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The vast majority of women who have undergone elective breast surgery—breast augmentation, breast lift and breast reduction—have been very highly satisfied with the results and would definitely make the same decision again. They share with us not just the obvious effects on appearance and markedly improved comfort with breast reduction but also the positive emotional and mental impacts. It is no wonder that breast augmentation usually ranks as the number one plastic surgery procedure selected by women or that the only regret that women have after having undergone a breast reduction is that “knowing what I know now, I should have done this years ago!”

As with any surgical procedure, there are many factors that can impact the outcome—both short and long term. These can be physician, patient, device and time related. Inferiorly performed surgery or using flawed aesthetic considerations will lead to substandard results and an unhappy patient. Patient related factors include unmet expectations and misconceptions, genetics, non-compliance, health-related concerns and injury. Breast implants, particularly silicone ones, are durable devices and can potentially last a long time but not necessarily forever. With the passage of time are changes which usually are not for the better: stretching and thinning of the skin, significant weight gain (or rarely loss) with alteration of body proportions, implant rupture or deflation, and evolution of our tastes and goals.

For these and various other reasons, another surgical procedure later in time is a significant probability. Some of the most common motivations for seeking breast revision surgery (secondary breast surgery) are:

 

Size of the Breasts

The most common complaint associated with breast augmentation is that they were not made large enough. It is very rare, however, that they are felt to be far too large (this is often related to particular surgeons who have earned the reputation for using disproportionately oversized breast implants).

With time, it is not uncommon for many women to decide that they would like to be even bigger. There are also those who want to downsize for a variety of reasons.

In women who have undergone a breast reduction, postoperative concerns with size issues are not very common. Over the long term, weight gain, loss or fluctuation or continued growth of the breasts can impact the need or desire for a procedure later in time.

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*Individual Results May Vary

Asymmetry of the Breasts

The majority of women have some degree of breast asymmetry prior to surgery. This can include dissimilarities in breast size, shape and positioning as well as of the shape, size and vertical position of the nipple. Though there can be a reduction in differences between sides through breast revision surgery, the breasts will never be identical in appearance and other factors.

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*Individual Results May Vary

Changing From Saline to Silicone Implants (or vice versa)

Silicone breast implants simulate the consistency of breast tissue far superiorly and feel considerably more natural compared to saline implants. Furthermore, they are also much more durable, generally lasting substantially longer than saline implants.

The vast majority of women who request changing the type of implant they have are going from saline to silicone. In my experience, it is very rare for a woman to want to switch from silicone to saline and it is usually not for aesthetic reasons.

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*Individual Results May Vary

Implants Not Positioned Appropriately

Improper implant positioning (malposition) can be caused by such issues as anatomic asymmetries or lack of meticulousness in the placement of the implants. In relation to their ideal position, the implants might be situated too high, low or close together or too far apart. Their placement can also be asymmetrical.

Implant Pocket Configuration Issues

During breast augmentation surgery, a space (also called a pocket) is created either behind or in front of the pectoralis muscle in which the implants will be placed. These implant pockets can be made too large, small, high, low or close together or irregular. There can be either too much or not enough space between the breasts. When they are so over-dissected that the breasts become confluent, this is known as symmastia or a “uni-boob.” The implants can also be placed too low, not low enough or unevenly. With over-enlarged pockets, the implants may shift abnormally far to one side or the other when leaning and/or lying down.

Capsular Contracture

Capsular contracture is the condition where one or both breasts feel firmer than normal or even hard, sometimes painfully so. This situation is caused by the development of constricting scar tissue that forms around the implants resulting in breasts that not only feel hard but can also be deformed in appearance. The incidence of this was greater in the past for a variety of reasons and higher for implants positioned in front of the chest wall muscle (submammary) as compared to those positioned behind the muscle (submuscular). Capsular contracture was also more prevalent among older types of silicone implants versus the ones used today.

Fortunately, there are a variety of techniques and precautions that can be taken that have been shown to reduce the risk of this developing.

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*Individual Results May Vary

Changing Implant Positioning from Submammary to Submuscular (or vice versa)

There are some general disadvantages of breast implants being situated in a submammary pocket (in front of the muscle) and some specific circumstances where the results are clearly inferior. By repositioning them behind the muscle (submuscular pocket), these issues can be addressed and with improved results.

The reverse can be performed though this is far less common.

Implant Rupture

Although they can be quite durable, breast implants are not lifetime devices. As a result and given enough time, they will probably need to be replaced. They could last up to 30 or 40 years depending on a variety of factors. Overall, silicone implants will last a lot longer than saline implants.

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*Individual Results May Vary

Implant Removal

While uncommon, some women decide that they no longer need or desire having implants any longer. This is not rare in women who have undergone breast reconstruction for breast cancer and have not had the smoothest reconstructive course.

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*Individual Results May Vary

More dramatic results from explantation:

*Individual Results May Vary

Skin Rippling Induced by Implants

Implant-induced skin rippling is virtually always associated with saline implants. The incidence and severity is substantially greater in women who have thin skin, those with large or disproportionately large saline implants, and where the implants are in a submammary pocket (above the pectoralis muscle).

Skin Stretching

Due to a combination of decreased skin tone and elasticity along with the effects of gravity, women who have undergone a breast reduction can expect that there will be some deterioration of their breast shape over time as well as a continuation of drooping. These changes will be exacerbated by sizable weight gains or fluctuations, pregnancy and by not wearing a supportive bra on a regular basis.

This is also true for women who have had a mastopexy with or without a breast augmentation. If there are large implants or they were placed above the muscle, stretching and thinning out of the skin along with breast drooping will occur

Breast Drooping (Ptosis)

Breast drooping does also occur independent of any previous breast surgery. Factors such as gravity, weight fluctuations, pregnancy and genetics are the common culprits. This elongation and descent of the breast (ptosis) can be addressed surgically with a mastopexy (breast lift) to help lift and restore a more desirable contour.

Breast Contour Issues

The presence of abnormally shaped breasts in a woman who has had previous breast surgery can be due to a numerous factors. These can be implant, time, congenital or genetics related or even as a consequence of non-ideal surgical technique, capsular contracture or weight issues.

Nipple-Areola Issues

The nipples and areolas (nipple-areola complexes) may be disproportionately large or small, situated too low or high, unevenly positioned or shaped, configured irregularly, inverted or over-projecting. These concerns can be genetic or post-surgical in nature.

Undesirable Scarring

Incisions can heal in a less than desirable fashion resulting in scarring that can be too wide, dark or painful. Scar revision and/or additional methods may be able to improve the final appearance of scarring.

Infection

Infections following breast surgery are relatively rare and may require surgical intervention. When this occurs in the presence of implants, then they may need to be either temporarily or permanently removed.

Implant Exposure

Implant exposure is where the implant is exposed to the outside due to either an area of skin breakdown or because of wound separation. This rare problem can be the result of breast infections, very large and “inappropriately” sized implants and breasts that have been previously exposed to radiation as part of breast cancer treatment.

With over twenty years of practice, Scottsdale plastic surgeon Steven H. Turkeltaub, MD has considerable breast revision experience including with all of the above issues. Although results can never be guaranteed, women have an increased possibility of realizing an optimal outcome by choosing a plastic surgeon who has the technical skill, experience, comprehension and appreciation of aesthetic principles.

Breast Augmentation Revision Before-and-After Photos*

The following before-and-after photos of actual breast revision patients at Dr. Turkeltaub’s practice show the true benefits of the breast revision procedure.

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*Individual Results May Vary


*Individual Results May Vary

Contact Our Practice

For more information about breast revision surgery, or if you are interested in scheduling a consultation with Dr. Turkeltaub, please contact our office today.

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