Westlake Plastic Surgery

TheBreastPlace is TheBestPlace for patient information about the breast enhancement process. Currently in the United States, the most popular plastic surgery procedure is a breast augmentation. And in my practice, I’ve seen a growing demand for secondary breast procedures. At TheBreastPlace, you will learn from my vast experience with all things breast, including breast augmentation, breast reduction, mastopexy or breast lift, augmentation/mastopexy and my very own BAR procedure or Breast Augmentation and Reduction.

There is a wealth of information to learn from by reading my breast augmentation article. I have an extensive collection of before and after photos that include my very own “patient stories,” or patient case studies. These stories provide all those seeking information on the breast enhancement process with comprehensive education and insight, whether it’s your first time or you’re looking for even more improvement with a secondary procedure. My goal is to make sure you get all you want from your breast enhancement and that you are well prepared and safe, no matter which Board Certified Plastic Surgeon you choose.

There is no better time than now to consider a breast enhancement. Turn “one day” into everyday. Stop wishing about a breast enhancement and take the first steps to achieving your goal! There is no better place to start than TheBreastPlace.

Breast Revision Academy (BRA)

The Breast Revision Academy (BRA) is a source of information for those who are interested in learning more about the breast revision process. A breast revision is any procedure that is performed, after an initial breast procedure, in order to improve the outcome of the breasts, for various reasons that are covered in this section of my website. One of my areas of surgical expertise is the evaluation and treatment of those patients who are considering a revision of their breast enhancement because they have experienced a complication, or they are simply interested in improvements or artistic changes to their results.

Breast enhancement has become the plastic surgery procedure in highest demand. In 2008, over 300,000 breast enhancement procedures were performed, and it is believed that there are over three million women who have breast implants.

Breast enhancement is popular because of the unique status breasts have in almost all cultures, and because the procedure has been refined over the years, with outstanding results and very pleased patients. Despite this fact, there are still some patients who experience complications related to the breast enhancement process. Breast implants will not last forever and the revision rate, even after only several years, has been claimed to be over 25%. Clearly, these operations are not perfect, for reasons that are discussed at length throughout my website.

There has been an explosion in the number of patients who seek revision of their initial breast enhancement procedure over the past several years. Be advised that the surgical care needed to address these difficult and challenging cases requires excellent judgment and experience. You should seek the counsel of only those surgeons who have clearly demonstrated the skill set to safely and consistently deliver superior outcomes.

This section of the WestlakePlasticSurgery.com website is dedicated to the education of all those patients interested in learning more about the breast revision process. Content will be added in the future to enhance the quality and clarity of the information to the benefit of patients all over the world. Any feedback or advice to improve upon this section is greatly appreciated.

The comprehensive list that follows will cover many of the reasons women seek revision breast enhancement. Ultimately, the causes of complications and dissatisfaction are multifaceted and overlap one another. Often, women will experience several of the issues noted below at the same time. Also, treatment of the problem typically involves several modifications of the breast enhancement (changes in not only the implant, but the breast as well), in order to arrive at a satisfactory outcome.

Complications that lead to breast revision procedures:

• Capsular contracture

  All breast implants develop a thin layer of scar tissue around them called the implant capsule. This is usually a thin layer of scar tissue that does not affect the breast implant or the softness of the breast. However, during the contracture process, the implant capsule becomes thicker and it squeezes the implant, progressively making it more firm and less mobile. This phenomenon may occur any time after the procedure, but usually occurs within five years after surgery. The cause of capsular contracture is not known with certainty. Capsular contracture is claimed to be the number one complication from the use of breast implants and has been reported to be as high as forty percent. Click here for a picture.

  The contracture process may lead to a change in the shape and “feel” of the breast. The breast may become more rounded in appearance and implant rippling is common. This may affect one or both breasts.

  In rarer, more advanced cases, the breasts can become tender and painful. A simple hug may become uncomfortable and a giveaway to others that something is not right (the “hugger” feels firm objects on the “huggee’s” chest).

  We don’t know who is likely to develop a contracture. In my experience, it is more common with subglandular implants (implants placed above the muscle) and less common when active breast massage is performed to keep the breasts soft. The contracture rate in my practice is less than 1% of breast enhancement patients.

  Treatment of a breast contracture usually consists of an implant change, a pocket change, and removal of the implant capsule. This does not guarantee that patients will not experience a recurrent breast contracture. Removal of the implants is also always an option.

• Symmastia (breasts that meet in the middle)

  Symmastia refers to breasts that look like they are touching in the midline of the chest. The skin appears to be lifted from the breast bone and the breasts look like one, rather than two (called a “uni-boob”). Click here for a picture.

  Symmastia is usually the result from a technical error by the surgeon or the selection of implants that are simply too large for the patient (the implants don’t fit on the chest wall).

  The correction of symmastia is achieved by separating the implant pockets in the midline of the chest. Smaller implants are recommended.

• “Window-shading” of the pectoralis muscle

  Windowshading is observed in breast augmentation patients when a crease or dimple forms along the lower part of the breasts after the chest muscle is flexed. Fortunately this condition is uncommon. It is related to overly aggressive cutting of the pectoral muscle at the time of breast implant placement. The muscle pulls away from the ribs at the breast crease and retracts upwards. It is unnatural in appearance, and disconcerting to patients.

  Windowshading is a difficult problem to manage.  In an ideal case, the use of ADM, or Acellular Dermal Matrix (human or pig dermis), helps secure the muscle where it belongs. The best way to avoid this issue is to choose an appropriately sized implant and to make sure that your surgeon is not overly aggressive in the manipulation of your chest muscle.

• “Bottoming out”

  Bottoming out refers to a condition where the breast implant moves below the breast crease. The breast appears “bottom heavy” and the nipple appears to be high. There is also a loss of superior breast fullness, causing the breast to appear less youthful and more matronly, with a long upper chest and breasts that appear to be sitting on the upper abdomen. The appearance is unattractive. Click here for a picture.

  Bottoming out occurs for several reasons. Probably the most common causes are the use of an implant that is too large and the cutting of the chest muscle at the breast crease during surgery. When an overly large implant is used, there may be no place for it to fit other than below the breast crease. When the muscle is cut, it removes a support structure for the breast implant. Over time the implant moves down with gravity.

  Another common cause of bottoming out is the placement of large, heavy implants above the muscle when there is breast ptosis, or sagging. This can lead to a “rock-in-the-sock” deformity.

  The solutions for this complication usually involve securing the implant in an elevated position where it should be and a procedure that fixes the new breast crease with a suture technique. A smaller implant is often advisable, if the original one is too large. A support bra will also help maintain optimal breast implant position and breast shape.

• Implant malposition

  Implant malposition refers to any condition that exists when the implant is not in its proper position relative to the breast. This change in the appearance of the breast may be obvious or subtle. Most women don’t notice changes over time because it happens slowly. For a trained eye like mine, it’s very obvious. Click here for a picture.

  Most implants will have a tendency to move down and to the side under a woman’s arms because of gravity. Some implants that haven’t settled or “dropped” appear high relative to the breast. “Bottoming out” is an extreme example of malposition when an implant falls down on the chest. “Symmastia” is a form of implant malposition where the implants move toward the middle of the chest, touch and even appear more like one breast. Implant contracture is a different type of complication that can often cause implant malposition.

  Treatment options involve modifications to the implant, implant pocket or the breast. A combination of procedures may be needed to adequately treat the problem. The most common and simplest treatment is an adjustment in the capsule around the implant so that the implant is secured in a more ideal position.

  The best way to avoid implant malposition is appropriate surgery and implant selection, and the use of a supportive bra after surgery to help maintain the best position of your implants.

• Implant deflation (saline) or rupture (silicone)

  All implants will eventually rupture or “fail”—it’s not a matter of if; it’s a matter of when. This is why all patients are told to expect future surgeries or breast revisions.

  Saline implants deflate, whereas silicone implants rupture. Saline deflation is obvious—the breast becomes smaller as the fluid is absorbed by the body. Click here for a picture of deflation.

  A silicone implant rupture, on the other hand, is not so obvious. Silicone implants generally don’t change size, as the silicone does not get absorbed by the body because it is cohesive and tends to stay within the implant capsule. This may be good or bad for silicone implants, depending on your perspective. Silicone implants can perform like a “run flat tire,” as they will continue to work and appear normal in most cases. If a patient experiences symptoms from a silicone implant rupture, pain and breast contracture are probably the most common.

  In reference to fixing these complications, a saline implant deflation is relatively “clean” compared to a silicone implant rupture. Although the silicone material does not “flow” like saline, it still requires more work to remove all the silicone material from the pocket. The silicone breast implant and the surrounding implant capsule behave like a “double hulled” ship. The rupture of the implant shell is contained by the implant capsule (outer layer of scar tissue surrounding the implant).

  It is not an emergency if your implants fail. Many people think it is beneficial to get CT or MRI examinations, but it can be difficult to determine if an implant has deflated or ruptured with these tests. For this reason, I would recommend that you forgo expensive tests that expose you to radiation when you think you are having a problem like contracture or deflation. Instead, get into your Board Certified Plastic Surgeon within a week or two for an evaluation. I usually recommend simply an exchange of implants for this type of complication.

• Implant rippling and visibility

  Implant rippling refers to the creases that develop in breast implants that are sometimes palpable through the skin. All breast implants will ripple to some degree; saline ripple more than silicone. Submuscular implants ripple less than subglandular implants because the muscle provides an additional layer of implant coverage.

  Rippling is usually seen along the bottom and sides of the breast because the tissue coverage is thinnest in these areas. Rippling between the breasts is less common, but if present, can be quite distressing as it is a highly visible area.

  Traction rippling refers to creases seen on the breast, when a patient changes position and the weight of the implant pulls on the skin (seen when bending over).  When a patient describes that she can “feel the bag,” this means that the tissue coverage on top of the implant is so thin that you are basically feeling and seeing the breast implant under a thin layer of skin only.

  An excessively “round,” or “stuck on,” appearance of an augmented breast is usually the result from an excessively large or overinflated saline implant or from subglandular implant placement. This can also result from an implant contracture, as well as the use of a high profile implant in a very thin patient.

  Treatment options vary, depending on the specific issues (implant size and type, implant location – above or below the muscle, and tissue characteristics, not to mention patient goals). A saline implant can be exchanged for a silicone variety. Relocation of the implant below the muscle can also help. Elimination of a contracture will soften the breast and treat the rippled, unnatural appearance.  ADM, or Acellular Dermal Matrix (human or pig dermis), can also be used in revision breast surgery to minimize some of these issues.

• Excessive thinning of the skin

  A breast implant acts as a tissue expander; as tissue expands it gets thinner and thinner (just like a balloon). The larger the breast implant and the smaller the breast, the greater the degree of stretching and thinning of the tissues. The “perfect storm” is a large breast implant and a small breast. Thinning skin is also associated with pregnancy, extreme weight loss and advancing age.

  Tissue thinning is more commonly seen in those patients who have subglandular implants and in those individuals who have poor skin quality. Implant complications like rippling and palpability are more easily appreciated when the tissues become thinner over time.

  Treatment alternatives include exchanging saline for silicone implants, moving subglandular implants beneath the muscle and choosing smaller implants. Some patients will benefit from the excision of the thinning tissue along the bottom of the breast with a breast lift.

  The best treatment however is prevention; always choose an implant size that works best with your tissue characteristics (surgeon responsibility), and support your breasts with an excellent bra (your responsibility).

• “Snoopy” breast condition

  The “snoopy” breast condition occurs when breast implants are used in patients whose breasts are narrow or “tubular” in shape. The appearance is like the nose of Snoopy the dog. The breast tissue fails to form to the shape of the underlying round implant, and it looks like a separate layer sitting on top.

  This issue is best addressed by releasing the constricted breast tissue and possibly reducing the size of the areolas.

• Excessive pain after a breast enhancement

  It is uncommon to experience pain that lasts longer than several weeks after the typical breast enhancement. Submuscular placement of implants is associated with more discomfort than subglandular implant placement. Breast augmentation is also associated with a feeling of pressure that resolves after the breast has settled and softened.

  Complaints of “stingers,” or “lightning bolts,” are not infrequent during the first six months after surgery. This is probably related to stretching of the sensory nerves. It will resolve by itself, with time and massage.

  “Pinpoint” pain in the first year after surgery may be a result of a cut nerve that has developed a “neuroma.” This is usually found along the sides of the breasts. Stretching and massage may help this condition.

  Probably the most common cause of breast pain is a breast contracture. Treatment of this problem varies, but usually consists of implant exchange, pocket adjustment, or pocket change, as well as a capsulectomy (excision of the scar around the breast implant). Breast pain is usually not a symptom caused by breast cancer.

  Pain requiring prescription pain medications after the first six weeks after a breast enhancement is very unusual and may be a sign of psychological dependency on pain medications. A referral to a pain specialist may be recommended by your surgeon in cases of unusual or excessive pain after a breast enhancement.

• Mondor’s condition (chest vein inflammation)

  These refer to the uncommon, post operative condition whereby a patient develops cords or bands beneath the breast at the incision site. These cords are initially red and tender, but will eventually soften and disappear after several weeks. The cords are more noticeable and tender when a patient raises her arms. Although it is distressing to patients, it is a self-limiting, benign condition.

  The condition is caused by inflammation of the superficial veins around the breast. Treatment consists of a short course of anti-inflammatories, such as Tylenol or Motrin.

• Poor scarring

  Poor scarring after a simple breast augmentation is rare. Good surgeons will make good scars. A scar will take up to two years to fully mature and look its best.When it comes to scarring, patience is a virtue. All scars are permanent. A patient’s genetic make-up determines about 80 percent of the final appearance of a scar. Some people simply heal better than others.

  It has been my observation that most patients heal quite well, across the board, with all types of breast surgery. Complaints about poor scarring are infrequent. The rating of scars, as good or bad, is quite subjective. Some patients have excellent scars that they complain about, while others have poor scars that they have no problem with.

  The “Benelli” breast lift procedure is often associated with the most significant potential for poor scarring amongst all mastopexy procedures. This is a technique that uses an incision only around the areola for the breast lift. It often spreads quite dramatically over time and is not particularly attractive. Obviously, this isn’t a procedure I recommend often.

  Scar revision refers to the manipulation of a scar in order to improve the appearance. Various techniques and tricks can improve the location and appearance of a scar, so that it is better situated and camouflaged, relative to the contours of the breast. All plastic surgeons can make a fine scar after surgery, but only the experienced can pass judgment as to whether a scar can be improved with additional procedures. If you truly have a poor scar, it is imperative that your surgeon understand WHY this occurred to make sure that history does not repeat itself.

• Stretch marks after a breast augmentation

  Thankfully, stretch marks after a breast augmentation are a rare occurrence. I have seen them about three times in my 25 years of practice. Surgeons don’t know why patients get stretch marks and who is likely to get them. The stretch marks appear within a short time after the procedure and can be quite red.

  The natural history of these stretch marks is that they will become less red over time and then they will fade substantially. I find it interesting that the patients who developed stretch marks were not nearly as disturbed about them as I was. There are no creams, ointments, lasers, or other “gimmicks” that will improve the appearance of stretch marks. A stretch mark is a scar, and a scar is permanent.

• Excessive movement of breast implants

  Breast implants will always develop a layer of scar tissue around them that forms the implant capsule or “pocket”. If the pocket is much larger than the implant, the implant may move around excessively and be bothersome.

  The implant pocket can become very large for several reasons: it may have been made large at the time of the initial surgery, or it became larger over the years, as the forces of gravity expand the pocket, inferiorly and laterally and the breast appears to move down and to the side.

  Patients heal differently based on their genetics. Patients that are considered “soft healers” don’t scar with any firmness about the implant, resulting in excessive mobility of the implant.

  Treatment options include implant pocket adjustments. The pocket can be made smaller with sutures or the pocket can be changed to a new location above or below the muscle. Sometimes a “textured” implant will “stick” more than the smooth walled variety resulting in less movement. Wearing a supportive bra will always reduce movement of the implants.

• Excessive movement of a submuscular implant

  All submuscular implants will move, to some degree, with the use of the pectoral (chest) muscle. In some patients, this movement is more exaggerated than others. Strenuous muscle contraction that occurs with weight lifting may cause an unnatural movement of the implant, upwards and outwards, that can be quite noticeable.

  Movement of the breast implant with muscle contraction is normal. It only becomes abnormal if this movement is exaggerated to such a degree that the patient is embarrassed, or extremely self conscious.

  Only rarely does this problem require formal surgical treatment. Often, it’s sufficient to reassure the patient that this is a normal, expected outcome with any submuscular implant.

  Surgical treatment options include adjustment of the submuscular pocket, or even moving the implant into the subglandular pocket so that the muscle no longer exerts its effect on the implant. If the problem stems from a “high riding” implant, it’s possible to massage the implant lower so that the muscle has less influence on the implant.

• Breast asymmetry

  Obviously, the goal of a breast enhancement is to create equal breasts in size, shape and “feel.” Few women are blessed with two perfectly shaped breasts by nature. Not only do most breasts appear different, but the underlying foundation of the breasts (the chest wall made from the thoracic ribs) is almost always different on each side.

  Poor breast shape may also be the result of an implant size that isn’t appropriate (too large or too small), a contracture process that distorts the breast, or the wrong type of implant or wrong position of the implant above or below the muscle. Even side sleeping can displace a breast implant toward the middle of the chest wall compared to the other side.

  The bottom line is that it is often quite possible to improve shape and symmetry, and the procedures available to an expert surgeon are extensive. Modifications of the breast implant, implant pocket and the actual breast itself can improve symmetry. Consulting with several highly regarded and experienced surgeons will help clarify the issues at hand and give you a good idea which procedure might be best for you.

  Having said the above, sometimes the enemy of “good” is “better”—that is, seeking higher degrees of improvement in breast shape may result in complications leading to an outcome worse than what you started with. As long as you consult with a Board Certified Plastic Surgeon with the right expertise in this area, your concerns regarding unsatisfactory breast shape should be appropriately addressed.

• Asymmetrical nipple-areola complexes

  The pigmented area around the nipple is called the areola. It becomes wider with age, pregnancy and breast feeding. In some cases, the areola can become quite asymmetrical in size and shape, which can make the breasts look lopsided.

  Excessive widening of the areola can be corrected with an areola reduction procedure, ultimately making the areolas the same size. Surgeons use a “cookie cutter” to make a circle around the nipple of the desired size, and then remove the excess areola. The resulting circular scar is around the perimeter of the new areola and usually heals quite well.

• Malposition between breast and nipple-areola complex

  The position of the nipple, as it relates to the breast mound, is critical. If it is too low, it can make the breast appear saggy and tired. If it is too high, it looks unnatural, and can pop out of your bra or bathing suit. Malposition can occur with all breast surgeries, not just when breast implants are used.

  Several different factors can account for malposition between the breast and nipple-areola complex. A breast implant contracture often results in a firm breast that is misshapen. When a breast “bottoms out,” the implant moves down, while the nipple-areola complex moves up. Implants that have not settled low enough usually result in a nipple-areola complex that appears on the bottom of the breast. A breast that needed a lift but was augmented alone may have a full upper breast with low lying nipple-areola complexes.

  The treatment for malpositioning of the nipple-areola complex usually involves adjusting the implant, the breast, or both.  Moving the implants into the correct position relative to the nipple-areola complex is a sure fix. Moving or adjusting the breast tissue and skin on top of a well positioned implant will improve symmetry tremendously.

• Change implant type

  The current trend in implant selection favors silicone. There are women who have enjoyed the saline variety, but are ready for a change to the silicone type. It’s rare for a patient to request an exchange from silicone to saline. Changing out saline for silicone implants often addresses some of the more common problems associated with the saline implants, such as rippling, visibility and the “water bag” feel.

  Changing implant shape or profile can be a powerful option to improve breast shape. Now, the trend is certainly in favor of the high profile implant variety. High profile implants are narrower and taller than the lower profile variety. In many patients, it provides for that “perky,” youthful appearance. It’s one of the best options for mature women who have wider breasts and prefer the look of a narrower, projecting implant, compared to the broad, fuller variety.

  We are still awaiting FDA approval of the newest generation of “form stable,” or very cohesive silicone implants. They are tear drop shaped, and are quite firm, compared to current silicone implants. Although I suspect that they will be heavily marketed as the “latest and greatest,” I believe that most patients will benefit from a smooth, round implant, and there will probably only be a small subgroup of patients who will benefit from the “form stable” variety.

• Desire for a size change

  It may come as a surprise to many that the most common request in my breast revision practice is for SMALLER implants! Many patients recall being told by their friends who have had breast implants to always go bigger than what they think they would like. Times have changed, and for most women, bigger isn’t always better.

  Moderate sized implants are usually in order for two main reasons. First, many women initially chose implants that were too large, or their surgeons chose for them, probably thinking “the larger the better,” and “the happier the patient.” Second, larger implants are associated with more breast complications (like malposition, thinning of the tissue, rippling, and a host of other problems). To effectively manage these issues with a breast revision, it’s often advisable to choose smaller implants.

  If you are pleased with your breast implants, have no complications, and simply prefer larger implants, this is a straightforward procedure. Patients choosing smaller implants usually will do well with an implant exchange alone but sometimes there will be a need for additional modifications to the breast in order to ensure that the breasts maintain a pleasing shape.

• Desire for implant removal

  Many women considered removing their breast implants when the FDA placed a moratorium on silicone breast implants in 1992. The reason, at the time, was due to a belief that breast implants may be related to human disease. Subsequent studies proved this not to be the case, and silicone breast implants were returned to the market in 2006.

  For many women, the thought of having to remove their breast implants is an unpleasant one. Careful and sensitive discussions need to take place any time a woman requests implant removal. It’s important that the real reasons are discovered so that there is no regret, or disappointment about the decision. Breast implant removal can also be a liberating experience for those who have always questioned their decision to enhance their breasts. For some, they had adequate breasts to start, and for others, the decision was made at a different time of their lives and times have changed.

  Fortunately for many, the breast retracts quite well after implant removal and no additional procedures are usually needed. In those who have particularly lax or inelastic tissue, there may be the need for a breast reshaping procedure to achieve the best outcome.

  The actual procedure for implant removal is straight forward. In most cases it’s probably better to remove the implants, wait several months for all the tissues to retract, and then evaluate the need for a mastopexy procedure to address any skin excess or breast asymmetry.

• Old implants

  Plastic surgeons have been known to quote a time frame after which breast implants become “expired.” The fact is, the longevity of implants is based on purely statistical analysis. The older the implant, the more likely it’s outer shell will have a fault, resulting in what we refer to as an “implant rupture”.

  It’s quite rare for a breast augmentation patient to request implant removal based on age alone, particularly when there are no problems with the breast implants.  A saline implant will deflate when the shell ruptures, whereas a silicone implant will likely continue to function normally (it will perform like a run flat tire). Eventually the breast will become firmer or develop some pain and discomfort.

  If I were to throw out a time frame to consider implant exchange, it would probably be 15-20 years. This is a good opportunity to change the implant style or size, or to “spruce up” your breasts with a pocket adjustment or breast lift. As much as we would all love for implants to last forever, they don’t. An implant exchange is the most common treatment to old implants. The option of simply removing them is not acceptable to most patients.

  An MRI exam of your breasts to detect for a fault in the implant shell is not a perfect test—its accuracy is about 80 percent, and is very dependent on the quality of the exam and the experience of the Radiologist. If you are experiencing any of the complications described in this section on breast revision, and your implants are over 15 years old, I would suggest considering an exchange for a new pair of breast implants. It’s not just peace of mind, it’s also a great opportunity to make additional improvements to your breasts, if you prefer.

• Health concerns and breast implants

  Silicone breast implants were removed from the market in 1992 due to concerns that implants may be related to connective tissue disorders (such as Scleroderma and Lupus). This was subsequently disproven with research and science, and the implants were replaced back on the market in 2006 by the Food and Drug Administration (FDA).

  There is no science from peer reviewed medical journals that implicates silicone breast implants with any disease process in humans. It’s theoretically possible that silicone implants may cause health issues in some patients; however, this would be very rare indeed. There is no simple test (like a blood test or x-ray) that is able to determine that your implants are causing you harm.

  Be aware that any Internet search about breast implants and disease will surely produce a plethora of websites extolling the danger of breast implants. There is no science to back the claims made by individuals or groups who would have you believe there is a connection between silicone and disease.

  If you truly believe that your breasts implants are causing you harm, the simplest, fool-proof remedy is to have your implants removed. A visit with an Internist or Rheumatologist may also be helpful.

  The real issue here is peace of mind. If you are someone who is going to worry about the potential for health problems from implants, despite the science, you can always elect to remove them or switch them out for the saline variety.

• Mastopexy/Breast reduction outcome improvements

  A breast reduction is “happy surgery,” as it reduces the burden of large, heavy breasts. A mastopexy, or breast lift, is designed to reshape the breast without tissue removal. Both procedures result in similarly shaped scars. Results from these procedures often lack superior breast fullness and “breast lift” features.

  Although patients have benefited significantly from these procedures, modern day advances in techniques and outcomes have drawn the interest of those seeking a higher level of refinement.  A reduced breast may lack a youthful shape and superior breast fullness. A mastopexy may have resulted in only temporary breast shape improvements that have fallen over time.

  Breast revision alternatives include additional reshaping procedures utilizing existing scars or even the use of a breast implant to optimize breast shaping. Nipples that are too high or low may be adjusted. Breasts that have been left too large after a reduction may be further reduced to the desired size.

  Breast revision procedures offered to patients who have had a previous breast reduction or mastopexy are at higher risk for complications and should be careful to explore options with surgeons with extensive experience with these challenging cases.

• Saggy breast with “ptosis”

  “Ptosis” refers to a saggy breast. It is measured by noting the position of the nipple as it relates to the inframammary fold. A nipple at or below the fold is considered low.

  Ptosis makes the appearance of the breast “sad,” or “boring.” There is a loss of superior breast fullness. The nipple sits low on the face of the breast and can point to the floor. These are all characteristics of a matronly, non-youthful, non-perky breast.

  Ptosis is inevitable in all breasts except maybe for the smallest ones. Significant weight fluctuations, pregnancy, lack of bra use, and poor genetics are all related to breast ptosis. Ptosis makes the upper chest longer and the abdomen shorter—attributes that are unattractive in most women.

  Ptosis after a breast augmentation occurs as the breast falls over time—it essentially falls off the breast implant.  The breast implant can also slide down the chest because of gravity—“my breasts used to sit up higher but have fallen over time”.

  The treatment for breast ptosis depends on the cause. A low implant may be moved higher. Loose, hanging breast tissue can be lifted and shaped into a more youthful position. My very own BAR procedure (Breast Augmentation and Reduction) is very useful in addressing breast ptosis.

  Performing a breast “lift” on a previously augmented breast can be a challenge, and should best be left in the hands of expert surgeons.

• Simply tired of large, matronly, low-lying breasts after a previous enhancement

  Perky, smaller breasts seem to be all the rage now. It could be any woman, but more often than not, moms who have had implants for years are realizing that they are too large and too wide, making them look older and less shapely (matronly). Their breast implants have served them well for many years, but because of the changes associated with pregnancies, they don’t have the breasts or figure that they used to have.

  Many women aren’t aware that breast revision plastic surgery can “turn back the clock” by reshaping the breast with a different implant, a breast lift, or both.

  “Perky” is:

  • Smaller
  • Narrower
  • Projecting
  • Forward facing nipples
  • Superior breast fullness
  • Breasts situated higher on the chest

  There are many alternatives to reshaping and repositioning breasts that are large and low. Smaller, high profile implants combined with a “breast lift” is a very powerful combination of procedures to reshape non-youthful appearing breasts.

• Desire for a “second opinion”

  How do you know if your breasts aren’t right? What if your surgeon has told you that your result is “normal”? What if the result from your breast enhancement isn’t what you had in mind? What’s wrong with wanting to improve your breasts, when you know that they aren’t what they used to be? A second opinion is a great way to gain a fresh perspective.

  Taking the first step and seeking a consultation with an expert in secondary breast procedures can offer you options and peace of mind. Maybe everything is the way it should be, but maybe improvements can be made to give you back what you used to have, or never had!

In my experience, I have realized that there are many women running around with unsatisfactory breast enhancement results; these situations can often be improved upon with a breast revision procedure. It doesn’t hurt to learn what is available, what outcome can be expected, and what it will cost you.

Robert Caridi, MD