Breast Revision in Westchester County, NY

Breast revision surgery can be needed for a variety of reasons. Overtime, a patient's existing breast implants may become damaged, misplaced, or ruptured, causing the appearance to be altered and unnatural. In other cases, patients may not be satisfied with their results or wish to alter the size of the implants. Dr. Michael Suzman is a skilled, board-certified plastic surgeon who can provide an informed, private consult at Summit Group's Westchester, NY, Greenwich CT or NYC  offices. During the consult, he will address each patient's needs and collaborate with them on an individual plan to help achieve their aesthetic goals. Dr. Suzman is skilled in breast revision surgery and will help each patient reach the ideal results that best fit their needs.

-Failed implant reconstruction from poor healing,  seroma, skin loss, or infection
 

About  7% of patients may have to have their implant removed because of poor healing over the implant.  Sometimes the skin overlying the implant has inadequate blood supply to heal, other times the body generates excessive swelling fluid reaction to the implant (seroma) that impairs healing. Both of these conditions provide “nutrition for bacteria” and can result in  infection and need to remove the implant. Patients with the following risk factors are more likely to have a failed first go at reconstruction: Overweight, multiple medical conditions (high blood pressure, diabetes smoking, known healing or bleeding problems), need for chemotherapy after surgery, previous radiation therapy, thin skin flaps, or skin tension too tight over implant.  If an implant needs to be removed , it usually happens within a couple weeks after the mastectomy surgery.  Patients typically heal well. All hope is not lost! Patients can go on to successful reconstruction. Typically, I advise waiting until after all cancer treatments  are complete. Then, placing  a new tissue expander and resuming reconstruction is possible.  Healing  risk of problems is much lower in this setting, as the skin and tissues over the implant are now stable and healed, not the freshly operated on skin flaps immediately after a mastectomy. If a patient has had previous radiation therapy, then bringing in non-irradiated, healthy skin is essential. The latissimus flap from the  back is typically ideal and can create a natural pleasing shape over an implant.  Abdominal-based flaps are also helpful in patients with an ideally sized donor site and can result in fantastic outcomes in the proper patient.

 

Inadequate size : too little projection or too large, heavy and broad
 

Many patients feel that the implant reconstruction does not provide the desired  amount of size and  breast projection. Too little projection is the most common size complaint. Sometimes there are limits to how large an implant or how much tissue expansion one can safely undergo after mastectomy. But once the body is well healed over 12 months or more, there is no reason that additional volume cannot be added with a better shaped implant or addition of fat grafting. Often this group of patients started with a single stage direct to implant reconstruction, or had a limited amount of skin to accommodate a larger or more shaped implant. With a combination of changing from a round implant to a more natural shaped implant and fat grafting (taking fat by liposuction from the abdomen or thighs), results can be gratifying to patients and surgeons alike.

Implants that are too broad , heavy or large more often occur in patients who have larger breasts or more excess to start.  Downsizing implants and narrowing the skin and soft tissue coverage can usually make significant improvements in a relatively brief outpatient surgery.  Patients often feel less discomfort from downsizing the heavier implant to one that stretches the tissues less.
 

There are 3 major breast implant manufacturers in the U.S.-- Allergan, Mentor and Sientra. Each offers a variety of shapes and sizes to get the best results possible, and each have a similar safety profile. Our practice has found Sientra shaped gels to offer the best results in softness and shape. Mentor has some implants with excellent projection for a fuller look that we like using.  Allergan is a long-time implant leader as well, with a large variety of shapes and sizes available.
 

Rippling or hollowing of the upper chestSometimes in thin skinned patients, the round implant does not adequately recontour the upper chest. A mastectomy removed breast tissue all the way up to the collarbone, and the abrupt transition from a round implant to the thin chest muscle and ribs can sometimes look unnatural. Creases and ripples in the skin can develop. A change to a higher projected implant with more height, along with fat grafting,  can help.

Poor Nipple  shape or position

Sometimes nipple reconstruction shifts or does not turn out as planned as the body heals. In other cases the natural nipple is preserved,  but forces of skin contraction during healing result in an improper contour or position. Reconstructing the nipple and areola with a combination of minor skin flaps and eventual tattooing for repigmentation can result in great improvements, with a very realistic appearance of the breast. The nipple reconstruction really brings the breast reconstruction to life. By making nipple and breast more realistic, patients can get dressed each day without a strong visual reminder of their mastectomy surgery, and they can focus on the important matters of the day.  A small outpatient procedures can really make a tremendous difference.

Tightness of the implant capsule causing pain or deformity

The natural healing mechanisms of the body result in internal scar and contracting of the skin and muscles around an implant.  Usually, the scar capsule that forms is helpful- keeping the implant in a proper position. On occasion, maybe as many as 1 in 5 patients over time, the capsule continues to contract and tighten, causing displacement of the implant and discomfort. Sometimes the capsule is quite normal but the weight of the implant exerts force on the muscles of the chest, causing soreness. There are a variety of treatment options, form a surgical release of the capsule, adding some additional tissue to support the implant (acellular dermal matrix graft, such as Alloderm) or in severe, recurrent cases, use of a tissue flap surgery or removal of implants altogether.  The bottom line is, there is no reason to live with discomfort or deformity. Seek out a plastic surgeon who performs this type of revision implant surgery all the time.  There are times when your result is good enough and it’s best to leave things alone. You can make this decision with the help of a caring and talented plastic surgeon.

Congratulations on making it through breast surgery.  We hope this information helps you on your path to years and decades of good health!