There are numerous options available from the standpoint of revision breast augmentation if you did not get what you wanted in the first place or things have changed over the years due to age, gravity, weight loss or pregnancy.
The most obvious change during revision surgery for breast augmentation is to change the size of the implants. While going larger will require the surgeon to enlarge the implant pocket, putting in a smaller implant may require a breast lift to correct sagging due to excess skin. When a patient wants to go larger, it generally requires a significant increase in implant size to make a noticeable change in cup size. Most patients will go up 150-200cc’s or more.
Change Implant Composition
When silicone implants became reapproved for breast augmentation surgery in November 2006 by the FDA, I thought that I would see a large number of patients come in to replace their saline implants with silicone prostheses. Surprisingly, relatively few patients sought to make the change. Most of those who did were already going to have surgery; either to replace a deflated implant or to go larger and chose to switch to silicone at the same time.
Alter the Implant Pocket
Breast implants can move out of their intended position so that they do not create the shape and contour that one desires or causing enough asymmetry that the patient is willing to undergo a second surgery to correct the problem. The implant pocket can be revised to be higher to move the implant more superiorly on the chest; or in can be moved down in a situation where the implant didn’t ‘settle’ like it was supposed to. In some cases, such as to correct visible rippling of the implants, a complete change of the implant pocket from on top to underneath the muscle may be necessary. Sometimes this can also be accomplished with an Elastic Wrap after surgery.
To Correct Symmastia
Implants that have been placed too close together can give the appearance that the breasts, which should have some separation in the midline, have blended into one structure; this is called symmastia. To correct this issue, the outer implant pocket needs to be opened to allow the implants to move laterally and the medial pocket on each side needs to be closed to try and prevent the implants from moving back together. In some cases, smaller implants may be needed to allow for proper separation of the breasts.
Perform a Breast Lift
Changes that occur in the breasts as a result of time, aging, weight changes or pregnancy and breastfeeding can result in loss of breast shape and sagging. For adequate correction, a breast lift may need to be performed. For patients who have their implants under the muscle, performing a breast lift (mastopexy) is not as difficult to perform compared with the situation where the implants are on top of the muscle. This is because blood supply to the nipple and areola may be limited by very thin breast tissue and skin caused by implants on top of the muscle.