Revision Breast Procedures

In some instances, changes occur after breast surgery, with and without implants, that lead to unfavorable results, possibly even posing health risks. In a thorough and thoughtful consultation, Dr. Samuels will evaluate issues resulting from your previous surgery and make suggestions based upon a critical knowledge of advanced techniques designed to restore a better breast aesthetic and perhaps the more youthful, attractive and beautiful appearance you may have intended to experience from your original surgery.

While there is definitely an art to a well-conceived and carried out initial breast surgical procedure, surgeons are well-intentioned, and while the optimal surgical outcome is the goal, occasionally factors may contrive to require breast revision. It is even more important when undertaking revision breast surgery, that patient and surgeon communicate well, that the surgeon listens carefully to the patient's concerns, but also that he or she have extensive skill and experience in the techniques required to undertake a successful revision. Having trained at the prestigious University of Texas Southwestern in Dallas, Texas, which has been named the best plastic surgery residency program in the U.S. the last 15 years, Dr. Samuels trained with the world's leading breast surgeons. She has also been invited to serve as clinical investigator to brand name breast implant manufacturers and has access to shaped, cohesive "Gummi-bear" implants that only a few surgeons in the country can utilize. Some of these devices prove to be very useful in the revision breast implant pocket. With decades of this type of experience in first-time as well as revision breast surgery, Dr. Samuels is uniquely trained and positioned to assist the patient who faces a revision of her breast surgery, and as a result, she has been sought out by women from all over the U.S. for help in this regard.

There are several different kinds of FDA approved textured, shaped breast implants on the market now which can be perfect for the revision patient, because they frequently assist the surgeon in "controlling the pocket" better than the use of a typical smooth, round device, typically placed under the pectoralis major muscle. Since Dr. Samuels was one of fewer than 30 surgeons in the U.S. able to use some of today's most advanced FDA approved silicone gel devices, having used them in their pre-approval clinical trials, she has over 25 years of experience in what are the best implant options for the breast implant revision patient. The newest silicone gel devices were thoroughly "vetted" by the FDA in the 1990's and approved for general use by plastic surgeons in the U.S. in 2006 and 2014. If you have developed or have a history of capsular contracture, Dr. Samuels may recommend the use of a substance known as "acellular dermal matrix" (ACDM) at the time of your revision surgery. ACDM is a temporary (absorbable by the body) substance that is placed inside the breast implant pocket around the new implant and has been shown to drastically reduce the risk of recurrent capsular contracture.

Dr. Samuels does not believe that one breast implant fits all primary breast enhancement patients, and there certainly is not one single implant that fits all revision patients. The list below summarizes the available breast implants. You may also wish to refer to the Breast Augmentation page of our website for more information or call us for a personal consultation with Dr. Samuels. We would also like to refer you to the links to our blog which deal with the Quick Recovery Technique and Revisional Procedures.

Types of Implants

1. Saline - Saline implants are filled with sterile saline, or salt water, which is a natural body substance. These implants are placed within the implant pocket and are then inflated with saline to the desired volume. While the incidence of rupture is low, it is slightly higher than with silicone gel due to the fluid nature of the filler as well as the presence of the fill port which can fail. Since salt water is absorbed by the body, a rupture is more easily detected by the patient. Should a rupture occur, all of the brand name implant manufacturers provide a lifetime warranty for replacement of the device. Also since the implant is filled with a fluid, the risk of rippling, wrinkling and heaviness in the lower pole of the breast are greater than with a silicone device, and it is easier to feel the edges a saline device . The more soft tissue coverage provided, the less noticeable these findings will be. For this reason, most saline devices are placed beneath the pectoralis major muscle if possible and are not as popular as their silicone gel counterparts.
2. Silicone (Gel) - Round and shaped, smooth and textured silicone implants are filled with a semi-cohesive silicone gel that gained FDA approval in 2006. These implants are unlike the old liquid gel devices used previously, in that the gel is thicker, rupture and capsular contracture are infrequent, and if there is a device failure (which is actually less likely than with a saline device), the gel sticks together and would be unlikely to leak into surrounding breast tissue. If a mammogram were suspicious for implant rupture, an ultrasound or MRI might be indicated for diagnosis. Cohesive round devices are available in three different projections, and textured shaped devices also exist. Many women believe silicone gel devices feel softer and more similar to normal breast tissue than saline implants, with less chance of detectable rippling, wrinkling, or edge palpability.
3. Cohesive shaped ("Gummi-bear") implants - All three brand name implant manufacturers have historically made anatomically shaped, more cohesive silicone gel implants, most of which gained FDA approval in 2014. Dr. Samuels is one of fewer than 30 surgeons in the U.S. selected to complete the clinical trial of some of these textured, shaped devices. These devices remain safe and extensively studied and widely used in Europe and the U.S., and textured shaped devices remain some of the best devices for breast implant revision and reconstruction patients. Since Dr. Samuels was one of the few surgeons in the U.S. who were approved to use the early shaped and round high profile devices, patients come from all over the U.S. for evaluation. Shaped devices provide a great option for patients who desire a more natural breast shape and for revision patients. Also, the more cohesive the filler, the more "form stable" its shape will be, and the lower the capsular contracture and rupture rates will be. In 2019, Allergan's textured saline and silicone gel shaped devices were removed from the market for general use due to a very low risk/association with a capsular disease process known as BIA-ALCL. ALCL (Breast Implant Associated - Anapestic Large Cell Lymphoma) was reported to have developed in the capsule of 0.03% of all textured devices. Sentra and Mentor's risk of this rare disease is at least 6% lower than that of Allergan, so Sientra and Mentor do still make a differently textured device that is still available for those patients who would receive a better cosmetic result with a textured, shaped device (than with a smooth round device). The nuances of which breast implant is best for each patient is carefully discussed with each patient at the time of their personal consultations. For more information on ALCL, please visit plasticsurgery.org or contact our office.

Surgical Preparation

Breast revision surgery, even given its increased complexity for the surgeon performing the operation, isn't typically any harder for the patient to recover from than primary breast augmentation or augmentation-mastopexy, with the exception of the fact that surgical drains are typically used for a period of ten to fourteen days after surgery. These drains are easily cared for at home by the patient and easily removed in the office, but otherwise, recovery times closely resemble those of primary breast augmentation or lift since Dr. Samuels uses the Quick Recovery Technique in all her breast implant surgeries. Additionally, Dr. Samuels has additional experience in the use of fat grafting techniques, and the use of acellular dermal matrix substances, which are occasionally helpful in a revision surgery.

As with primary breast augmentation, cessation of nicotine usage six weeks prior to surgery as well as after, is important for optimal healing. Dr. Samuels and her staff will spend appropriate time in consultation and in your pre-operative appointments to answer all of your questions regarding your surgery.

Revision breast surgery is an outpatient procedure performed at Baptist Eastpoint Surgery Center (where Dr. Samuels was an original owner/investor and special pricing is available), or at Premier Surgery Center, Baptist Hospital East, Jewish Hospital East, or Norton Brownsboro Hospital.

Post-Operative Care

Other than the difference in surgical technique and related nuances that any surgeon faces who is willing to assist the revision breast surgery patient, there are no real differences in healing period or wound care experienced by the revision patient beyond that of the typical breast augmentation, mastopexy or augmentation-mastopexy patient. During a very extensive and thorough pre-operative office visit, Dr. Samuels and her staff review all aspects of the post-surgical care and recovery period, including drain and wound care, as well as the additional anxieties that all revision patients understandably experience. Having helped many patients through a revision surgery, we acutely understand what the patient is going through, and we also are committed to the extra time it might require to answer all of their concerns and questions.

***Call for special surgical pricing (502) 897-9411***