Sometimes, the results of your breast surgery don’t match your expectations. Perhaps they are too small, big, soft, or firm. Incorrect implant placement and similar issues may lead to uneven breasts and other cosmetic problems. If you’re struggling with results, know there are options and a team of experts ready to provide the support and guidance you need.
It’s Your Personal Choice
The decision to have breast reconstruction is very personal and may not be right for every woman. It’s important to remember that this is your body and your choice. Many women find that restoring the breast helps them feel complete and whole again, lessening the psychological and emotional impact of a mastectomy or lumpectomy. Other women opt not to reconstruct their breasts, choosing to “go flat ” instead.
Breast implant revision surgery is a standard or routine procedure that must be explicitly tailored to the patient’s goals and desires. Therefore, this surgery should be performed by a board-certified plastic surgeon who is well-trained and experienced in all types of breast surgery and who will listen to the patient’s goals and desires and develop a surgical plan specifically to address all of the issues at the time of surgery.
Implant replacement is a common procedure: 1 out of 5 patients who have implants need some revision procedure over time.
Common reasons for implant replacement include capsular contracture, implant rupture, the age of the implant, a desire to change size/shape, and the desire to replace implants with one’s natural tissue. If you are having an issue, you may need to change out your implants.
Many women with breast implants will need or want to replace them at some point. The goal of revision or corrective procedures after breast reconstruction is usually to improve the appearance of the breast.
Some revision procedures can also reduce discomfort or chronic pain due to previous reconstructions. Implant replacement is a common revision procedure for replacing or removing older implants. Many of the techniques used for revision surgery, such as fat grafting, liposuction, breast lifts, reductions, and augmentation, are also used for women having their first breast reconstruction. These procedures are usually, but not always, part of ‘stage 2’ reconstruction.”
Whether breast reconstruction was done using an implant or the patient’s tissue, there may be opportunities to improve the appearance of the reconstructed breast or both breasts.
The American Cancer SocietyTrusted Source notes that two options after a mastectomy include breast implants and recreating the breast with a person’s body tissue. This is called flap surgery. A surgeon can take tissue from areas such as the buttocks, thighs, tummy, or back and use it to rebuild the breast.
When is corrective surgery needed?
Corrective surgery may help to treat symptoms such as:
- appearance of breasts, such as asymmetry or a drooping breast
- size of the breasts
- pain from capsular contracture
- interference with exercise, such as from a subpectoral implant
- issues like rupture or change in position of the implant
- nipple position
- noticeable scars
- loose skin
- symmastia
Some significant issues with implants for which people may require corrective surgery include:
Capsular Contracture
One potential complication of getting breast implants is capsular contracture.
Capsular contracture occurs when complex scar tissue forms around the implant. This can pressure the implant, making the area feel tight and painful. Capsular contracture can also alter the shape of the breast and make it sit higher up in the chest.
Most cases typically occur within the first 12 monthsTrusted Source after getting implants. Breastcancer.org notes that a person’s chance of developing capsular contracture may be increased if they have previously undergone radiation therapy to treat breast cancer.
A surgeon may replace the implant with a new one with a protective layer around it. The body will then form new, less dense scar tissue around the implant.
Capsular contracture can reoccur. However, it is less likely to reoccur if the surgeon removes the capsule and replaces the implant. A surgeon can also prescribe medications to help prevent the recurrence of capsular contracture.
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Corrective Surgery
Some common corrective surgeries include:
- Breast lift: This can help with concerns such as nipple placement, uneven breasts, drooping breasts, or loose skin.
- Breast reduction: This decreases the size of the breasts. It can be done with implants and autologous reconstruction (transplant from your body tissue).
- Skin tightening: Skin tightening may help reposition the nipple or breasts or fix droopiness and loose skin. This technique may involve surgical mesh, which gives support like an internal bra.
- Nipple repositioning and reconstruction: The surgeon may move or reconstruct a new areola and nipple from somewhere else on the body.
- Nipple tattoo: This gives the appearance of an areola and nipple from tattoo ink. Some people choose to have a decorative tattoo to cover the area or scars. Check with your plastic surgeon to ensure you are well-healed before the tattoo.
- Fat grafting is injecting fat from a different body area, such as the abdomen (belly). It can help in various situations, including thick, toughened skin from radiation or apparent indentation.
- Replacing implants: If an implant ruptures or moves out of the surgeon’s pocket, the surgeon may replace it with another implant or autologous (self) tissue. This may involve reattaching skin to the breastbone or artificial mesh to keep the implants from moving.
- Pectoral revision: The implant gets moved from behind the pectoral (chest) muscle to the top of the muscle. It can be helpful for those who have discomfort during exercise or don’t like the appearance of how the chest muscle pulls.1
- Scar revision: This may be an option when the mastectomy scar is large, very noticeable, or rubbed by clothing.
- Capsulectomy: Surgical removal of hardened tissue that forms around breast implants (capsular contracture)
The Difference between Breast Reconstruction and Breast Augmentation
- Although breast implants generally work well for cosmetic breast augmentation in women who have not undergone mastectomy, inherent problems with their use in breast reconstruction may make this kind of breast replacement a less desirable choice for many women.
- Why is there such a difference when both procedures use implants? First, women who have implants placed for cosmetic breast enlargement have natural breast tissue that covers the implants and acts as a protective layer, helping to prevent the capsule that invariably forms around an implant from being noticeable. When all of the breast tissue has been removed by mastectomy, only a thin layer of skin remains. The absence of breast tissue after mastectomy can make it more challenging to achieve a natural look and feel using breast implants.
Second, since a synthetic implantable prosthesis has a fixed shape and cannot be sculpted, if a woman has only one breast reconstructed with an implant, achieving a satisfactory degree of symmetry with the natural breast may be difficult. Matching an implant to the shape of the other breast’s natural tissue is difficult.
Although complications and unplanned reoperation also happen after cosmetic breast augmentation, they occur much less frequently than after implant reconstruction.
Revision Surgery and Corrections
- Revision surgery is a procedure aimed at correcting or improving the results of previous breast augmentation surgery. It can address asymmetry, capsular contracture, or implant rupture. Additionally, revision surgery can upgrade or change the type of breast implant.
- It’s important to note that revision surgery requires high skill and expertise. Therefore, it should be performed by a board-certified plastic surgeon with experience in revision surgeries. Minor corrections can be made without surgery, such as adjusting or repositioning the breast implant to improve its appearance. However, in most instances, revision surgery is necessary to achieve the desired results.
- By understanding the potential need for revision surgery and choosing a qualified plastic surgeon, you can ensure that any issues with your initial breast augmentation are addressed effectively, leading to a more satisfactory outcome.
Breast augmentation is one of the nation’s most performed cosmetic surgery procedures. Breast implant doctors use different types of breast implants and surgical techniques to help you achieve breasts that are more proportionate to your body frame. Plastic surgeons also perform implant surgery for breast reconstruction after mastectomy or injury.
Types of breast implants
Many women choose breast augmentation so their breasts can be more proportionate to their body frame. Implants can improve the size, shape, and contour of your breasts, adding fullness and volume. Your doctor will discuss types of implants with you in pre-surgery appointments. The two main types of breast implants are saline and silicone.
Saline implants:
Saline implants have a silicone outer shell. They’re filled with a saltwater solution. The U.S. Food and Drug Administration (FDA) has approved silicone breast implants for patients who are over the age of 18. Your surgeon fills saline breast implants after they’ve been inserted. This allows surgeons to use smaller incisions, so you’ll have less visible scarring after your procedure.
Silicone implants:
- Silicone breast implants are filled with silicone gel instead of saline. They are FDA-approved for breast augmentation in patients over the age of 22 and for breast reconstruction in patients of any age.
- Many women prefer silicone implants because they have a more natural look and feel than saline implants. Silicone implants are a common choice for those who are very thin as well as for individuals who are having breast reconstruction after cancer.
Interested In Corrective Reconstruction Surgery?
In the first few months after reconstruction surgery, it’s normal to have some swelling, wrinkling, imbalance, or other minor distortions. These issues may take six months to a year to settle. If you still have visible defects after more than a year, or if you’re experiencing symptoms, you may want to schedule a consultation with a plastic reconstruction surgeon to discuss the corrective breast reconstruction options that may be available to you. These options may depend on a variety of factors, including the size of your breasts, your body type, the kind of reconstruction you have done, and whether you’ve undergone radiation therapy.
Many women improve the look and feel of their breasts with corrective procedures. To help them know what to expect, before and after photos of previous patients who have undergone similar reconstructive surgeries (with consent) are shared during consultations.
Breast and plastic surgeons offer state-of-the-art approaches such as nipple-sparing mastectomy and reconstructive flap microsurgery, and our radiation oncologists employ technologies designed to reduce the risk of radiation exposure to the heart and other critical organs.
Many women end up living with reconstruction results they aren’t happy with because they don’t know they have options available to help them. However, many issues that impact the look and feel of both reconstructed and natural breasts may be changed with additional surgeries. In many cases, those surgeries are already covered by insurance and may significantly improve a woman’s satisfaction with her reconstruction.
Myth: Women who are unsatisfied with their initial reconstruction have no options to make it better.
Some women who have had reconstruction may not be delighted with the results of the surgery. This can cause feelings of anxiety or depression. They may think there is no way to address these issues and do not bring them up with their surgeon.
Your surgeon will emphasize the importance of possible additional operations to improve symmetry and produce more pleasing results that are routinely performed. Revision surgery does not mean something went wrong in the first operation. Instead, the goal is to address issues that may be troublesome to patients.
For example, a breast reconstruction with an implant often leaves a dent in the upper part of the breast that is difficult to hide with clothing. Reconstructive surgeons can fix the area by grafting fat from the body and injecting it into the hollow spot. This can’t be done during the initial operation — the temporary reconstruction must heal to form a pocket that can receive the fat.
Other times, women may want surgery on the unaffected breast to achieve symmetry. These procedures are generally minor and typically done in an outpatient setting. Teams of plastic and reconstructive surgeons recently published results showing that people with revision procedures are happier with the outcome.
Non-Surgical Alternatives to Improve Aesthetics
If revision surgery isn’t an option—or you’re not ready to take that step- here are some non-surgical alternatives to consider:
- Breast prosthetics and enhancers
- A well-fitted breast form or enhancer can restore symmetry and provide a natural look under clothing.
- Specialized bras and clothing
- Post-mastectomy bras provide better support and comfort, while certain clothing styles can enhance confidence.
- Massage and physical therapy
- These can help reduce tightness, improve skin elasticity, and even slightly enhance sensation.
Updating Your Breast Reconstruction
If you had breast reconstruction many years ago and are interested in redoing your reconstruction using the latest methods, common revision surgeries can include the following:
- Replacing older implants with newer devices that are softer and more comfortable.
- Changing the position of the implant from “below the muscle” to “above the muscle.”
- Removing unsatisfactory implants and replacing them with breasts reconstructed from your own natural tissue (flap reconstruction).
Additional Risks for Women Who Smoke
Using tobacco narrows blood vessels and reduces the supply of blood, nutrients, and oxygen to tissues. Smoking can delay healing in any surgery and is linked to a higher chance of wound complications. This can cause more noticeable scars and a longer recovery time. Sometimes, these problems are bad enough for a second operation to fix. You may be asked to quit smoking a few weeks or months before surgery to reduce these risks. This can be hard to do, so ask your doctor for help. Sometimes, your plastic surgeon might choose to delay your surgery until you stop smoking.
Insurance Coverage
Breast lifts, reductions, and augmentations are considered cosmetic surgeries and are only covered by insurance when they are a planned part of breast reconstruction. According to the Women’s Health and Cancer Rights Act of 1998 (WHCRA), all phases of breast reconstruction are covered by insurance. This coverage includes revision breast reconstruction, even if it is years after your original reconstruction surgery. Speak with your surgeon regarding your ultimate goals. Proper planning for these procedures is essential for obtaining insurance coverage.
SUMMARY
Patience is key when it comes to changing the size of your implants. Most doctors advise waiting about a year after your initial surgery before making this decision. This period allows your body to heal fully and gives your implants the time they need to settle into their final position. This ensures that you can make this significant decision with confidence and reassurance.
Additional Support and Information
If you’re unhappy with the size or shape of the reconstructed breast or your other breast, let your breast care nurse or surgeon know. They can talk to you about possible options. You are likely to have emotional ups and downs after surgery for breast cancer and breast reconstruction. Even months afterwards, many women find it helpful to talk about their feelings and ask about things that worry them.
Your breast care nurse is your first line of support. They are there to talk to you through any worries and give you the reassurance you need. Additionally, other women who have undergone similar surgeries can be a valuable source of support. You can ask your nurse or doctor to contact you with someone who has had similar surgery or complications, ensuring you feel secure and well-guided.
You may want to have further surgery on the reconstructed breast or on your other breast to give you a better match and symmetry. It’s not unusual to need several surgical procedures before your breast reconstruction is complete. These may include surgeries for nipple reconstruction, tattooing, or adjustments to the other breast to achieve symmetry. Your surgeon will discuss these potential procedures and help you understand their purpose and timeline.
References
City of Hope
Friedman Center for Breast and Lymphatic Surgery
Medical News Today
Memorial Sloan Kettering Cancer Center
The Ohio State University | The Wexler Medical Center
The Plastic & Reconstructive Surgery Group
Very Well Health
