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Revision Breast Augmentation

One of the things I specialize in is revision breast augmentation surgery, usually after someone has already had breast implants (or augmentation) done before but is unhappy with the size, symmetry, shape, and/or feel of their breasts. Sometimes patients may have had breast augmentation elsewhere and might be unhappy with their size or shape. I routinely see patients for revision breast surgery cases in which the implants are exchanged; the “pockets” are changed (for example, if the implants are “above the muscle,” they may be switched to below the muscle); and/or the “capsule” has to be opened, removed, or even redesigned to allow the implant to “sit” better on the chest wall. Each particular patient’s case is really individualized and tailored to their specific concern and/or problem.

The most common revision is probably “capsular contraction,” which is a “hardening” that some women experience after having breast implants—mostly it is on one side but it can be also seen on both sides. This is more common in patients with “really old silicone implants” that have hardened, which is often caused by rupture or leaking of these very old silicone gel breast implants. Houston plastic surgeon Dr. James F. Boynton is very experienced at removing the old implants (and material if necessary), removing the old capsules, and replacing a new set of implants, which leads to improved shape and feel.

Revision Breast

Old silicone gel implants that were place 18 years before subglandularly (on top of the muscle) and likely ruptured.

The other most common situation that requires breast revision is malposition of a previous breast implant. Sometimes the implants can be too high (known as a “high riding” implant) or fall too low (known as “bottoming out”). Many patients experience implants that also fall to the sides (lateral malposition), especially when they lie down. Saline breast implants are typically “heavier” than silicone gel breast implants, and this can exacerbate the issue. Implants that get too close together can sometimes create symmastia (where the implants are touching). Each of these scenarios requires a well-thought-out, individualized plan that includes removing the old implants, choosing the right replacement implants, selecting the proper pocket and tissue plane, and revising the capsule—the latter of which sometimes involves tightening the capsule, removing parts of the capsule, shaping it, and/or adding an ADM (acellular dermal matrix) such as Strattice™. All of these techniques are extremely important in malposition cases.

Many patients with old saline breast augmentation (especially if they are on top of the muscle) really hate the “sloshing” of fluid that, in many cases, can be visible even on the outside in various positions, depending on how thin the tissues are. When this is the case, Dr. Boynton typically likes to remove the old implants, perform a site/pocket change to under the muscle, and replace the implants with one of several types of silicone gel implants. This often leads to a much more natural shape and better feel, and the wrinkles/ripples typically go away.

Another common revision is for patients that are “unhappy” with implants that are too large and they want to be “downsized.” This often involves removing the implants, “tightening” the capsules, and placing smaller implants. In some cases a breast lift may be also necessary, but Dr. Boynton has a technique that allows for some tightening “internally” without the need for adding a breast lift incision.

Implants can “drift” to the side or below the natural crease under the breast (malposition of breast implants), or they can sometimes be too close or even too “visible”—showing ripples and wrinkles that may not be desired. Dr. Boynton regularly performs revision surgery to correct these problems.

Neo Pocket Technique

Also referred to as the neosubpectoral technique, the neo pocket method for breast revision surgery can often be an excellent option for patients interested in downsizing/upgrading their implants, as well as those who are experiencing capsular contracture, malpositioning, and/or other complications from implants that have been placed underneath the pectoral muscle during a previous augmentation. With this approach, a new implant “pocket” is dissected in front of the anterior wall of the preexisting capsule, and the original pocket is then collapsed and secured to the chest wall. The inframammary fold (the natural crease underneath the breast) can also be raised and repositioned properly during the procedure for an optimal outcome. With the neo pocket method, a textured, anatomically shaped, form-stable cohesive gel implant is most commonly utilized, as Dr. Boynton has found that this type of implant creates the best results for most individuals.

Dr. Boynton is currently one of only a few plastic surgeons in Houston to offer the innovative neo pocket technique for revision breast augmentation surgery. The key advantage of this implant revision method is that it enables the new implants to be resituated underneath the muscle as opposed to changing their location to a subglandular position. Compared to other revision approaches, additional benefits of the neo pocket technique may include a quicker, more accurate procedure, reduced discomfort, and a diminished risk of future/recurring complications.

Ultimately, the neo pocket method has proven to help Dr. Boynton achieve beautiful, natural-looking results for qualified revision breast augmentation candidates.

Strattice™ Revisional Breast Surgery

Patients with weak or thin breast tissue, as well as those who have had implant rippling or capsular contracture that resulted from a previous breast augmentation, may benefit from an advanced dermal grafting technique called the Strattice™ Reconstructive Tissue Matrix, or Strattice™ ADM (acellular dermal matrix) breast revision. The Strattice™ reconstructive tissue matrix is placed in the breast pocket to re-enforce weak tissue and support new cell growth and regeneration of your own tissue.

A soft, natural product, Strattice™ basically works as an “internal bra,” providing the implants an extra layer of support and protection. It helps to secure the implant in place and reduce the potential for complications that may have occurred from the original breast implants. The Strattice™ ADM can also increase the chances of more natural-looking results.

The video below offers a more detailed look at Strattice™ breast revision and how it can enhance the results of revision breast augmentation.

Soft Tissue Reinforcement with GalaFLEX® Scaffold

In addition to Strattice™ ADM (acellular dermal matrix) for breast revision patients who need soft tissue support, Dr. Boynton offers the GalaFLEX® and GalaFORM™ 3D scaffolds—the latter of which is the only three dimensional scaffold with a reinforcing rim for support. Composed of a bioresorbable polymer that is fully compatible with the body, the GalaFLEX® and GalaFORM™ 3D scaffolds work to fortify and support areas of thin tissue while providing a lattice-like framework that stimulates the development of new, stronger tissues through the natural growth and development of collagen and blood vessels. Once placed, the bioresorbable scaffolds will safely and gradually break down through hydrolysis (the degradation of a material via water) over the course of about 18-24 months, ultimately resulting in regenerated tissue that can be as much as three to five times stronger than the breast tissue originally present.

In Dr. Boynton’s experience, the GalaFLEX® and GalaFORM™ 3D scaffolds help to provide exceptional reinforcement for the placement and protection of breast implants in revision augmentation patients with weakened and/or thin breast tissue. In essence, they are like internal bras that can greatly stabilize the position of implants. Furthermore, the GalaFLEX® and GalaFORM™ 3D scaffolds can be excellent for the correction of “bottoming out” and malpositioned implants, and due to the stimulation of continual tissue growth, they can often help limit the potential for any breast drooping that may be caused by the weight of implants over time.

Schedule a Revision Breast Surgery Consultation

If you would like to schedule a consultation to talk about revision breast surgery, please contact Dr. James F. Boynton. Our experienced plastic surgeon will be happy to answer your questions and discuss your goals.