Breast augmentation revision surgery or breast implant revision surgery is often the most challenging procedures that I perform at Advanced Concepts in Plastic Surgery in Sacramento. This is because while breast augmentation or breast implant surgery has a very high success rate, the rare complications tend to be well… complicated. Basically, complications arise when something goes wrong in the healing process after breast augmentation. These usually come in the following categories
Capsular Contracture
Capsular contracture is a shrinkage of the scar tissue around the implant make it feel hard and firm. Sometimes it can cause considerable discomfort.
Malposition
The breast implant can be displaced downward or to the side. The most challenging is when the breast implant gets malpositioned downwards.
Wrinkling and Rippling
Wrinkling and rippling is caused by a thin coverage over the implant and making minor irregularities in the implant visible.
Deflation or Breakage of Implant
Deflation or breakage of the breast implant often associated with capsule contracture.
Each of these problems is treatable but it has potential problems.
Capsular contracture is repaired by removal of all or part of the scar tissue and replacement of the breast implants. The problem is the scar tissue can come back.
With malposition, the implant is removed and the pocket of scar tissue is made smaller by suturing on the inside. When the pocket has to be closed down below the only thing holding together for at least six months are the sutures. Sometimes the tissues can be very thin.
Rippling if the implants are above the muscle were playing can be seen anywhere on the breast. If the implant is under the muscle usually the rippling is only seen in the outer lower quadrant. This can be very difficult to fix with thin-skinned, even with placing the implant under the muscle.
Deflation or failure if this is corrected soon after the problem severe scar in or closure of the pocket is unlikely if it is done much later than the chances of scarring are higher.
A new tool available to surgeons is showing a lot of promise lately. ADM is Acellular Dermal Matrix, and is basically a sheet of processed skin either from a skin bank or from an animal, quite often a pig. This is basically just a matrix or a framework because all the proteins that are reactive to the immune system have been removed. It usually comes in a sheet approximately two to three inches by four to six inches. It provides needed thickness in areas of thin skin and builds up the tissues surrounding the capsular contracture. This repaired tissue now has been shown to decrease recurrence by breaking up the wall of scar tissue. ADM can be used to close up an overly large pocket or provide extra support. In cases of rippling, it provides extra bulk to hide the rippling.
ADM is a very effective new tool that enhances our ability to treat complications after breast implant surgery. Since it is quite new, my experience with it is limited to only a few cases. But, those results have been excellent, better than anything that could have been achieved without the material. Does everyone who is having a breast implant complication procedure need ADM? No, but patients with a severe enough issue can achieve excellent correction with ADM available.
