The Surgeon Minute

Managing Patient Expectations with Breast Revision

Managing Patient Expectations with Breast Revision

A breast implant is not always a lifelong device. As the most popular cosmetic surgical procedure in the world, many breast augmentation patients get their original implants while still in their 20’s. Over time, that patient’s aesthetic may change. What looked perfect at 22 may no longer look right at 42. And while wanting a different breast size is the number one reason why most patients seek breast revision surgery, there are others.

Though rare, an implant can rupture. Some patients develop capsular contracture (a hardening of the pocket around the implant), while weight gain/loss, pregnancy and hormones can also adversely affect the appearance of augmented breasts. Board certified plastic surgeon Dr. Adam Hamawy of Princeton, NJ discusses breast revision surgery and why it’s never as easy the second time around. 

Reasons for Breast Revision Surgery  

Whenever Dr. Hamawy performs a breast augmentation, he discusses with his patient the fact that at some time in her life, “your implants will need to be changed.” There is no hard and fast rule as to the lifespan of a breast implant; surgeons used to say 10 years, but that is no longer the case. Certainly if you are young when you get your first implants, “you may grow out of them” explains Hamawy.

They might begin to feel a bit too small for you or a bit too big. There is also the possibility of:

The latter tends to occur when the skin and tissues of the breast become stretched or weak, often due to:

  • weight gain/loss
  • pregnancy
  • breast feeding
  • age 
  • hormones

This compromised tissue is no longer capable of holding your implant in it’s original position, so it may drop or move to the side. While none of these things may happen and some patients have their original implants for decades, it’s always best to be aware. “If you plan for it, you won’t be surprised if it happens,” shares Hamawy. 

What is Breast Revision Surgery? 

Breast revision surgery is a procedure to exchange or remove your original implants. However, no secondary surgery is ever as easy as the first time around. Every patient is unique, so different techniques are needed depending on what you are trying to achieve.

Breast revision issues.

For patients who are wanting to go a little bit larger, the surgery is a fairly simple exchange of the smaller implant for a larger one. On the other hand, “going a little bit smaller is not as straightforward,” explains Hamawy. This is because if you want to reduce the size of your implant, the plastic surgeon will also need to reduce the size of the pocket in which your implant sits. 

Pocket Reduction & Soft Tissue Support

If the patient has a saline implant, Dr. Hamawy will often deflate the implant before breast revision surgery in order to give the skin and breast tissue a chance to retract, and for the pocket to naturally get smaller. This makes the subsequent surgery much easier. For those who have silicone implants however, he will remove both the implant and the capsule that naturally forms around any foreign device in the operating room. He will then close the pocket so that it is possible to fit a smaller implant without the breast sagging too much. 

Sometimes, a patient will have asymmetry between the two breasts, or breast tissue that is no longer strong enough to hold an implant in place. For these situations, Dr. Hamawy may add some soft tissue support in the form of a mesh to redefine the outlines of the breast.

GalaFLEX mesh for sagging breasts.

In the latter case, he may also combine the implant with a breast lift. If there is capsular contracture, which is a hardening of the capsule around the implant, he will need to remove the implant, the capsule, and oftentimes change where the implant is located. For example, if your implant was above the muscle, he will now place it below the muscle and vice versa. 

Breast Revision Surgery Patients Expectations are Different

A successful breast revision surgery requires planning and an honest discussion with the patient about what to expect. Breast revision patients typically come into the office disappointed. For whatever the reason, their breasts do not look right. Sometimes, they have not looked right for a long time.

Expectations during breast revision.

The patient is frustrated, angry and possibly a little scared. This can make them more difficult to deal with because, ironically, they have extremely high expectations about what a breast revision can deliver. It’s up to the surgeon to make sure that the patient’s desired outcome is actually attainable. Many times, breast revision surgery is more expensive than a breast augmentation because the patient may need soft tissue support or a breast lift. This increases the time in the operating room. It’s vital for the patient to understand exactly what can be achieved.

3D Imaging Helps Manage Patient Expectations

3D imagining is an incredibly helpful tool for managing a patient’s expectations, as it allows surgeons to show the patient what an implant will actually look like on her body. Dr. Hamawy always encourages his breast augmentation patients to clear their minds of numbers, such as bra sizes, and instead, focus on how you want to look. This helps the patient to feel confident in her choice.

3D imaging with Vectra.

However, if a patient is waffling between two implants that are close in size, he always advises them to go with the larger size. Why? Because the most common reason that he sees patients for breast revision surgery is because they went too small the first time. The nice thing about breast revision surgery is that it allows patients to feel happy with their breasts over time, no matter what changes life may bring.

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