Breast Surgery Revision

Revision is not a word that any breast surgery patient wants to hear, but the reality is that no breast augmentation lasts forever. Just as you may need to renovate a kitchen that was done in the 70’s, the same may be true for your breast implants. What seemed like a good idea at 20 may no longer fit your personality and lifestyle at 40, in addition to changes caused by aging over time.

Dr. Richard Restifo of Orange, CT discusses the various reasons why his patients seek breast surgery revisions and how, in most cases, it is for aesthetic, not medical, reasons.

Time + Gravity = Breast Surgery Revision

“Revisions are very common,” explains Dr. Restifo. He always tells his patients to keep in the back of their minds that in 10-15 years, “you may want a revision. None of this is permanent. Most women will have a least one revision in their lifetime. Sometimes more.”

The majority of these revisions are for aesthetic, not medical, reasons; a patient may no longer be happy with the appearance of her breasts, versus something went wrong or there has been a surgical complication such as capsular contracture.

The main reasons for a breast surgery revision are:

• The tissues of your breast have fallen due to time, pregnancy and/or weight gain/loss
• Your breast implants have moved out of position
• No breast implant lasts forever; they eventually wear out
• Your aesthetic goals have changed over time

“As talented as your plastic surgeon may be, the plastic surgery can not stop the two forces of nature: time and gravity,” explains Restifo. They will eventually cause the tissues of the breast to fall. Furthermore, implants, because they are moveable (which is a good thing because the movement of the implant is what helps make them look softer and more natural) can move out of place over time.

Your implants can also simply wear out. It used to be that the lifespan of an implant was about a decade. While that is no longer the case and the new gel implants are lasting much longer, they won’t last forever. And lastly, the size and shape of an implant that you might have wanted at 20 may be very different than what you are going to want at 40.

Surgical Challenges Going from Large to Small Implant

One of the trends that Dr. Restifo is seeing among his patients is the death of the very large implant. Most of his breast revision patients are “downsizing” their breast implant as they age, which can present certain surgical challenges.

“Sometimes when going from a larger size to a smaller size… you are left with a little bit of excess skin or hanging tissue and sometimes it’s necessary to tighten that skin,” explains Restifo. This is done with a breast lift. The excess skin is removed and the entire breast is lifted to a higher point on the chest, and the incision is typically placed either around the areola or under the crease of the breast. Along with the new implant, this delivers a more youthful looking contour to the entire torso.

Unsatisfied Patient Typically Seeks Revision within First Year

While most of his breast revision patients are switching out larger implants for smaller implants, Dr. Restifo also has patients who simply want their implants out. Others may need to have their implant pocket revised in order to place the implant in a better position if it’s moved over time. While it is possible to do a revision on only one breast, whether or not this is a good idea is really going to depend on the time frame.

If it’s been 10-15 years since the original implant surgery, then it, “makes sense to put in two fresh implants and start the clock back at zero,” says Restifo. While it is not any more challenging to do a breast revision on a patient who had their original surgery done elsewhere, Restifo does like to have the operative report from the first surgery since it will give him information about the actual implant, which is the most crucial information.

The unsatisfied patient tends to come in much sooner than the one who is simply suffering from the effects of gravity, time, weight gain/loss and pregnancies. For example, a woman may come to him after a year because she’s unhappy with how things turned out. At a year, you can be assured that the implant has settled and this is your final result. About half of Dr. Restifo’s revision patients are simply unhappy with their original result, and half are patients who were happy, but with time have become less happy with how things look.

Breast revision surgery can be very gratifying to perform. With any surgery, a patient starts at A and wants to get to C – but maybe the original surgery only got her to B. So, it is easier, in some ways, to only get a patient from B to C than it is from A to C. “So, they’re fun cases because you can take a patient that is unhappy and disappointed with the profession of plastic surgery and restore her faith in the specialty,” shares Restifo.