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Breast Implant Revision

Dr. Shim Ching is one of Hawaii’s leading specialists in breast implant revision, performed at his Honolulu practice for patients who are considering improving their breasts after surgery done elsewhere. Unfortunately, breast revision surgery can become necessary after an initial breast enhancement surgery, and there are several reasons why this could happen. One is “implant malposition,” in which your implants may sit too low on your chest, too far to the side of the chest or armpit area, or too close together in the middle of your chest. You may have “capsular contracture,” in which firm scar tissue around the implant makes the breasts hard and misshapen. Rippling and wrinkling of the implants can also be a problem for revision patients. Your tissues may be very stretchy, or your implants may show signs of visible wrinkling and rippling. If you have experienced any of these issues following your original breast surgery, a revision procedure with Dr. Ching can correct even the most complicated problems and give you the beautiful, natural-looking breasts you were hoping for the first time!

If you’re considering a breast revision surgery, the first step is to request a consultation or call us at (808) 585-8855. In your initial appointment, Dr. Ching can evaluate your breasts and work with you to develop a plan for surgery.

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Your Breast Revision Procedure

During your consultation for breast revision surgery at Asia Pacific Plastic Surgery in Honolulu, Dr. Ching will evaluate your breasts and recommend the type of material to use and techniques to provide the best outcome. Dr. Ching was the first surgeon in Hawaii to utilize acellular dermal matrices such as AlloDerm® and Strattice™ for breast reconstruction, and he is one of the most experienced surgeons in the state in the use of advanced tissues in breast surgery revision patients.

Approximately 20% of Dr. Ching’s breast practice is revision or secondary breast revision surgery from patients who were treated outside of our office, and he is very experienced in correcting these very challenging problems. Usually, when you have one or more of these complications, your body is telling you that your own tissues are not strong enough on their own, so you need some additional tissue or implantable scaffolds to help support your weakened tissue or replace excessive scar tissue. The loss or lack of natural breast tissue to adequately cover a breast implant may also result in rippling, another unsatisfactory outcome following breast surgery.

Innovations in Breast Revision

For breast revision surgery at Asia Pacific Plastic Surgery, we use new materials such as the highly purified silk SERI™ Surgical Scaffold, along with porcine and human dermal tissues Strattice and AlloDerm. These products are revolutionary new materials that help provide support and eliminate undesirable outcomes, such as implant malposition and capsular contracture. Fat grafting is another important procedure that can improve the appearance of the breasts. These techniques enhance your breasts after prior surgery and help you achieve an improved natural shape, softness, and appearance.

What is SERI Surgical Scaffold?

SERI Surgical Scaffold is a new bio-absorbable, highly-purified, woven silk mesh that may be used during breast revision to support breast tissue. It is most useful in cases of implant bottoming out or symmastia.

Learn more about this new technology that is transforming breast revision surgery.

What is Strattice breast revision surgery?

Strattice and its human tissue-based counterpart, AlloDerm, are tissue substitutes that may be used in breast augmentation, breast revision, and breast reconstruction. Both are designed to help control the breast pocket location and size, support and hold the implant in place, reinforce malposition repairs, and offer an additional layer of tissue that may help mask implant visibility, wrinkling, and rippling. There is also increasing evidence that these techniques correct and reduce the chance of developing capsular contracture, which is the leading complication in all breast implant surgeries. Using this material and these techniques for breast revision, Dr. Ching has had great success in fixing recurrent capsular contracture that was not treatable by other methods.

Why might Strattice breast revision surgery be recommended for me?

Breast implants can permanently increase the size of your breasts and bring your body into better proportion. Strattice enhances the outcome of breast implants following breast surgery, decreasing the chance of further complications and future need for additional breast revision. The result for many women at our Honolulu practice is enhanced self-confidence and a more positive body image with longer-lasting results.

Common Breast Revision Questions

How can I resolve asymmetry of my breasts?

Patients will often see us because their breasts are not symmetrical after breast enhancement surgery. Adjustments can be made to the implants to try to achieve as much symmetry as possible. There are several ways to achieve breast symmetry: Different types of implants may be used, different volumes may be used, or changes in the pocket dissection may be used to help achieve as much symmetry as possible.

What is bottoming out?

Bottoming out involves inferior (i.e., downward) 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. It is the loss of internal implant support that can cause a slow downward migration of the implant. This is because support of the implant by the skin alone is not always enough to prevent downward migration of the implant. Also, over-dissection of implant pockets at the time of surgery may cause immediate bottoming out. This is corrected by “raising” the inframammary fold using internal sutures and supporting materials such as Strattice or SERI.

What is capsular contracture?

After breast augmentation surgery, excessive scar tissue may form around the breast implant, which causes the breast implant to harden (similar to what a contracted muscle feels like). There are different grades of capsular contracture, ranging from mild to severe. Correction of capsular contracture can be handled surgically by the removal of the capsule (capsulectomy) and placement of Strattice, which dramatically lessens the risk of the contracture returning.

What is capsulorrhaphy?

The capsulorrhaphy procedure, also known as pocket correction or use of internal sutures, involves closing a portion of the breast pocket to correct displacement of the implant. This can also be necessary when breast implants fall toward the axilla (armpits); the pocket needs to be internally sutured to keep the breast implant in the correct position on the chest wall. Supporting materials such as SERI or Strattice are usually used for additional support.

What is symmastia?

Symmastia — commonly referred to as bread-loafing or uni-boob — occurs when two implants touch one another in the center of the chest. If the breast implant pocket is over-dissected in the middle, this causes the implants to migrate toward the middle of the chest, causing symmastia. Correction of this involves suturing the medial part of the pocket closed, placing support materials such as SERI, and decreasing the size or diameter of the implants.

Other Problems Corrected by Breast Revision

Change in Size/Type of Implant

Some patients choose to change their breast size after undergoing breast augmentation surgery. The most common thing that patients say after breast augmentation surgery is that they wish that they had gone bigger. After a year or so, they may decide to remove their current implants and replace them with larger breast implants. Other patients may have gone larger when they were younger and are now ready to have a more natural look, so they decide to remove their larger implants and replace them with smaller implants.

Patients frequently decide to change the type of their implants as well. The most common change is from saline to silicone. These patients choose to go from saline to silicone because they have rippling, they want more of a natural feel, or just personal preference.

Deflation of Breast Implant

Breast implants may deflate or rupture for reasons such as trauma to the breast, injury from surgical instruments, normal wear and tear on the implant, and mechanical damage prior to or during surgery. If a deflation or rupture occurs, the treatment option is to return to the operating room, remove the ruptured implant, and replace it with a new breast implant. If the ruptured implant is a silicone gel implant, then care needs to be taken to clean out the ruptured silicone gel from the pocket area before replacing the breast implant with a new silicone gel breast implant.

Superior Displacement (Riding High)

This problem occurs when breast implants are too high on the chest wall and there is too much fullness in the upper breast. This displacement may cause the nipple-areola complex to appear low or appear to point downward. In this case, the pocket is lowered to allow the implants to settle into the pockets and have a nicer placement on the chest wall and more natural look.

Rippling/Palpability

When a patient doesn’t have much breast tissue or body fat, she may be able to feel the edges of her breast implants and notice implant rippling. Although the breast implants may be placed under the muscle (submuscular), the outer edge and cleavage areas are not covered by the muscle, and these are the most common places where rippling occurs. Correction of this problem may entail switching an implant from one type to another that’s less prone to rippling, such as replacing saline implants with silicone. In other cases, specific types of implants, such as the overfilled Natrelle INSPIRA® implants or the more cohesive Natrelle® 410 implants may be used. Strattice and fat grafting can also resolve rippling.

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Shim Ching, MD