TakeTwo; A look at revision breast surgery:

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Plastic surgeon Nicholas Nikolov, M.D., explains to Sophie Gordon why revision of breast augmentation surgery may be required.

Simply put, there are two main reasons for having a revision of breast augmentation procedure. The first is that the patient simply doesn’t like something about the original procedure’s cosmetic outcome, and the second is that there are medical problems as a result of the first breast augmentation. “Probably half of the women I perform secondary surgery for come to me because they don’t like the way their breasts look — there were flaws with the original procedure,” says Dr. Nicholas Nikolov.

He explains that most revision surgery he has done for aesthetic reasons has been because the patient was not happy with the shape of her new breasts rather than their size. “However, it is not uncommon for the patient to want slightly larger breasts,” he notes.

Obviously it is preferable to avoid revision surgery altogether. But by good communication of needs and desires, getting two or three opinions before taking the
plunge, and doing research, a patient may be able to ensure a happy result.

However, sometimes secondary surgery is necessary because of a medical problem. The most common problem encountered by women with implants is capsular contracture. Formation of a scar tissue — a “capsule” — around an implant is a natural part of the human body’s inflammatory response to a foreign body.

Everybody will develop scarring around their implants but in most people, that scar layer is thin and unnoticeable, in some cases even helping to keep the implant in place. However, in some people, the scar layer can become thick and may squeeze the implant out of shape.

There can be several reasons for developing a thick scar. Minor bleeding may have occurred or a very lowgrade (clinically insignificant) infection may have developed (studies indicate that irrigation with antibiotic solution may lower the risk of capsular contracture). If it’s a serious infection, the implants must be removed, as antibiotics will not cure the infection alone. And then some people simply have the propensity to scar more. “Whenever you’re forming a scar, the body heals wounds by producing collagen,” says Dr. Nikolov. “Some bodies may turn off that mechanism a little early resulting in a weaker scar. In others, the mechanism may be turned off far too late and you develop too much scar tissue.”

For this reason, Dr. Nikolov advises most patients undergoing either primary or revision breast augmentation surgery to aggressively massage the breasts. “Moving the implant around and constantly pushing the scar away from the implant keeps the pocket a little bigger so it doesn’t contract and tighten around the implant.” He stresses that to be effective, massage should be undertaken daily for the first six months.

Patients who have had a capsular contraction will be advised to have a capsulectomy where the entire scar is removed. “Whenever I do a capsulectomy, I always put new implants in,” advises Dr. Nikolov.

Other problems that may occur that are major precursors to augmentation redos are implant deflation or rupture. It’s difficult to say how long an implant will last. Studies submitted to the FDA on saline implants show that on average, follow-up surgery took place after nine and a half years. The rupture rate of both saline and silicone implants is between 2% and 4%.