BREAST REVISION

THE PHILADELPHIA AREA’S DR. SCOTT CHAPIN CAN REPLACE AND REMOVE IMPLANTS TO ADDRESS PROBLEMS, CHANGE STYLES, AND MORE

If the results of your breast surgery did not meet your original goals, breast revision with the Philadelphia area-based Dr. Scott D. Chapin can effectively improve your results or correct complications from your previous breast surgery.

Dr. Chapin is a plastic surgeon who is nationally recognized for breast revision due to his cutting-edge, advanced techniques that produce unparalleled patient outcomes. Dr. Chapin has set himself apart from other leading board-certified plastic surgeons in both primary and secondary breast surgeries in a variety of ways.

The most frequent reasons women decide to have breast revision are:

• Dissatisfaction with the initial implant size and/or shape
• Desire to replace the current implant type with another type
• Capsular contracture
• Malposition, also known as laterization
• Rippling
• Implant rupture
• Double bubble

Breast revision can:

• Change the size and/or shape of your breast implants
• Upgrade your implant type
• Correct complications from a previous breast surgery

OUR CUSTOMIZED BREAST REVISION APPROACH

Dr. Chapin will ensure that you receive the time and attention required during your breast revision consultation to make certain he understands your individual aesthetic goals. If it is determined that a breast revision is necessary, Dr. Chapin will thoroughly educate you on all your options and develop a customized breast revision plan to achieve your original goals and/or correct any complications you may be experiencing. He will make certain that you have a complete understanding of how your breast revision will look and feel to ensure you are satisfied with your breast revision decision.

BREAST REVISION TO CHANGE IMPLANT SIZE/SHAPE

If you find that you are dissatisfied with the size and/or shape of your current breast implants, Dr. Chapin can correct this with breast revision by decreasing or increasing the size of your implants. He can also address any concerns regarding shape.

Dr. Chapin’s goal for breast revision is to achieve a look that makes you feel comfortable. The size of the implant should relatively match the width of your breast. Going too large or too small can cause long-term complications and dissatisfaction. Your desired look in combination with your breast dimensions will help determine what size would fit you best.

Please keep in mind that when surgeons reference breast implant sizes for breast augmentation or breast revision, they use cc’s rather than cup size as a measurement tool. Cup size may vary among bra manufacturing companies and therefore is not an accurate way to measure breast volume. It is Dr. Chapin’s philosophy that it is the look of the breast—not the cup size—that is most important.

If you are considering breast revision, consult with a board-certified plastic surgeon who specializes in breast revision for optimal results.

REASONS FOR CHOOSING BREAST REVISION

BREAST REVISION FOR AN IMPLANT UPGRADE

Due to the increased risk of complications associated with saline implants, it is not uncommon for breast revision patients to upgrade to cohesive gel silicone implants. You may have heard of the terms “cohesive,” “gummy bear,” “form-stable,” or “highly cohesive” breast implants. Each is a different way of describing an implant that retains its shape and cannot leak if the implant were to rupture.

Click here to discover some of the benefits cohesive gel silicone implants have to offer patients considering a breast revision procedure.

BREAST REVISION FOR CAPSULAR CONTRACTURE

Capsular contracture occurs when the normal scar tissue around an implant thickens and contracts, resulting in the formation of a hardened shell around the breast implant. Patients usually become aware of changes in their breast implants when capsular contracture occurs, because the look and feel of the breasts will change.

Dr. Chapin can help correct this issue with breast revision. Many cases of capsular contracture are quite subtle and can develop over time. It is possible that Dr. Chapin may recommend breast revision, which may consist of implant exchange and removal of the scar tissue—also known as capsulectomy.

BREAST REVISION FOR MALPOSITION

Breast implant malposition literally means the breast implant is in the wrong place. Generally, breast implant malposition is an acquired problem that develops gradually over time.

Breast implant malposition occurs when breast implants sit too high, too low, too medial (close together), or too lateral (far apart). Breasts come in a variety of shapes and sizes, and because every patient’s anatomy is unique, it is not always possible to have implants “perfectly” positioned.

Breast implant malposition is treatable, it is best to start with a consultation with a board-certified plastic surgeon who specializes in breast revision, such as Dr. Chapin.

Although there are some nonsurgical options available, it is possible that breast revision will be necessary if your implants are significantly out of position. If you are considering breast revision, it is always a good idea to try to obtain your operative records and preoperative photos from your original surgeon prior to breast revision.

After Dr. Chapin obtains your full medical history and performs a thorough physical exam, he will formulate a breast revision plan for the best possible outcome. If breast revision is recommended, Dr. Chapin may suggest using cohesive gel silicone implants to replace the implants you have.

It is important to note that it is normal for the breasts to appear too high in the early postoperative period. Throughout a patient’s first year after surgery, breast implants normally settle slightly lower on the chest. After one year, if your implants are in a less-than-ideal position, you may want to consider breast revision to reposition your implants. At a year, the implants are stable, and correction is more predictable.

BREAST REVISION FOR RIPPLING

“Rippling” describes irregularities of the implant surface that can be visible or felt through the skin. This can be caused due to thinning of the tissue covering the implant, a saline implant that is underfilled or overfilled, the placement of the implant, or a combination of factors.

Rippling occurs more often with saline breast implants than cohesive gel silicone implants. It is also more likely in women with a small amount of pre-existing breast tissue or when the breast implants are placed above or superficial to the chest muscle. If you are experiencing rippling, it is best to consult with a board-certified plastic surgeon who specializes in breast revision. Dr. Chapin treats rippling with breast revision.

Breast implant rippling with a saline-filled implant can be improved by simply exchanging the implant for a cohesive gel implant through breast revision, provided there is enough breast tissue to adequately “hide” or cover the implant. Cohesive gel implants ripple much less than saline implants due to the molecular structure of the gel inside. If the implant is located above the muscle, it can be relocated below the muscle (subpectoral site change) in breast revision to gain more tissue coverage of the implant itself. Lastly, fat grafting or “lipofilling” can be utilized to provide more coverage to camouflage the implant during breast revision.

BREAST REVISION FOR IMPLANT RUPTURE

When a breast implant ruptures, the patient may experience a variety of symptoms. If you have experienced a rupture, Dr. Chapin will be able to provide you with the most advanced breast revision options to achieve optimal results. Below are the three scenarios of ruptured implants:

• When a saline implant ruptures, the saline (salt water) leaks very quickly and causes the implant to deflate much like a balloon that has lost the air inside. This creates an obvious cosmetic deformity and asymmetry. This scenario generally requires the patient to undergo breast revision to exchange the ruptured implant for a new one.
• If a liquid silicone implant (no longer available) ruptures, the leakage may be slow and go unnoticed. The leaking silicone can stay inside the capsule, which is the thick layer of scar tissue that naturally grows around the implant, or it can leak outside of the scar tissue capsule. When it leaks outside the capsule, the liquid silicone can migrate to other parts of the body, including the lymph nodes under the arm and major organs such as the lungs, where it is impossible to remove. The longer a patient waits to have a ruptured liquid silicone gel implant removed with breast revision, the more time the silicone has to leak inside the body.
• The newest generation of cohesive gel silicone implants is comprised of a strong silicone shell that surrounds the cohesive silicone gel filler that is solid, yet soft and rubbery. This cohesive silicone gel is similar in consistency to a gummy bear candy. In the extreme unlikelihood that one of these cohesive silicone gel implants were to sustain enough trauma to cause a rupture, the gel would remain intact. This prevents the contents of the implant from seeping into the body and makes the ruptured implant easily removable for replacement with breast revision.

BREAST REVISION FOR DOUBLE BUBBLE

“Double bubble” is used to describe a specific type of breast augmentation complication following surgery. Double bubble occurs when an implant drops down behind the natural fold (inframammary crease), causing a second bulge below the natural crease of the breast. This migration creates an unnatural line across the bottom (lower pole) of the breast that is particularly visible when the arms are lifted above the head.

The most common causes of double bubble are because:

• Implants were not the proper size in the original breast augmentation procedure. If an implant was too heavy for the chest wall, it can cause the supporting tissue to stretch, allowing the implant to drop down below the inframammary crease
• Implants were not positioned properly by the surgeon
• The mammary crease is constricted
• Capsular contracture
• Tuberous breasts
• Scarring from previous surgeries

Dr. Chapin has several ways to correct double bubble, all of which involve breast revision. One option is breast revision involving a breast lift (mastopexy) and dual plane placement of the implants. Breast revision lifts the implants back into their proper position and stabilizes them to help prevent them from migrating.

The breast crease can also be modified for correction of a double bubble. This breast revision method requires a small incision to be made in the crease, which is then tightened and raised by placing sutures along the bottom of the breast. This eases the implant back into its proper position.

The best double bubble correction for your situation should be determined during a consultation with a board-certified plastic surgeon who specializes in breast revision, such as Dr. Chapin.

BREAST REVISION: FIVE REASONS TO CONSIDER COHESIVE GEL SILICONE IMPLANTS

LONGER SHAPE PREDICTABILITY

Over time, saline breast implants can fold and lose their shape, creating an unflattering appearance. This can ultimately lead patients to breast revision to correct the problem.

Saline and liquid silicone implants lose their shape faster than cohesive gel silicone implants due to the difference in their respective composition. The new generation of cohesive gel silicone implants is firmer than the traditional saline or liquid silicone implants but is still soft to the touch. Cohesive gel silicone implants retain their shape longer and exhibit improved longevity when compared to saline and liquid silicone implants.

DECREASED RUPTURE RATE

Cohesive silicone gel has been dubbed “gummy bear,” as its consistency resembles that of a gummy bear candy. Amazingly, this cohesive gel implant will not leak, even if the implant is cut in half.

This feature is thought to make these implants safer and easier to remove, even if there is a tear in the outer shell.

Cohesive silicone gel implants are advantageous in the rare event of implant rupture. Should a saline implant rupture, the implant will typically deflate completely. Although the body harmlessly absorbs the saline, the patient will require implant replacement right away due to the significant cosmetic discrepancy that is created.

A cohesive gel implant, on the other hand, will retain its shape even if there is a significant tear in the implant shell. Patients with cohesive gel implants who are seen to have a tear in the implant shell (usually noted on MRI) have the option to pursue breast revision for replacement or simply observe the implant over time. This does away with the financial and emotional burden of rapid breast revision surgery in the case of implant injury.

Saline implants have a much shorter shell life compared to cohesive gel silicone implants. There is no doubt that cohesive gel silicone implants offer a longer shell life, and consequently minimize the number of reoperations you are likely to require over time.

DECREASED CAPSULAR CONTRACTURE

Capsular contracture may require patients to undergo breast revision surgery to remove the scar tissue and exchange the implant. However, there are some proven operative techniques that have reduced the risk of capsular contracture in our patients. Use of antibiotic solutions, the Keller funnel, and inframammary (under the breast) incisions all contribute to a decreased chance of developing capsular contracture. Dr. Chapin routinely employs all of these maneuvers during surgery to decrease this chance.

DECREASED RIPPLING

Although rippling can happen to any patient and may require breast revision to be corrected, there is research to support which factors increase the chance of implant rippling:

• Overfilling of the breast implant: This can only occur with saline breast implants, as silicone breast implants are prefilled and cannot be “overfilled.” Overfilling occurs when more saline is inserted into the breast implant than was recommended by the manufacturer. This can cause the edge of the breast to pull, which can induce a ripping effect.
• Underfilling the breast implant: Underfilling can also only occur with saline due to silicone implants being prefilled. When an implant is underfilled, it leaves the shell emptier than intended, resulting in wrinkling and folds in the implant.
• Poor tissue coverage: This can occur with saline or silicone breast implants, but is most often seen in women with small breasts. It is more noticeable to see rippling in those with small breasts simply due to the fact that there is not as much breast tissue to cover the implant. Those with more breast tissue provide more coverage of the breast implant, consequently lowering the risk of rippling that is visible or felt.
• Subglandular (over the muscle) breast implant placement: Breast implants are most often placed under the muscle for a variety of benefits. However, in rare situations it may be recommended to place the implant over the muscle. Breast implants that are placed over the muscle provide the least amount of coverage for the implant, which increases the chance of visible rippling.

THE DAY OF YOUR BREAST REVISION

Breast revision will be performed with general anesthesia at a Bucks County or Montgomery County AAAA-certified facility. On the day of the breast revision, Dr. Chapin and his highly trained team will meet with you to review all details and answer any questions before surgery. Generally, breast revision takes about an hour to perform. You will receive exceptional and comprehensive care following your breast revision to ensure your comfort.

BREAST REVISION RECOVERY

There is less pain associated with breast revision than the initial procedure. This is due to the fact that the pockets for the implants have already been created and your muscles have already adjusted to the implants. Breast revision recovery time is typically 25 percent of what is usually experienced with the initial augmentation procedure.

Dr. Chapin will provide complete preoperative and postoperative care instructions for breast revision. He will monitor and advise when patients can gradually resume their daily activities including exercise after they have had breast revision surgery.