Many women after a breast lifting or augmentation operation using silicone implants would desire a second surgery to correct failures that may have occurred after the first surgery. Sometimes pregnancy, breast-feeding, weight fluctuation can have dramatic consequences in the shape and breast size in order to alter the original shape and size.

Also women who wish to change the size of the implant to a bigger or smaller one. Furthermore women whose implant has moved from its normal position, the development of prosthetic capsule and issues concerning the surgical technique and physiological characteristics of the breast as double bubble deformity, implant displacement, not suitable implant location and combinations of the above are reasons for a breast reoperation.

Am I a suitable candidate for a breast reoperation?

Women who have one of the following aesthetic deformities in the breast are candidates for breast reoperation:

• Implant volume loss, especially in saline implants
• Silicone leaking from the implant found after an x-ray or magnetic resonance imaging (MRI)
• Women who wish to change the size of their breast
• Women who wish to improve the scars image made to a previous surgical operation
• Women who experience changes in the shape of the breast
• Women who have developed a periprosthetic capsule condition
• Women who have any kind of breast aesthetic deformity caused by wrong positioning of the implant (double babble deformity)
• Women experiencing breast asymmetries

Visit to the plastic surgeon Dr Kretsis

During your first visit to Dr Kretsis you should inform him about the type and nature of surgery that you had undergone as well as for the origin and brand of the implants used.

You should mention the problem that you wish to correct and how you would prefer it to be reformed. Dr Kretsis will examine in detail your medical history, any breast cancer history and if you had undergone any U/S or mammogram tests.

He will assess the type of surgery in which you had been submitted and how to improve any aesthetic deformity concerning the shape of the implants, the quality of the skin as well as the quality of the scars that have been preceded by previous operation.

You should also mention if you are planning to lose weight or get pregnant because it could affect the outcome of the operation.

Breast implant volume loss

It is a situation of great discomfort not only due to aesthetical deformity issues, but also due to certain practicalities such clothing, sleeping, walking.

Usually volume loss concerns saline implants. Thus in Europe we no longer use this type of implants.

Regarding silicone implants, this phenomenon occurs in those manufactured 20 years ago where the silicone used was in liquid form. Nowadays silicone implants are life guarantee, the silicone used is compact and because of that even if the implant gets torn the silicone will remain in place.

Volume loss due to silicone leakage is diagnosed through MRI or U/S (ultrasounds).

In both cases the reoperation regards the replacement of the implants with new ones so as the shape and size of the breast to be natural.

The surgery is performed on both breasts at the same time, during which we replace the defected implants with new ones. If the fault implant had remained in the breast for a long time then it might has altered the shape of the breast.

In this case we use anatomical implants and additional use of fat to correct the problem permanently.

Changing Implants

Breast reoperation in order to change the implants is quite often. Usually we change implants to gain greater breast volume. It concerns a very simple operation in which we change the size of the implants to the desired one as mentioned above. The patient leaves from the hospital the same day. The operation is much less severe than the original, because there is already the sheath, in which we position the larger implants. Before surgery the patient should provide information on the type, origin, size and shape of implants that were used before.

In women who wish to change implants into a smaller size should be assessed the new desired size in comparison to the previous one as well as the quality of the skin and the position of the nipple and areola. A very big change to a smaller size implant can also impose some degree of intervention due to the excess skin that will occur after the change. This does not concern the majority of the cases.

Dr. Kretsis after being fully informed about the type and the size of the implants used previously, and after taking in to account all the clinical parameters, will suggest the operation that provides the most natural result with the smallest intervention to the breast.

Prosthetic capsule

Even to this day it is unknown what causes the creation of the capsule around the implant. Hematoma, transfection, infection, type of implant and more have been implicated. By periprosthetic capsule we mean the tissue creation around the implant which by its nature is mostly scar tissue and tends to tighten the implant.

Depending on the degree of the periprosthetic capsule, we have a range from small difference in breast texture (the breast with the capsule is tougher than the other) to very high stiffness, deformation and severe pain in the breast which has developed a capsule of high degree.

Today the creation of periprosthetic capsule is at very low rates due to the use of high quality implants (rough surface implants) with anatomical size and the performance of detailed surgical techniques (avoid hematoma, no use of tubes in the breast). The woman who has suffered a high degree capsule will undergo a total capsulectomy. Any other operation would not guarantee the non-repetition of the capsule phenomenon and even in a short period of time.

Through total capsulectomy we achieve to keep only the healthy tissue to the area and to place the new implant without the use of tubes. Thus is the only operation that solves the problem permanently.

Moving the implant

The movement of the implant may be in any direction either up, or down, in or out, (axillary cavity) or inwardly towards the breastbone.

Whatever the nature of the implant movement, large breast envelope, capsule development, trauma etc, we have an aesthetic deformity which is intense if compared to the other breast.

In this case the operation regards the remodeling of the breast skin envelope and the moving of the implant to the normal position.

Double Bubble Deformity

It is an aesthetic deformity where breast and implant do not behave as a single anatomical unit. The implant is visible to the lower part of the breast. This usually occurs at the lower part of the breast. This deformity is corrected with the use of a smaller implant or by opening the internal breast in order to cover the implant.

Water Fall Deformity

It is an aesthetic deformity in which the implant remains on a high level to the upper part of the chest while the breast droops downwards (like a waterfall). As described above, again implant and breast do not behave as a single anatomical unit.

This is due to wrong implant positioning, either on a higher level / under the muscle (in large breasts) or due to capsule or trauma development.

This deformity is being corrected by positioning the implant to the right position or by changing the implant’s shape from round to anatomic.

Symmastia

It is an aesthetic deformity wherein the two breasts are located on or above the sternum midline. This is an inconvenient deformity which is caused either by the use of very large implants or by the extension of the breast skin envelope near the midline.

The deformity is corrected by repositioning the skin envelope to a normal position (use of internal sutures) and by changing the silicone implants.

Rippling

It is a deformity felt along the outer side of the breast and the inner side of the breast next to the cleavage making the existence of the implant visible.

This is either due to very thin tissue under the skin, but mostly due to wrong surgical plan when placing implants. Which should be placed beneath the breast and not beneath the muscle. Is an aesthetic deformity that has to do with the thickness of the tissue over the implant in order for it not to be obvious.

Rippling is corrected by using artificial collagen pads in order to place the implant under the muscle or by injecting fat to the problematic areas.

In conclusion

Breast reoperations in order to be properly performed and correct aesthetic deformities need experience in breast surgery as well as knowledge of all the modern techniques which can provide a solution to any personal issue.

In VK Institute Of Aesthetic and Plastic Surgery the huge emphasis and expertise in breast surgery and breast reconstruction after mastectomies establishes us as specialists in the restoration of such aesthetic malformations after unsuccessful breast operations.

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