Breast Augmentation Revision

Correcting Problems with Breast Implants

Although board certified in the entire spectrum of plastic surgery, Dr. Revis has chosen to focus his practice on breast augmentation surgery, which he practices exclusively. Within that spectrum, he has developed a special interest in breast augmentation and its potential problems. Breast augmentation surgery — both new and revisionary procedures — are the most common procedures performed by Dr. Revis (600-650 breast implant procedures each year). In the interest of your safety, he only performs surgery in a fully accredited ambulatory surgery center with M.D. anesthesiologists.

Dr. Revis has been selected as one of only 35 members for the Mentor Worldwide LEAD Council. Read more about Mentor’s LEAD Program Advisory Board.

What Is Breast Augmentation

Breast augmentation is a procedure that is often assumed to be simple in nature and execution but is actually quite complex. Proper surgical technique and attention to detail are essential to good results, and too often these are overlooked. In his opinion, this is why Dr. Revis sees so many patients who are dissatisfied with their augmentation or have developed one or more complications. There is no such thing as a simple breast augmentation, and an attitude of “seen one, seen them all,” commonly held by many plastic surgeons, simply will not suffice when dealing with the subtle complexities and intricacies of breast augmentation.

Breast augmentation revisions may be needed for the following reasons:

• Problems with surgical placement or implant position
• Problems with the patient’s tissue characteristics
• Problems with the implants themselves

When a problem does arise, the proper correction focuses first and foremost on carefully diagnosing why the problem exists. Many patients have a problem that falls into more than one of the above categories, creating an even more challenging situation.

Too high

Implants that remain too high post-operatively (and do not drop or settle into the correct position)

Too widely spaced apart

Implants that are too widely spaced apart, lacking desirable cleavage or falling into the armpits upon lying down

Snoopy Deformity

Snoopy deformity (prominence of the nipple-areolar complex characterized by herniation of some of the breast tissue into the nipple-areolar complex, named after its similarity to the cartoon character Snoopy) should be addressed during the initial operation but occasionally only becomes apparent post-operatively.

Tuberous Breasts

Tuberous breasts (characterized by a narrow base of the breast, a widening of the breast near the nipple-areolar complex, and a short or deficient inframammary crease) should be addressed during the initial operation because if overlooked or not treated properly will inevitably lead to an unsatisfactory outcome.

Elongation of the Skin

An elongation of the skin and sagging of the breasts over time as tissue elasticity is lost as a result of aging, sun damage or smoking

Pre-existing Asymmetry

Pre-existing natural asymmetry not corrected during the initial operation. Most breasts differ from one another, sometimes greatly. This may be a difference in size, shape or position and is rarely perfectly corrected during surgery. However, asymmetries should be properly diagnosed and documented preoperatively in an attempt to correct the asymmetry as much as possible during surgery.

Dissatisfaction

Dissatisfaction with the size of one’s implants is the most common reason women have a second operation is to change the size of their implants (almost always switching to a larger implant). Dr. Revis spends a considerable amount of time with you discussing size, your expectations and your chest dimensions during your initial consultation and during your preoperative visit. Dissatisfaction with your implant size should be totally preventable by a thorough evaluation and decision-making process.

Implant Visibility

Implant visibility, being able to see the outline of the implants through the skin, usually accompanies rippling and palpability. See rippling explanation above.

Implant Palpability

Implant palpability, being able to feel the implants beneath the skin, usually accompanies rippling and visibility. See rippling explanation above.

Developed Through Decades of Experience

As a specific example of a problem requiring a thorough, systematic approach and innovative techniques demonstrated in photographs below, Dr. Revis has seen a dramatic increase in the number of patients presenting from other offices with bottoming out of one or both implants. This means that the pocket, or capsule, surrounding the implant has enlarged or stretched under the effects of gravity and have become too low on the chest wall or rests too far laterally when lying down. This may cause the appearance to be unattractive and even uncomfortable when wearing no bra. The implants may hang too low, preventing you from being comfortable when braless. You may also experience the implants falling far apart and even into the armpits when lying down.

Silicone Gel vs. Saline Filled Breast Implants

There are two basic types of implants, silicone gel and saline filled. The new silicone gel implants arrive from the manufacturer already filled with cohesive silicone gel (not liquid silicone) in their sterile packaging. Saline implants arrive from the manufacturer empty, in sterile packaging, and are actually filled with sterile saline solution in the operating room. Saline implants typically lift better, and are more perky and rounded, whereas silicone implants are the most natural look and feel that you can achieve.

Your Choice

There are several reasons a woman might choose one type of implant over another, and these include body type, current breast size, and the desired look and feel after surgery. During your consultation, Dr. Revis will discuss with you which implant type might be the best choice for your individual needs. You are encouraged to bring any wish pics or goal pics you may have found to your consultation or preop appointment.

Where the Implant Goes Matters

The incision for breast augmentation may be placed underneath the breast, around the areola (the pigmented skin surrounding the nipple), in the armpit, or in the belly button. Dr. Revis performs all of these types of incisions, and he will discuss which might be the best for your specific situation at the time of your consultation.

A cross-sectional diagram of subglandular (left)
and submuscular (right) augmentation

Our Expert Advice

Whenever possible, Dr. Revis prefers to place the implants in a totally submuscular position. Dr. Revis believes that the advantages of placing the implants completely beneath the muscle of the chest wall greatly improve the long-term appearance of your breasts following augmentation. This is for three main reasons. First, mammography is easier and the quality is better when the breast implant is separated from the breast tissue by the layer of muscle. Secondly, there is a lower incidence of capsular contracture when the implants are placed totally beneath the muscle. Capsular contracture occurs when the body produces scar tissue around the implant. This may change the shape of the implant and make the breasts asymmetric. Finally, placing the implants beneath the muscle of the chest wall makes your breasts appear more natural because there is more of your own tissue covering the implant, making it less likely that you will be able to see or feel the implant.

What Is Your Ideal?

This is one of the most important decisions you will make. Because of this, we use several approaches to help you make the best decision based on your anatomy, personal preferences, and the appearance you wish to achieve. Interestingly, in a recent national survey, over 80% of patients undergoing breast augmentation stated that a “C” cup was their desired post-operative goal. A “D” cup was the second most popular request.

Try Before You Buy

Finally, we will have you try on various implant sizers in a surgical bra. You may wish to bring a bathing suit, tank top or other clothing to see how you will look with different implant sizes. This helps confirm that you are making the right implant choice. We usually perform the trying on of breast implant sizers during the preoperative visit. This is because the initial consultation is very thorough, lasts approximately one hour, and tends to provide you with a tremendous amount of information to digest. In his experience, trying on implants at this point in the developing physician-patient relationship rarely leads to a conclusive decision and almost always needs to be repeated. However, we also understand that many patients travel a long distance for a consultation with Dr. Revis. With that in mind, we are willing to be as flexible as possible with out of town patients and allow the trying on of implant sizers during the initial consultation if we are given enough advance notice to schedule a more lengthy appointment. Also, please feel free to make as many trips to the office as you need to be satisfied with your implant selection. Our goal and the measure of our success is your happiness.

Thorough Consultation

After reviewing your medical history, Dr. Revis will discuss your concerns, priorities and motivations for pursuing plastic surgery, as well as your fears. After examining you, Dr. Revis will be able to offer advice and options to help you achieve the appearance you desire. He will explain the advantages and disadvantages of the different options you have before you. You will also be shown the different types of breast implants.

Transparent Process

At the completion of your consultation, you will be given a written estimate of the cost of your procedure. At this time, you will also have the option to schedule your procedure if you so choose. The decision to undergo surgery is a very important one, and the final decision should be given very careful consideration. Dr. Revis realizes the importance of this decision, and at no time will you be pressured to make a decision. You are also encouraged to bring your spouse, significant other, family member, or a friend to your consultation.

Safe & Comfortable

Anesthesia is an essential part of any surgical procedure and must be performed safely. Endotracheal intubation is the deepest form of anesthesia. You have an endotracheal tube inserted into your trachea, you are given muscle paralytic agents, and the ventilator is doing your breathing for you during surgery. This form of anesthesia is usually not required for breast augmentation unless the patient specifically requests intubation or the patient has a difficult airway as assessed by our board certified M.D. anesthesiologist.

Just Like Sleeping

What to Expect

Breast augmentation usually takes one to one and a half hours to perform. After you have changed into a gown and had your intravenous line started, you will be given a dose of intravenous antibiotics as a precautionary measure. Dr. Revis will use a surgical marking pen to identify certain landmarks on your chest. This ensures proper implant placement and symmetry post-operatively. He will also review the entire operative plan with you including incision location and implant type and size.

Incisions and Pocket Creation

After allowing time for the local anesthetic mixture to take effect, Dr. Revis will make the incisions necessary for placement of the implants. Using the newest techniques and instruments, Dr. Revis is able to create a pocket beneath the muscle of the chest wall without cutting any of the muscle. This is extremely important for the maintenance of long-term results.

Clean & Safe

During the filling process for saline implants, Dr. Revis uses a closed system to fill the implants with saline. This means that the saline that enters the implant is never at any time exposed to the air in the operating room. The saline flows from a sterile bag through a sterile tubing directly into the implant. Dr. Revis feels this additional precaution prevents any foreign material from inadvertently being injected inside the implant.

Fully Certified

Dr. Revis is certified by Keller Medical and uses the Keller Funnel in every silicone breast implant procedure he performs, as part of his ongoing effort to continuously improve surgical results for his patients.

Pick these up before your procedure

Silagen or Skinuva– Made with 100% pure medical grade silicone, these products offer a clear, fast drying gel that will help flatten, soften and smooth scars. It also helps reduce redness, discoloration, itching, and pain.

Arnica Montana/Bromelain Complex is a natural product from Sweden which has been shown in clinical studies to reduce post-operative bruising and swelling. Begun the evening prior to surgery, this product is continued for four days post-operatively.

These products are available for purchase in our office. Please ask us about these products and others if you have any further questions about whether or not these would be beneficial for you during your healing period.

Always at Your Service

Breast augmentation revisions are performed as an outpatient procedure. After recovering in the recovery room for approximately one hour, you will be able to go home in the company of a friend or family member. Dr. Revis will also give you his cell phone number so that you may reach him directly at any time with any questions you might have

Post Procedure

The antibiotics that were prescribed during your preoperative visit (usually Augmentin) should be taken twice daily beginning on the evening prior to surgery. Continue this medication for five days post-operatively or until it is gone. The pain medication prescribed by Dr. Revis during your preoperative visit should be taken fairly regularly, every four hours or so, during the first 24 hours (when you are not asleep, of course). Most patients find that they are able to transition to Tylenol or Ibuprofen after three or four days. It is not safe to drive a car within 24 hours of taking pain medication, as your reflexes and alertness may be altered. Dr. Revis may prescribe a muscle relaxant (usually Flexeril) for you if he suspects that your muscles may be tight and uncomfortable following surgery. If so, you may take one tablet every eight hours if needed for muscle tightness.