What is Breast Revision Surgery?
Breast implant revision surgery commonly involves removal and/or replacement of breast implants and is performed to change the size or type of your implants or to correct any complications from your primary breast augmentation. The overall goal is to restore your youthful breast contour and appearance and safety.
The Procedure
General anesthesia is commonly used during your breast revision procedure, although local anesthesia or intravenous sedation may be desirable in some instances.
For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood. Your surgeon will follow the surgical plan discussed with you before surgery.
The exact procedure your surgeon will use for breast implant removal and replacement varies depending on the reason for your breast revision. Once the operation has begun, the surgeon may decide to combine various techniques or change a technique to ensure the best result:
Change in implant size: If you decide to change your implant size, your surgeon will most likely use your original incision for implant removal and replacement. If you want a larger implant, your doctor will surgically enlarge the "pocket," or space in the breast, surrounding your implant to accommodate a larger implant. If you want smaller implants, you doctor may surgically reduce the size of the pocket with sutures to properly fit smaller sized implants. A breast lift may be performed at the same time.
Capsular Contracture (hardening of the capsule and implant): Your doctor will most likely use the same incision used to insert the original implants in order to remove the hardened capsule and implant. He or she will then insert a new replacement implant.
Implant Rippling: When the edges of breast implants are visible and palpable (able to be felt), your surgeon may use the same incision to remove or reposition the implants as was used to originally insert them. Your surgeon may choose to used a different type of implant or placing the new implant into a different breast pocket that either has thicker muscle coverage or uses other tissues to cover the implant edge.
Implant Malposition: Sometimes implant pockets are created too far apart or too close together, resulting in poorly positioned breasts. To correct this, using the prior incision, your surgeon will manipulate the scar tissue from the capsule surrounding the implant and reconstruct the pocket in the appropriate position using suturing techniques. Your surgeon may need to utilize other tissues to reinforce this new implant pocket.
Implant Removal: If your implants are large and your skin has stretched, your surgeon may recommend a breast lift in addition to implant removal, but implant removal alone may suffice. The original incision created to insert the implant will almost always be the same one used to remove it. The lining around the implant, or "capsule," is often surgically removed at the same time to facilitate rapid healing.
Nipple and Areola Position Elevation: If it is necessary to elevate the position of your nipples and areolas (pigmented skin surrounding the nipples), you will need additional incisions. Incisions around the upper portion of the areola will be adequate in cases where not much elevation is needed.
When more lifting and tightening is necessary, an incision all the way around the areola, including a vertical scar extending down from the areola to the crease under the breast, may be necessary.
For cases where significant excess skin needs to be removed (such as in women who have had massive weight loss), a third incision may be necessary that will extend horizontally beneath the breast, following the natural curve of the breast crease. If your nipples need lifting, the nipples and areolas remain attached to underlying mounds of tissue and this usually allows for the preservation of sensation and the ability to breast-feed.
After your procedure is completed, you will be taken into a recovery area, where you will continue to be closely monitored. Occasionally, drainage tubes may be used for a short time following surgery.
The procedure normally takes between 120- 180 minutes.
Am I a candidate for surgery?
Even if your breast implant surgery was perfectly planned and beautifully executed, changes can occur over time. Some common reasons why you may consider breast revision are:
If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.
Advantages of Breast Revision Surgery:
Disadvantages of Breast Revision Surgery:
Preparation for Surgery
Prior To Your Arrival
Before traveling to Cyprus, as part of your surgery preparation you will complete a detailed specific questionnaire and will submit a recent Chest X-Ray and photographic images of the problem areas which you wish to have treated.
Initial Consultation: Once the images have been received by us, we will schedule a consultation with your chosen surgeon, via Skype or telephone. This will allow you to ask any questions regarding the procedure and will also allow your chosen surgeon to assess your condition and determine your eligibility for your chosen procedure.
During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Your chosen surgeon will evaluate you as a candidate for breast revision and clarify what a breast revision procedure can do for you. Understanding your goals and medical condition, both alternative and additional treatment options may be considered. You should be prepared to discuss your complete medical history. This will include information about:
If you are planning to lose a significant amount of weight, be sure to tell your plastic surgeon. The surgeon may recommend that you stabilize your weight before undergoing surgery.
If you think that you may want to become pregnant in the future, discuss this with your surgeon. Pregnancy can alter breast size in an unpredictable way and could affect the long-term results of your surgery.
Your treatment plan
Based on your goals, physical characteristics, and the surgeon’s training and experience, your surgeon will share recommendations and information with you, at this point including:
In advance of your procedure, your surgeon will ask you to:
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen cosmetic procedure.
Before your departure to come to Cyprus your records will be reviewed thoroughly by our surgeon. This includes Chest X-ray and a complete medical and surgical history. You may need to have a mammogram before revision surgery.
Getting your house ready before your surgery
It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.
Before surgery, stock your refrigerator with high-protein, low-sodium foods, including premade meals, fresh fruits and vegetables and lots of caffeine-free beverages and water. Avoid food and drink containing salt during your recovery.
As you heal, your arms will have a limited range of motion, so store all the supplies you'll need during recovery where they're easily accessible (counter level, not in overhead or very low cabinets).
Stockpile movies or prerecorded programs, and novels and magazines. If possible, have a speakerphone by your bed and a remote control for the TV.
Remove all your throw rugs or anything on the floor that may cause you to trip.
Move phone and electrical cords close to the walls.
Move necessary personal items you need to reach to shelves and tables that are above your waist level.
Preparation for the hospital
Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:
Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing. Decide what you will wear for the first few days; pick items that open in front. Wear slip-on shoes so you don't have to bend:
Upon Arrival
After traveling to Cyprus, a new set of blood tests, E.C.G and chest X-ray will be taken as well as an in person physical examination. To help detect and track any changes in your breast tissue, your plastic surgeon may also recommend a baseline mammogram before surgery.
The surgeon and anesthetist will meet with you and go through your medical and surgical plan.
During this consultation, your surgeon will discuss your surgical procedure and answer any further questions. Your plastic surgeon will proceed to examine measure and photograph your breasts for your medical record. Your surgeon will also consider and further discuss:
Day before surgery
Your doctor or nurse will give you more instructions based on the type of prep.
You should not eat or drink anything after midnight the evening before your surgery.
Morning of surgery
Bring all your medicines, if any in their original containers with you to the hospital.
You will meet with the anesthesiologist. This doctor will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery. You will have an IV or intravenous line put in to give you fluid and medicine during your surgery.
Your plastic surgeon shall consult with you once again and shall make any markings he needs on your chest, indicating the incision marks for the proposed procedure.
Recovery after surgery
When you wake up after your surgery, you will be in the recovery room. You will stay there until you are awake and your pain is under control. Most patients return to their room after a couple of hours.
You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.
After your breast revision procedure, you shall be placed in a surgical dressing that can include a support bra or garment.
You will have some redness and swelling after the surgery. As the anesthesia wears off, you may experience some pain. Typically, the most pain is experienced within the first 48 hours after breast revision surgery. Your pain level will decrease each day and may be effectively treated with various pain medications.
Your breasts may feel tight and sensitive to the touch and your skin may feel warm or itchy. You may also experience difficulty raising your arms. Some discoloration and swelling will occur initially, but this will disappear quickly. Most residual swelling will resolve within a month.
Hospital discharge and home instructions
Your diet is slowly increased from ice chips to liquids to solid foods as your intestines start functioning.
Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.
You will be able to leave the hospital when you are:
Most people are able to go home 2-3 days after their surgery.
Recovery time after the procedure and the length of your hospital stay depend on your overall health and the type of procedure performed.
Life After Surgery
These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your doctor’s discharge instructions if they are different from what is listed here. This will include information about wearing compression garments, care of your drains, taking an antibiotic if prescribed and the level and type of activity that is safe. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.
Undergoing a breast lift in conjunction with implant removal will lengthen your recovery time.
If your breast implants are removed entirely, your recovery will likely be brief, with minimal discomfort.
For two to five days, you may feel stiff and sore in your chest region.
Any surgical dressings will be removed within several days. You shall be instructed to wear a support bra during your early healing period to prevent fluid accumulation, control swelling and keep implants in place during the initial healing period.
For the first week postoperatively, you will benefit from sleeping with your head and back elevated to reduce swelling in the chest area. You can use pillows, a wedge pillow, or sleep in a recliner chair.
Your plastic surgeon will probably permit you to shower one to three days following surgery, but do not immerse your breasts in a tub, spa or Jacuzzi for at least four weeks after surgery.If drains are placed, don't shower until 24 hours after the drains are removed, which is usually after three days.
If you have external sutures, they will be removed in about a week. If your surgeon used tissue glue or tape, it will fall off on its own in a week or two.
You may be able to return to work within a few days to a week, depending on the nature of your job.
You should refrain from lifting, pulling or pushing anything that causes pain and limit strenuous activity or upper body twisting if this causes discomfort.
Your Activity
It is fairly common to feel weak and tired immediately after discharge from the hospital. The body needs time to recover from the stress of surgery.
Walking is permitted and encouraged beginning the same day of surgery. At home, start short, daily walks and gradually increase the distance you walk.
Going up and down stairs is permitted. Initially, have someone assist you.
You may lift light objects (less than 10lbs.) after your discharge. This may be increased gradually after 2 weeks. If lifting an object causes discomfort, you should discontinue the activity. This restriction helps prevent hernias at the sites of your incisions.
Showers are permitted 2 days after surgery. Wash over your incisions gently with soap and water. Be careful to rinse well. Pat the incisions dry.
Driving is not permitted for 2 weeks after surgery or your first follow-up visit with your surgeon. If you are taking prescription pain medications or narcotics, DO NOT DRIVE.
Sexual intercourse may be resumed as your comfort level permits.
People with sedentary jobs have returned to work as early as 2 weeks postoperatively. A physically demanding job may require 4 weeks before returning to work. This may be determined by you and your employer. Some people have residual fatigue several weeks after surgery.
It is common to feel a lump at the sites of the operation. This lump is a combination of normal fluid and scar tissue forming in this area. It usually goes away slowly over the first month or two following surgery.
Your bowel habits
You may have different bowel habits after your surgery. Loose stools are common for the first week or two after surgery. If you have watery diarrhea, call your surgeon. This may be a sign of a bowel infection. Severe constipation should be avoided. See the section below on medicines for constipation.
Your diet
There are generally no dietary restrictions following cosmetic surgery. Avoid foods that cause diarrhea or digestive discomfort. You will eventually be able to resume your regular diet. A dietary supplement or drink can be used.
Medications
Your medicines: Take the medicines you were taking before surgery, unless your surgeon has made a change.
Your surgeon will order a prescription pain medicine for you after surgery. As your pain lessens, over the counter pain medicines such as acetaminophen or ibuprofen can be used. They can also be used instead of your prescription for mild pain.
Prescription pain medicines can cause constipation. Your doctor may order a stool softener to prevent this. You should be back to your normal bowel routine in about 2 weeks. If the stool softener does not work, take Milk of Magnesia. If you still are not getting relief, call your surgeon.
Call your surgeon right away if you have:
Long-term
It may take several weeks or months for new implants to "settle" into their final position. Altered sensation, such as numbness or tingling, may be present around the incision site, but this should decrease over the following weeks or months.
Your surgeon will encourage you to schedule routine mammograms at the frequency recommended for your age group.
Following breast revision, you should continue to perform breast self-examination.
How Long Will the Results Last?
Under normal circumstances, the results of your breast revision surgery will be long-lasting; Routine follow-up with your surgeon is important.
Your breasts can change due to:
After a number of years, if you become less satisfied with the appearance of your breasts, to restore a more youthful shape and contour.
Follow-Up
Follow-up after surgery is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need. For safety, as well as the most beautiful and healthy outcome, whenever you notice any changes in your breasts do not hesitate to contact your surgeon. In order to identify and treat any complications as they may arise, close, lifetime follow-up is essential.