Revisions

On occasion, surgery must be performed to revise the results of previously performed surgery on the breasts.  Fortunately, this is not common.  Dr Burden and Dr Ennis often see patients who are unhappy with their results from an augmentation performed elsewhere and are often able to improve upon the previous results.

 Dr Ennis and Dr. Burden frequently evaluate patients who are sent to them from other physicians to evaluate their results following breast augmentation, breast reconstruction and breast reduction.  Each problem is specific to the primary procedure performed.  What follows is the discussion on the problems that can arise following breast augmentation, breast reconstruction and breast reduction along with before and after photographs. Some of the more common problems following breast augmentation and reconstruction with an implant are:capsular contractures, an implant not dropping or dropping too far and rippling.

Capsular Contracture

Capsular contracture is the term used to describe the formation of scar tissue around the implant which, when thickened, can make the implant feel hard and round. Although the implant itself remains soft, the scar tissue “squeezes” the implant which makes the implant feel hard. In the submuscular position, the rate of capsule contracture is decreased in general from greater than 15% to less than 3%.  That's a significant difference.

This patient had previously undergone a breast augmentation by an outside surgeon and developed a right breast capsular contracture (top row).   She subsequently underwent a right breast capsulectomy at Destin Plastic Surgery to correct the contracture which is seen in the bottom row of photos.

Rippling

"Rippling" occurs when the implant shell is easily felt beneath the skin.  With subglandular augmentation, the possibility of this occurring is greater than with the submuscular position.  Large studies have shown that the chance of "rippling" is 3 times greater with subglandular augmentation than with submuscular augmentation.

The disadvantage of the submuscular placement versus subglandular placement is that the postoperative recovery is lengthened and the patient may experience more postoperative pain. In addition, there may be more motion of the implant with forceful pectoral contracture. All things considered, the submuscular placement of an implant is the least at risk for for the complications of capsule contracture and "rippling."

Silicone implants offer a much more natural feel and allow women with small breast to have larger enhancements without the problems of rippling that can occur with saline implants. The larger the saline implant and the less breast tissue a woman has, the more likely it is to ripple. Silicone offers small breasted women the option of going much larger with less concern about rippling.

The patient above had very little breast tissue and underwent a submuscular breast augmentation with saline implants by an outside surgeon.  The patient was unhappy with the rippling that occurred when she leaned forward. She subsequently underwent an implant exchange from saline to silicone at Destin Plastic Surgery and as you can see in the right hand picture, the rippling was significantly improved.

This patient underwent several prior surgeries on her breast before presenting to Dr Ennis at Destin Plastic Surgery. She underwent an endoscopic implant exchange through the underarm to have her subglandular implants changed to the submuscular position. Note the significant improvement in the appearance and shape of the breast when the implants are in the submuscular position.  The large ripple at the top of the right breast has also resolved.

Bottoming Out

Bottoming out is the term used to describe an implant that drops too low  (also know as implant mal-position or a double bubble). This gives the perception that the nipple is to high and can make clothes fit poorly.  Many patients who have experienced this bottoming out complain that their nipple is too high and will show out of the tops of bathing suits. This happens because the distance between the nipple and the bottom of the breast is too long and the nipple will ride up out of the top of the bathing suit. 

This may be corrected by tightening and raising the fold.  The fold is tightened/raised by making a small incision underneath the breast and placing sutures along the bottom of the breast to tighten the fold and reposition the implant back into the proper  position which re-centers the nipple over the implant.  This will significantly improve the appearance of the breast and clothes as well as bathing suits will fit much better.

This patient underwent bilateral capsulorraphies to correct the bottoming out  by raising the implants which significantly improves the apperance of the breast.

This patient underwent a left breast capsulorrhaphy to correct the bottoming out  by raising the implant which significantly improves the apparance of the breast.

Double Bubble

A Double Bubble occurs when an implant drops too low or when the implant drops down behind the natural fold of the breast rather than forward into the breast. This creates two folds with an unnatural appearance to the breast.

Depending on the patients breast, this may be corrected in one of two ways; either by tightening and raising the fold or with a mastopexy.  The fold is tightened/raised by making a small incision underneath the breast and placing sutures along the bottom of the breast to tighten the fold and reposition the implant back into the proper  position.  The other option is to perform a mastopexy in which the skin of the breast is tightened. Your surgeon can further discuss which option may be best for you.

This patient underwent an augmentation several years prior by an outside surgeon and subsequently developed a double bubble on the right side. She underwent an implant exchange from saline to silicone and a right breast Capsulorrhaphy to correct the double bubble.

Please see our section on REVISIONS under the PHOTO GALLERY

Dr. William R Burden, MD, FACS and Dr. L. Scott Ennis, MD, FACS are known for their experience and dedication to staying in the forefront of leading technology in plastic surgery. They perform over a thousand breast procedures per year including many revisions from other places.   Drs Burden and Ennis not only treat many patients from the Florida panhandle including Panama City, Pensacola, Fort Walton Beach, Tallahassee, Dothan, Atlanta, and Birmingham but also from around the world.  Many people travel from Europe, South America and Asia to Destin to seek out their services.

(850) 654-1194 

Before and After Photos