The Surgeon Minute

It’s Often Revision, Revision Breast Surgery

It’s Often Revision, Revision Breast Surgery

No implant lasts forever; most breast augmentation patients are going to need at least one revision breast surgery at some point in their lives. This may entail replacing the implant, exchanging the implant for a different size and/or addressing issues with the breast pocket. However, many patients who had a successful initial breast augmentation have a much less successful experience with their revision breast surgery. Dr. James Namnoum of Atlanta, GA discusses why this happens and what to look for in a surgeon to ensure the best possible results from your revision breast augmentation.

Why Is Revision Breast Surgery More Difficult?

Patients who come in for a revision breast surgery consultation are often 10, 20, even 30 years down the road from their primary surgery. In many cases, these women have already had multiple revision surgeries on their breasts. Dr. Namnoum’s typical revision breast surgery patient got her initial implants in her 20’s with some sort of revision in her late 20’s to early 30’s that didn’t go well. They will often say, “The initial augmentation was fantastic so why have all these other operations been so not fantastic?”

The reality is that with each operation, the patient has:

  • a new sort of scar that can be external on the breast itself or internal around the device
  • the skin on the chest wall may have stretched
  • there is distortion of the breast pocket causing the implant to move

All of these issues lead to an alteration of the architecture of the breast, and with each subsequent operation, the issues compound with one problem piled on another problem piled on another problem. “It’s no wonder that their breasts no longer resemble…their initial augmentation,” explains Namnoum.

Imaging is Key

The challenge for the surgeon is not only trying to piece together what the patient has already been through, but also trying to better understand the patient’s goals. “It’s not unusual for patients to say one thing and mean something completely different,” explains Namnoum.

There is a proven disconnect between the words that are mouthed about the goals and the actual goals. This is where 3D imaging can be key. The ability to image breast augmentation results pre-surgery is an incredible tool that helps to ease patient concerns, as well as hone in on a desired outcome.

Vectra 3D imaging for breast revision.

3D imaging is a helpful tool to surgeons and patients, but can also be a double-edged sword. Sometimes the image presented to patients is too perfect and not representative of the end result and most imaging systems have a disclaimer warning that the images are not a guarantee of results. It’s a difficult situation because often patients want to see their end result a head of time, and at the same time, once seen, they cannot get that image out of their brains.  They expect what they saw. Balance is actually the key here – balancing patient education with visual references. “A job of a good doctor is to help the patient understand what is possible and what isn’t possible,” shares Namnoum

It’s Important to Find a Surgeon Who Really Listens

“Often, revision surgery is revision, revision surgery,” says Namnoum. The stakes are high. When a patient has had multiple “failed” surgeries, they’ve spent tens of thousands of dollars on their breasts, not to mention the time away from their lives and their families.

James Namnoum - breast revision before and after.

The surgeon wants to get it right this time. He or she does this by being thoughtful and really listening. It’s critical to find a surgeon who will take the time during your consultation to uncover the entire history of what happened with your breasts at every operation. The surgeon must discover:

  • What’s happening to the environment around the device? Does the patient have a capsule?
  • What’s happening to the pocket that the implant lives in? Is it stretched or distorted in some way?
  • What about the breast tissues that overlay the implant? Are they stretched, deformed or deficient?
  • What’s the position of the nipple in relation to the implant? Is it too low, off to the side or too high?

The surgeon can then come up with a plan — selecting the appropriate device for the patient, revising the pocket to fit the selected device, and managing the nipple and the soft tissues to create breasts that are soft, beautiful and natural looking.

Breast revision before and after.

“The critical element in any interaction with another human being is fluency. You need to understand them and they need to understand you,” says Namnoum. Imaging helps, yes, but it really comes down to listening. He will often take an hour and a half with his consults, picking apart the patient’s brain. Many patients react defensively to his “vulcan mind melt” at first because most of us don’t want to reveal that much about ourselves.

These women are also embarrassed. A lot of the time, their husbands haven’t seen their breasts in years. It takes some work to break through all their defenses, but it is vital for ensuring a positive outcome. “Patients really want to be heard,” explains Namnoum. They want someone who they think is listening because their kids don’t listen. Their mothers don’t listen. Their husbands don’t listen. “If you can establish that from the beginning, you can build a rapport built on trust, and empathy and compassion, and that often goes a long way even if there’s a problem.”

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