BREAST REVISION

Correct Problems from Prior Surgery in the Philadelphia Area

If the results of your breast surgery did not meet your original goals, breast revision surgery with Dr. Scott D. Chapin can effectively improve your results or correct complications from your previous breast surgery. Dr. Chapin is a nationally recognized breast surgery expert 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 are not satisfied with their breast surgery are:

  • Dissatisfaction with the initial implant size and/or shape
  • Desire to replace the current implant type with another type (most commonly from saline to the latest cohesive silicone gel or “gummy bear” implants)
  • Capsular contracture (scar tissue forms and constricts the implant, causing the breast to harden)
  • Malposition, also known as laterization (the implant migrates from the original position, causing a change in the appearance of the implant, especially when lying down)
  • Rippling (refers to folds or wrinkles in breast implants that are visible through the skin)
  • Implant rupture (the implant sustains trauma or wear and tear that causes the shell to rupture)
  • Double bubble (the implant falls, producing a second bulge below the natural crease of the breast)

Breast revision can:

  • Change the size and/or shape of your breast implants
  • Upgrade the implant type
  • Correct complications from a previous breast surgery (i.e., capsular contracture, malposition, rippling, implant rupture and double bubble)

Our Customized Approach

Dr. Chapin will ensure you receive the time and attention required during the 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 recommend the best approach to your unique situation. He will develop a customized plan to achieve your original goals and/or correct any complications you may be experiencing from your primary breast surgery. He will make certain that you have a complete understanding of how your new breasts will look and feel to ensure you are satisfied with your breast revision decision.

Change Implant Size/Shape

If you find that you are dissatisfied with the size and/or shape of your current breast implants, this can be corrected with breast revision surgery with Dr. Chapin. Through breast revision surgery, Dr. Chapin can decrease or increase the size of your implants, as well as address any concerns regarding the shape.

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

At your Chapin Aesthetics consultation, we will conduct a sizing test so that you can see your potential result in the mirror prior to surgery. This will provide the most accurate representation of what you will look like post surgery.

Please keep in mind that when surgeons reference breast implant sizes, 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 surgery due to the dissatisfaction with the implant size or shape, consult with a board-certified plastic surgeon who specializes in breast surgery for optimal results.

Implant Upgrade

Due to the increased risk of complications associated with saline implants, it is not uncommon for patients to upgrade to the recently FDA-approved textured 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 due to its cohesive molecular makeup.

Gel implants are found to be strong, yet they remain remarkably soft and natural to the touch. Cohesive gel silicone offers multiple advantages over other implants for numerous reasons. Click here to learn all the benefits that textured, cohesive gel silicone implants have to offer patients for both primary and secondary breast augmentation procedures.

Capsular Contracture
Capsular contracture is the most common, yet most complex complication associated with breast augmentation surgery. Capsular contracture occurs when the normal scar tissue around the implant thickens and contracts, resulting in a hardened shell around the breast implant.

Patients usually become aware of changes in their breast implants when capsular contracture occurs. Many patients notice that their breast starts to harden and loses its normal soft, natural feel. They also may see a visible change in appearance of the breast with the implant appearing slightly higher on the chest wall. In addition, the patient may feel discomfort or tightening around the breast.

If you have been diagnosed with capsular contracture, Dr. Chapin, a nationally recognized breast implant consultant, can help correct this issue. Depending on the degree of your capsular contracture, Dr. Chapin will recommend medical or surgical treatment for the problem. Many cases of capsular contracture are quite subtle, and can simply be observed for progression over time. It is possible that Dr. Chapin may recommend surgery, which may consist of implant exchange and removal of the scar tissue, also known as capsulectomy.

Malposition

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

Breast implants malposition occurs when the breast implants are 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. Although breast implant malposition is treatable, it is best to start with a consultation with a board-certified plastic surgeon who specializes in breast surgeries, such as Dr. Chapin.

Meet Dr. Scott Chapin

Dr. Scott D. Chapin blends medical science, artistry, and humanity in every procedure he performs. As a board-certified plastic surgeon, he specializes in aesthetic surgery, with a particular focus on breast surgery. His national reputation and commitment to excellence make him a top choice for Doylestown and beyond.

  • Dr. Chapin has been inducted into the RealSelf Hall of Fame

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

After Dr. Chapin obtains your full medical history and performs a thorough physical exam, he will formulate a treatment for the best possible outcome. If breast revision surgery is recommended, Dr. Chapin may suggest using textured cohesive gel silicone implant to replace the implants you have. Smooth implants have an increased risk to shift out of position because they do not adhere to the tissues and do not have a coefficient of friction that prevents them from sliding around in the pocket. Textured implants help to stabilize the position of the implants, as they are less likely to migrate out of position in the future.

It is important to note that it is normal for the breast to appear too high in the early postoperative period. Throughout the first year post 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 surgery to reposition your implants. At a year, the implants are stable, and correction is more predictable.

Rippling

“Rippling” is used to describe irregularities of the implant surface that can be visible or felt through the skin. This complication can be caused from thinning of the tissue covering the implant, a saline implant that is under filled 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 surgeries. Dr. Chapin can treat breast implant rippling with several treatment modalities, depending on each patient’s unique circumstances.

Breast implant rippling with a saline-filled implant can be improved by simply exchanging the implant for a cohesive gel implant, provided there is enough breast tissue to “hide” or cover the implant adequately. Cohesive gel implants tend to 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) 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.

Implant Rupture

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

  • 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 revision breast surgery immediately to exchange the ruptured implant for a new implant.
  • If a liquid silicone implant (no longer available) ruptures, the leakage may be slow and go unnoticed for a lengthy period of time. 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, 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 to the same consistency of a gummy bear candy. In the extreme unlikelihood that one of these cohesive silicone gel implants was ever to sustain enough trauma to cause a rupture, the gel remains intact. This prevents the contents of the implant from seeping into the body and makes the ruptured implant easily removed for replacement.
Dr. Noah Prince

Meet Dr. Noah Prince

Dr. Noah Prince applies his high-level expertise and compassionate bedside manner to give his patients the full benefit of his surgical skill. Throughout his career, the Harvard and Tufts University educated plastic surgeon has completed more than 4,000 procedures. His state-of-the-art techniques and exceptional outcomes help his patients love the way they look and love the way they feel.

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:

  • 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 surgical intervention. One option is revision breast augmentation surgery involving a breast lift (mastopexy) and dual plane placement of the implants. This lifts the implants back into their proper position and stabilizes them to help prevent them from migrating in the future.

The breast crease can also be modified for correction of a double bubble. This 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 surgery, such as Dr. Chapin.

Five Reasons to Consider Textured 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 surgery to correct the problem. Breast revision surgery increases both the costs and the risk of complications to the patient.

Saline and liquid silicone implants lose their shape faster than textured cohesive gel silicone implants due to the difference in their respective composition. The new generation of textured cohesive gel silicone implants is firmer than the traditional saline or liquid silicone implants, but is still soft to the touch. Textured 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.

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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 immediate implant replacement 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 replacement or simply observe the implant over time. This eliminates the financial and emotional burden of immediate reoperation in the case of implant injury.

Research and testing has shown conclusively that 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 occurs when the scar tissue around the implant becomes inflamed and creates a thickened, hard shell around the breast implant. Below are the most common capsular contracture symptoms that patients may experience:

  • Breast becomes hardened and loses a soft, natural feel
  • Breast changes in appearance and becomes distorted
  • Feelings of tightening and discomfort

Capsular contracture is an unpredictable complication. Presently, we do not know exactly why capsular contracture may form in one patient and not in another—or even why capsular contracture may only occur in one breast and not the other.

Capsular contracture may require patients to undergo 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. The use of textured implants is one way to decrease the risk of capsular contracture. The rough surface of textured implants deters a hard capsule of scar tissue from forming around the breast implant. The 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 migration

Breast implants can migrate or move—medically known as malposition, laterization, or supine shift— from their original placement at the time of surgery. If the implant has shifted in the breast pocket, the patient may notice a change in appearance of the implant or a change in location of the implant.

When laterization has occurred, the patient may need to undergo surgery to correct the placement of the implant. Additional surgery causes the patient to endure more costs and risks of surgical complications. The risk of laterization can be reduced with the use of textured cohesive gel implants. Textured cohesive gel silicone implants provide a more stable position to the implant over smooth implants, which reduces the risk of the implant shifting over time. Smooth implants have an increased risk to shift out of position because they do not adhere to the tissues and do not have a coefficient of friction that prevents them from sliding around in the pocket. Textured implants help stabilize the position of the implants, as they are less likely to migrate out of position over time.

Decreased rippling

Breast implant rippling refers to folds or wrinkles in breast implants that are visible through the skin.

Typically, rippling is the most noticeable on the bottom or sides of an implant, but may also occur in other areas such as the middle or near the cleavage region. Although rippling can happen to any patient, there is research to support what 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 with more saline is inserted in to the breast implant than what 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.

Implant Size

Choosing the size of your breast implants is the most emotional part of the decision-making process.

Implant Shape

You have the option to choose between the traditional round implants or shaped implants. The shape of your implant will affect your overall look after surgery.

The majority of women have round implants, which often gives more volume and upper pole fullness to the breast. Generally speaking, shaped implants are ideal for patients who are seeking a natural look and do not want an abundance of superior fullness. Dr. Chapin has found with his extensive experience that shaped implants are helpful with patients who have nipples located lower on the breast mound and for patients who do not have a large amount of natural breast tissue because they offer more shape inferiorly. However, the best way to determine what shape is best for you is to have a candid discussion during your consultation about what look you are seeking.

Implant Position

There are three options for the breast implant position:

  • Submuscular breast implant position (behind the muscle): Placing the implant under the pectoralis muscle gives a more natural appearance, as the muscle tends to mask the implant and provide a smoother appearance to the upper pole of the breast. Another advantage of placing the implant beneath the muscle is that it is less likely to create a drooping or waterfall effect by stretching out the breast tissue, which can occur over time. Also, placing the implant under the muscle decreases the chance of capsular contracture or interference with breast exams and mammography.
  • Subglandular breast implant position (in front of the muscle and behind breast tissue): The advantage of this placement is that it can increase volume to the area of the breast behind the nipple. However, this placement of the breast implant makes the implant more easily visible and felt due to the lack of muscle covering the implant in the upper pole of the breast. Additionally, there is an increased risk of capsular contracture with the subglandular breast implant position.
  • Dual Plane (the implant is placed beneath the pectoralis major muscle superiorly but lies directly under the breast tissue inferiorly): Although dual plane offers several advantages, many surgeons do not offer this specialized technique. Dr. Chapin is part of the small minority of plastic surgeons who educates patients and performs dual plane implant positioning.

Dual plane allows Dr. Chapin to be the most accurate with implant placement and provides the best shaping of the inferior portion of the breast. It allows the breast tissue to ride up relative to the implant so that it does not appear that tissue is drooping off the implant. The patient will still benefit from all the advantages of submuscular position, such as decreased visibility and reduced risk of capsular contracture.

Also, for patients who present a small amount of breast sag, a dual plane is an ideal method to allow the implant to still be placed under the muscle and give a lift to the breast while avoiding the need for a breast lift procedure.

Incision Placement

There are three options for the incision placement in breast augmentation surgery:

  • Axillary (underarm): An endoscope (lighted camera) is utilized to help tunnel through the subcutaneous fat to construct a pocket behind the breast. This incision site is most often used to place unfilled saline breast implants.
  • Periareolar (around the nipple): Although this incision type can be the most concealed, it is linked to an increased risk of breastfeeding difficulties than the other incision options because periareolar incision involves cutting through the breast tissue. Other increased risks with this incision type are capsular contracture and a higher likelihood that nipple sensation will be affected.
  • Inframammary (under the breast): This is the most common incision type today, and the incision takes place right under the breast fold. This is an optimal choice because it may cause fewer breastfeeding difficulties than the periareolar incision and capsular contracture, as well as allow the procedure to be more straightforward and precise.

The Day of Your Procedure

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

Breast Revision Recovery

There is less pain associated with breast revision surgery 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. Recovery time is typically 25 percent of what is usually experienced with the initial procedure.

Dr. Chapin will provide complete preoperative and postoperative care instructions. He will monitor and advise when patients can gradually resume their daily activities including exercise.

Contact Our Office

Dr. Chapin serves patients from Philadelphia and Bucks and Montgomery counties. To learn more about breast revision surgery or to schedule a complimentary cosmetic consultation, contact our office today.

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