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Breast reconstruction is generally not a one and done endeavor. That is, just one procedure is needed to obtain the final reconstructive results and you then live happily ever after.

No, that is not very common at all.

Whether the reconstruction is immediate or delayed and whether it is implant or autogenously based (using one’s own tissues), generally one procedure will not be the last one done or needed.

And that is just as relates to the initial reconstructive period.

If tissue expanders are used, by definition there will be at least two “initial” procedures. The first procedure involves placement of the tissue expanders and whatever else needs to be addressed. Another procedure will need to be done to remove these and place the more “permanent” implants.

Implants are not permanent devices so given enough time, they will break down and ultimately will need to be replaced or removed. They could last 5 years or up to 30 years or more. There could also be other reasons for more surgery such as the development of capsular contracture – hardness of the breasts from firm scar tissue forming around the implants.

Improving the reconstructive results after the initial reconstruction, also known as breast revision surgery, is often desired by patients. This could occur a week later or it can be five, ten or more years later. There are so many reasons that revision of a breast reconstruction would be performed. Some of these reasons are medically related while others are patient preference. The following are common reasons for revision of a breast reconstruction (in no significant order):

• Complications from initial reconstruction
• Asymmetry of breast size, shape or location – either early on or that have developed over time
• Patient unhappiness with breast size from reconstruction
• Contour irregularities
• Implant rupture
• Pain
• Capsular contracture
• Infection
• Size changes over time due to weight increase or decrease
• Patient general unhappiness with outcome/want overall improvement of the reconstructive result
• Implant exposure
• Desire just to have implants removed and no longer in body – for whatever reason

The following patient of mine exemplifies a common reason for a woman to desire a secondary breast reconstruction. This 60 year old female underwent a bilateral mastectomy by a breast surgeon with immediate bilateral breast reconstruction by a plastic surgeon. Silicone breast implants were placed in front of the muscle along with the usage of mesh. (Photos A, C and E).

She had several issues with the outcome that included the appearance and symptoms she was experiencing. These included significant asymmetries, contour related issues, skin laxity and palpability of the mesh and implants. Her desire was to improve the results as much as could be done in one procedure without getting too complex. There was no desire for creation of nipple-areola complexes.

A. Before breast reconstruction revision surgery

B. After breast reconstruction revision surgery

C. Before revision

D. After revision

E. Before revision

F. After revision

To address these issues for her breast revision surgery, I used far more projecting silicone breast implants that were ultra-cohesive, employed acellular dermal matrix (ADM) on both sides for support and increased tissue thickness, released and removed scar tissue and did bilateral breast contouring. (Photos B, D and F).

The results were exactly what she was seeking so she was extremely happy with the outcome.

If you are considering revision surgery of your breast reconstruction, please feel free to call our office at (480) 451-3000 or contact us by email for more information and to schedule your consultation.

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

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