole of the breasts. This distance can be increased in the operating room and the fullness of the lower pole of the breasts enhanced with the implants. A major portion of Dr. Pousti's practice involves helping patients who wish to enhance the appearance of their breasts (breast augmentation). Some patients present with the finding of a short distance from their areola to their inframammary fold. The patients often wish to increase that distance and the appearance of "fullness" of the lower pole of the breasts.  Careful measurements area made in order to achieve as much symmetry as possible – care is taken to avoid over-dissection and a resulting “bottoming out” of the implants.

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