Breast augmentation is one of the most popular aesthetic plastic surgeries performed. I have personally performed over three thousand implant based breast surgeries in my career. Many women considering the procedure are concerned about needing additional operations down the road after breast augmentation. I feel that if the original surgery is done properly with appropriate choice of implant size and placement techniques, the need for additional surgeries can be greatly minimized.
In this article I want to discuss the common causes of revisionary breast implant surgery, and the solutions to these sometimes difficult problems. I am often asked why I am biased against excessively large breast implants. The reason is very straight forward. My goal in any breast implant surgery is to provide natural results with the lowest potential revision rate possible. Large implants have higher revision rates, in fact, much higher revision rates. This is primarily due to the excess weight large implants place on the breast tissue and skin. Additionally, some surgeons are willing to alter the breast folds under or at the outside of the breast to accommodate larger implants than what would normally fit. Releasing breast folds to accommodate larger implants dramatically increases the incidence of implant mal-position down the road. Implants can drift out to the side, drop below the normal fold underneath the breast, or even touch in the middle of the chest. These problems are much more common with over-sized implants. Measurements of your chest wall should be done prior to deciding on implant size to avoid this problem.
The most common reason that breast implant revisionary surgery is required is a phenomenon called capsular contracture. A woman’s body forms a flimsy capsule around breast implants when they are inserted. In some women, this capsule can become thick and firm, leading to breast pain and shape distortion. In the last few years, it was discovered that implants placed through the areola or armpit have dramatically higher rates of capsular contracture, and that is why I always place implants through the fold underneath the breast.
Rippling or wrinkling of implants can occur leading a patient to desire implant revisionary surgery. This occurs when tissue over-lying the implant thins excessively. Tissue thinning, rippling and wrinkling and implant mal-position are all more common with saline than silicone implants, particularly when the implants are large. It is also a much more common problem when implants are placed on top of the chest wall muscle.
I have discussed the three most common reasons for breast implant revision surgery: Implant mal-position, scar tissue (capsular contracture), and wrinkling and rippling. Now, what can we do to improve these problems? The good news is, there are now products available that make these surgeries far more successful than they used to be! Flipping old implants out and new ones in with a bit of pocket re-suturing rarely holds up over the long haul. Those techniques of yester-year were simple and quick, but led to high re-revision rates. Instead, when I am faced with the need to correct the problems described above, I use a product called Strattice. It is a thin bio-engineered piece of skin derived from pigs. The product is unique in that it is both very strong and very pliable. It is put through a biochemical process that takes the pig cells out, but leaves the strong collagen lattice work behind. Your own blood vessels grow into the lattice work, thickening your own coverage of your implants. This property of Strattice reduces any chance of wrinkling or rippling. The strength and thickness of the product allows the new pocket dimensions to be constructed by sewing the Strattice in the proper place so that the implant sits properly on the chest wall. Unlike thinned out tissues that don’t hold sutures well, Strattice is strong and holds the implant in proper position. The other great property Strattice has is it prevents recurrent scar tissue problems in patients who have suffered capsular contracture.
As you can see, Strattice does a lot to address complex problems in revisionary breast surgery. About now you must be asking, “What are the down-sides?” Strattice is difficult to manufacture and consequently it is expensive, but far less so than a re-revision surgery. It takes skill and experience to use it in surgery, and some surgeons are a little stubborn about learning to use it and taking the time necessary in the OR to insert it properly. It is a “foreign body.” So is an implant, and when Strattice becomes incorporated, your own blood vessels are coursing through it. You can’t even identify it as foreign on a mammogram. There have been no cases of rejection, and it is incredibly resistant to infection. In the rare instance that additional surgery is needed down the road, the surgeon can cut right through it without difficulty and sew it back up without the need to remove it.
I now have several years of experience using this product and have yet to be disappointed. I have put together a photo album of patients in whom I have used this product, and they are all exceptionally happy. In case it sounds like I work for Lifecell, the company that makes Strattice, I don’t. The only benefit I receive from using the product is the satisfaction of my patients, which is very important to me! If you are desirous of learning more about this exciting product, please visit their website at www.renewingyou.com. If you are struggling with any of the implant problems described above, help is available. If you meet with a surgeon to discuss implant revision, and Strattice or another similar product is not discussed, please continue your research. I would love to meet with you to discuss in consultation any questions you may have about issues discussed in this article. Please call my office to arrange an appointment.
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Categorized in: Our Practice, Breast Augmentation, Popular