Breast Implant Revisions Aren’t Simple

When a lady comes to my plastic surgery practice in southern New Jersey for breast augmentation, we discuss that implants are not necessarily lifelong devices and that eventually a revision may be needed. The hope is that a revision is 20, 30, 40, or many years down the line. Unfortunately with breast surgery, sometimes a revision is needed soon after the initial surgery.

Revisions are needed for many reasons:
– size change
– implant leaks
– position change
– due to hardness
– due to asymmetry
– due to rippling
– due to shape of result
– due to healing problems
– due to synmastia
– due to bottoming out

I perform hundreds of breast enhancement procedures a year and believe that I can correct almost any breast deformity that comes to my office. I have developed a large breast implant revision practice with patients from Pennsylvania, Delaware, Maryland, and of course New Jersey coming to see me as it is something I commonly fix.

Some of them seem simple, and some of them seem quite complex, and yet in truth they are all quite complex. Any revision has statistically higher rates of problems as they are not unscarred canvasses but rather tissues that have already had problems. For ladies with capsular contracture, whatever risks and tendencies made her develop this in the first place is going to give her a risk of recurrence. Synmastia and overdissected implants pockets means often working with thinned tissues that need to be stitched and modified.

I saw two ladies this week inspiring me to write this entry. One of them has had about 9 surgeries already by 3 different surgeons. One of them has had at least 7 or 8 surgeries by 3 different surgeons over a long time period. Complicated cases like this are going to need complex plans to address them. Not only is scar tissue present, but blood supplies have been altered repeatedly and thus healing will be influenced by less blood flow. Every one of these ladies wants to look perfect, and while perfection is a great goal, the truth is that some things will be uncorrectable. An honest discussion about what can and cannot be corrected is paramount.

I am honest with my patients and certainly complications happen to my breast implant patients. If a surgeon denies this, run the other way because he/she is lying. Even with perfect technique and surgical execution things can go wrong. An informed patient is a better educated patient. Part of the healing process is dependent on the body and some people do not heal as planned. We often discuss the “art and science of plastic surgery” and simply put, even in the best hands, sometimes things do not go as hoped. Without an exact scientific study with 100% long-term followup I cannot give exact rates of problems, however I estimate a capsular contracture rate of about 2-3% in my practice, an infection rate of less than 0.25%, an significant asymmetry rate of 2%, a poor scarring rate of 2-3%, an incision healing delay rate of 1%, and tell my patients that any problem can happen to even the best of surgical candidates. I do everything possible to minimize these problems, and believe that I keep these numbers lower than many published data due to the techniques I use and my experience. I will also say that if I do have a lady with a difficult outcome, I stand by her as long as needed and do what I can to get her as good a result as possible in a difficult situation.

How can you optimize your outcome of a revision or reduce the risk of a problem in the first place? Find a surgeon who does a large number of breast cases. Find a surgeon who works mostly on the breast and body. Find a surgeon who is board certified by the American Board of Plastic Surgery, not some other board that claims to be the same thing. Is there a difference in board certification? I do not tell patients that I do a large number of facelifts. In fact, I tell them honestly that I simply do not do many facelifts. If you are having a facelift complication I am not the surgeon to come see for a second opinion. I believe the “jack of all trades, master of none” saying is completely true. Can I guarantee any individual patient a perfect result just because I have done thousands of breast surgeries? Of course not. I would not and I could not do so. Still I have a keen understanding of the problems, what causes them, the anatomy involved, the options to fix them, and the ability to do so.

A final story about a cosmetic surgeon in the Philadelphia area who claims to do more breast surgery than anyone else: Funny thing is that I have repaired so many ladies that he operated on initially that I have lost count. Just doing lots of surgery doesn’t mean doing it well. I cringe when I see some of his results especially when he tells the ladies that they have a good result and does not see the problem that they are concerned about. I recall a lady with a significant malposition from another philadelphia plastic surgeon who told her that she was fine and nothing needed to be done. She was so asymmetric that she was embarrassed to remove her shirt. After her difficult but successful revision she was literally able to pose for Playboy(TM) photos.

In a perfect world ladies from all over the country would not be coming to me to fix implant related problems. Problems are wide spread, and if you are having one, make sure that you find someone with experience and someone that you can trust to help repair the problem. Each successive revision is going to be more and more difficult, so rather than have ten surgeries to fix a problem, find someone who will optimize your chance at success. Good luck out there!

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