After an unhappy experience elsewhere, can breast augmentations be fixed?

At St. Louis Cosmetic Surgery, we are often asked to perform revisions on breast augmentations done elsewhere. Patients may desire a revision for many reasons, and our goal is to help each one achieve the results they wanted from the very beginning.

Many women come in wanting a revision due to unhappiness with the size of their breasts after implants. Whether they are too large, or too small, occasionally patients will change their mind and end up wanting a smaller or larger implant. It may also be that the surgeon didn’t listen carefully to the patient’s preferences. In order to correct a size issue, first we determine if the original implants are too small or too large. For too small implants, we normally release the capsule (membrane around the implant) superiorly and medially, then insert a larger implant. For those that are too large, we need to do a pocket adjustment to make the pocket smaller. Generally the skin will shrink up satisfactorily.

Another common issue is the position of the original implant. If the implants are too high or too low, these are the easiest adjustments to make.The breast crease can be raised or lowered, sometimes under local anesthesia.

Drooping, or sagging, is another unfortunate ailment that we can fix. Drooping (ptosis) of the breast can be corrected with a breast lift, which raises the breast to a “perkier” position.

Sometimes women will present with rippling of the tissue, which is usually seen with a saline implant or a subglandular (on top of the muscle) implant. This can be greatly improved by switching to a silicone gel implant and/or moving the implant beneath the muscle.

Every so often we will see a patient with a visible ridge of breast tissue inferior to the areola that is most visible when she raises her arms. This is usually an indication that the patient had a tuberous breast before surgery, a condition where there is a very short distance between the areola and the crease. The problem is that there is not enough breast tissue to reach down to the crease. Frequently it is not necessary to treat this, as it is rarely seen by anyone other than the patient herself. This could be improved by raising the breast crease or by placing the implant on top of the muscle.

It is not unusual that a patient will have a combination of issues and more than one procedure will need to be performed during surgery. In almost every instance of revision, there is a good chance for improvement.

Dr. William Huffaker, M.D., F.A.C.S

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