It has been my experience that most women who have had breast implants placed either for breast augmentation, breast lifts with enlargement or even for breast reconstruction rarely elect to have them removed permanently unless they have been experiencing long term problems. In fact, I have had numerous patients in their late 70’s and even early 80’s who needed either to have their implants removed or replaced with new ones due to rupture and most all opted for the replacement. They were so happy with their results and appearance that they could not nor did not want to imagine themselves without them.

There are, however, women who elect for a variety of reasons to have their breast implants permanently removed. A frequent question that they ask of this breast revision surgery is what their breasts will look like after the explantation (implant removal).

There are many factors that play a role in affecting the outcome so that there is not one simple answer to this question. The only consistent response to this is “smaller”. Some of the factors that can influence the final appearance of the breasts can include how long the implants have been in, their size, whether or not they are above or below the muscle (submuscular versus submammary), the quality of the skin, any and number of intervening pregnancies, any breast feeding and total duration, weight fluctuations and extent and even the existence of capsular contracture.

The following patient demonstrates a good result following breast revision surgery with removal of her implants but this is not representative of all results. This 40 year old woman had originally undergone a breast augmentation more than 10 years ago with saline implants that were placed above the muscle. Recently, she noted a deflation of the left breast implant (photos A, C and E) and just wanted the implants permanently removed.

A.) Before breast implant removal

B.) After removal of breast implant

C.) Before implant removal

D.) After surgery

E.) Before explantation

F.) After surgery

Her surgery involved the straight forward removal of the implants through her previous incision along the bottom of her areola. There was virtually no discomfort postoperatively and she was back to work within a few days. At little more than 3½ months after surgery, her breasts have a very pleasing appearance (photos B, D and F).

If you would like additional information on any type of breast revision surgery, on breast augmentation or for any other plastic surgery procedure that I perform, you can call my office at 480-451-3000. We would also be happy to schedule a complimentary consultation for you if you so desire.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

A not infrequent reason that women see me in consultation for breast revision surgery is that they have had their implants in for many years and are considering some “updating”. In the intervening time, often involving the child raising years, many have had significant changes in the appearance of their bodies including a noticeable increase in weight and girth and may have also developed drooping of their breasts. Some state that their breasts have felt hard for a few years and have developed an irregular shape.

The following patient of mine is a 54 year old woman who had her original breast augmentation performed 32 years ago which was followed by three pregnancies and three children (photos A, C and E). For the last several years she has noted firmness of both breasts and irregularities of shape. Her desire was to have larger, softer and more attractive appearing breasts but not very ostentatious.

A.) Before breast revision surgery (frontal view)

B.) After breast revision surgery (frontal view)

C.) Before surgery (oblique view)

D.) After surgery (oblique view)

E.) Before surgery (side view)

F.) After surgery (side view)

Her breast revision surgery consisted of removal of the old silicone breast implants which were still intact, resection of the calcified scar tissue that surrounded them (capsulectomy), recontouring of the pockets in which the implants were situated and placement of smooth surfaced, high-profile silicone breast implants which were substantially larger than the ones that they replaced. Their volume was selected based on her desired overall general cup size and was tempered to keep her outcome more age appropriate (photos B, D and F).

She experience little discomfort postoperatively and was up and around her house the day of surgery. The size, shape and proportionality were exactly what she had desired which made her quite happy, satisfied and proud.

For more information on breast revision surgery, breast augmentation or on any other plastic surgery procedure that I perform or to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Whether inserting implants for a breast augmentation or in breast reconstruction, the outcome is not always what was expected or desired. One such unplanned result is where the breast implants are so close together that they form a “uniboob” which is technically known as symmastia. A variant is where the implant on one side crosses the midline of the chest and extends to the other side. In my post of Dec. 14, 2009 (Etiology of Symmastia aka the Uniboob Following Breast Enlargement), I explore symmastia issue in some detail.

Though occurring far more commonly as a result of breast augmentation surgery, this condition can also manifest itself with breast reconstruction. It is not a rare problem but it can be quite challenging requiring very tedious and intricate techniques to correct. With the advent of AlloDerm®, Strattice® and other tissue matrix (dermal graft) options, the treatment can potentially be more predictable, desirable and permanent.

The following case of mine illustrates an example of a symmastia variant that was successfully treated with this approach. This is a 60 year old female who underwent an implant exchange a few years ago, replacing those which had been present from her breast augmentation performed 30 years. The symmastia occurred following this most recent procedure. She was very unhappy with the deformed appearance, contour irregularities, the substantial asymmetries, rippling of the skin which had developed and the limitations that she had in wearing many styles of clothes (photos A, C, and E). Notice the right breast with the implant extending well over to the left side and the associated irregular contour. The left implant is also significantly higher than the right.

A. Symmastia and deformities - before surgery

B. After surgery

C. Side view before surgery

D. After surgery

E. Before surgery - oblique view

F. After surgery - oblique view

Her breast revision and symmastia surgery consisted of exchanging her large broad implants for more projecting high profile implants that were smaller in volume and precisely placed. Contouring and repositioning of the tissues were performed and AlloDerm® tissue matrix graft was employed to meticulously secure and configure the breast implant placement.

The results shown just 7 weeks following the reconstructive surgery illustrate the substantial improvement in her breast positioning, contour and projection with resolution of the rippling that she was experiencing (photos B, D and F). Needless to say, she was quite satisfied with the outcome.

If you would like additional information on symmastia and its treatment, on breast augmentation, breast reconstruction or any other plastic surgery procedure or to schedule a consultation, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Breast revision is a commonly performed procedure that serves to address one or more issues in a woman who has previously undergone a cosmetic or reconstructive breast surgery. This can involve a prior breast augmentation, breast reduction, breast lift or even a breast reconstruction. Each individual has unique issues which have to be addressed accordingly in order to obtain more desirable results.

The following 62 year old patient underwent a prophylactic mastectomy with breast implant reconstruction 25 years ago (specifically called a subcutaneous mastectomy) due to a strong family history of breast cancer. This was followed by multiple procedures over the years in attempts to improve the outcome. She consulted with me because of the chronic and substantial pain that she was experiencing in both breasts, their extreme hardness as well as the significant and problematic deformities of appearance.

Prior to breast revision surgery - frontal view

Following breast revision surgery - frontal view

Before breast revision surgery - oblique view

Following breast revision surgery - oblique view

Before breast revision surgery - side view

After breast revision - side view

After breast revision surgery

Before surgery

In her photos you can appreciate the marked asymmetries of shape, contour and implant position with the right side being situated too high. The skin has extensive irregularities and folds and in areas is quite thin. Her nipples also are too low relative to the breast mounds creating far too much fullness higher up.

Her breast revision surgery consisted of meticulous removal of deforming scar tissue known as a capsulectomy, reshaping of the breasts and placement of AlloDerm® (a regenerative tissue matrix – dermal grafting material) in both sides for support, contouring, durability and increased tissue thickness. Appropriately configured and sized implants replaced those that were present.

The outcome of all this were significant improvements in the appearance of her breasts for which the patient was extremely happy and quite thankful. It also boosted her self-confidence tremendously.

If you have any questions regarding breast revision surgery, breast reconstruction or any other plastic surgery procedure that I perform or if you would like to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

It has been unequivocally clear to me that women prefer general anesthesia rather than a twilight anesthesia when undergoing a breast augmentation procedure. During my more than twenty two years of plastic surgery practice in the Scottsdale, Glendale and Phoenix metropolitan area, countless patients that consulted me for their breast revision surgery have recounted their highly unpleasant and very painful experience of having their breast enlargement performed with only sedation and local anesthesia. Many indicated that they felt wide awake. Even 15 or more years later, they still vividly remembered their horrible experiences – not something the operating doctor should be proud of.

An overwhelming majority of board certified plastic surgeons perform breast augmentations, breast revision surgery and breast lifts using general anesthesia in certified facilities such as outpatient centers and hospitals, using anesthesiologists – doctors whose specialty is providing anesthesia safely and effectively. It is a far more pleasant experience and overwhelmingly safe given everything else being equal.

Furthermore, in most of the situations where the twilight anesthesia (sedation with local anesthesia) is used, it is administered either by the operating doctor, a nurse anesthetist, a standard nurse or even worse, one of the physician’s office employees and is performed in an office. Quite a contrast in terms of safety, quality, standards and experience!

To compound the issue, more than likely the doctor performing the cosmetic breast surgery in these situations is not a board certified plastic surgeon. They may be an obstetrician-gynecologist, general surgeon or even a family practitioner or internist.

Would you really want these individuals who have not undergone long and rigorous training like plastic surgeons do performing your surgery?

I don’t think so!

If you have any questions regarding anesthesia and breast augmentations, breast lifts or breast revisions or on any other plastic surgery procedure that I perform or if you would like to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona