In general revisionary surgery in Plastic Surgery is challenging, however, breast revisionary surgery is double challenging.
Revisions can be performed both for post-mastectomy reconstructive procedures and for primary cosmetic breast surgeries such as breast augmentations, breast reductions, and breast lifts.
The most common revision surgery in both categories is capsulectomy/capsulotomy with or without exchange of implants.Capsular contracture(hardening of the breast) is relatively uncommon however should it happen, it results in an unnatural appearance of the breast with the migration of the implant to the upper chest wall and loss of the soft feel of the breast. This deformity might be associated with pain and tenderness of the involved breast.
It is more common with silicone gel implants which are placed above the chest muscle. The capsule is the scar tissue that the body generates around the implant. The deformity results if the scar tissue excessively squeezes the implant. Scar formation around the implant is a normal, response of the body. However, it is the amount of the scar and the degree of compression that results in the deformity.
Treatment usually involves a total capsulectomy (surgical removal of the scar) with or without exchange of the implant with a new and different implant. It is performed under general anesthesia in an outpatient setting.
Ruptured implants, both saline inflatable or silicone gel, are a relatively common occurrence. A deflated saline implant will be noticeable within days of leakage, unlike ruptured silicone gel implants. Diagnosis of ruptured silicone gel implants is usually made by MRI examination. Ruptured silicone gel implants can be associated with capsular contracture of the breast. Treatment involves the exchange of the ruptured implant with a new implant. Total capsulectomy can be performed in conjunction with the exchange of the ruptured silicone gel implant. Implant companies normally provide a new implant with no charge if the deflation occurs within ten years of the initial surgery. Health insurance companies usually cover deflated implants in reconstructive surgeries.
Certainly there are many more conditions for breast revisions such as post mastopexy (breast lift) bottoming out with the nipple/areola being located in an unnatural location, correction of asymmetrical breasts, management of scars following breast reduction surgery and revisionary surgeries in post-mastectomy reconstructions.