What does this involve?
Whilst every attempt is made to achieve the perfect result at the first operation, infrequently, for a variety of reasons, you and your surgeon may decide that revisional surgery is required. In general, this falls into two main areas.
The first is that the size of the implant that was decided upon pre-operatively is incorrect and that the implant is either too big or too small, or the profile of the implant is wrong. From our experience the most common mistake is the selection of an implant that is too small and that once the post-operative swelling has settled, patients not infrequently feel that the implant is 30-50 cc too small.
As mentioned earlier in our web page, this is because in the early post-operative period the swelling in the breast is always present and is usually about 100 cc. This means that patients initially become accustomed to an appearance, which is significantly larger than the final result. Because of this, it is critically important that you discuss the size of your implant and the likely post-operative appearance in detail with your surgeon before selecting your implant.
If the size is incorrect but the implant position is otherwise as planned and is sitting in an anatomical position, then a change over to a larger implant usually can be done in a relatively straight forward way as long as the increase in size is not significant. If the implant volume is increased by more than 100 cc, it will require refashioning and resculpting a larger pocket to accommodate the larger implant.
This therefore will require significantly longer operative time and skill in ensuring that the pocket is carefully enlarged so as not to alter the implant position.
Conversely, in the rare circumstance that the implant is too large and a smaller implant is required, then the implant pocket needs to be modified so that it will hold the new smaller implant in the correct anatomical position. If this is not done, not infrequently the implant tends to migrate laterally out towards the armpit with the creation of a large gap in between the breasts and a loss of cleavage.
There are various techniques utilised to modify the implant pocket, almost all of them involve a form of local flap procedure, dissection of the pocket of the breast and strategic placement of a number of fine sutures to hold the implant in its new position in a permanent manner. In most instances this surgery can be performed as a day case or as a one night stay.
In our practice we always perform this surgery in a hospital setting and in any situation where there is extensive modification of the implant pocket, we will place a drain tube for the first 12 hours following surgery. It is important that after this surgery you rest and recover for at least the first 72 hours after surgery and obviously if more extensive pocket modification has been required, then a longer period of rest and recuperation is also required and it may be that you may need to rest for up to a week after surgery.
In every one of these cases it is also critically important that you keep you incision and wound clean and dry and that you continue to take the antibiotics for five days after surgery. During this period it is important that you do not use a bra as this may distort the new pocket and therefore result in the implant sitting in the wrong position post-operatively.
The other main reason for revision surgery is because there has been a problem in the pocket post-operatively. This may be because the pocket at the time of surgery was over dissected or was not created in a way to match the implant profile.
From experience we have found that this is uncommon. The most likely reason is because the weight of the implant and movement of the pectoralis major muscle has resulted in forces being placed on the implant forcing the implant into a down and out position. If this was to occur, then the surgery to correct this is significantly more difficult, time consuming and problematic than the first case scenario where an implant is simply to be changed.
In most instances this surgery takes somewhere between two and three hours and involves taking down of the implant pocket and then reinforcing and refashioning of the pocket in its inferolateral portion so that the implant is properly supported.
As you might expect, problems with the implant pocket are more commonly seen with a larger implant, particularly those implants with a volume of over 450 cc, some surgeons would advocate that for this reason, the larger implants should have a textured surface so that the implant position can be controlled more accurately.
Because this type of revision surgery is significantly more complicated and difficult, it is not unusual for the recovery to be longer than your first operation. Most patients finding that they need to take at least a week or 10 days off and need to refrain from heavy exercise, gym, yoga and Pilates for a period of six weeks after surgery.
Once again it is critically important that you keep your wound clean and dry and that you continue taking the antibiotics for the first week post-operatively.
The final need for breast revision is the development of capsular contracture. Capsular contracture, as mentioned previously, is a rare but important situation in which the scar tissue surrounding the implant becomes thickened and then contracts causing deformation of the implant and an alteration in the breast shape. Not infrequently it is accompanied by a dull aching pain. In this case the implant needs to be removed and the capsule needs to be taken down and the scar tissue that is causing the problem removed.
Again, this is a significantly bigger undertaking than your original augmentation and therefore requires you to take at least a week to 10 days off work and to refrain from heavy exercise for six to eight weeks.
Surgical revision may be able to use the item number 45554, however in most cases no item number is not applicable.