Nipple and areola micro-pigmentation (tattooing)
In revision breast surgery a variety of techniques may be used to re-design or reshape the breasts. Some ladies have a less-than-ideal aesthetic outcome following cosmetic surgery or may have experienced changes in their results following fluctuations in weight. Occasionally some ladies experience symptoms such as tightness or pain following breast surgery. For those with breast reconstruction the results may have changed over time, particularly with implant reconstruction.
Correction of either cosmetic breast surgery or post-reconstruction problems requires experience, judgment and skill of the surgeon. As a female Breast Surgeon I intimately understand how your feelings about your breasts can influence your self-image and femininity. My aim is to help you feel better and look better by giving you the results you are seeking. As a surgeon who performs complicated breast reconstruction surgery every week my skill and expertise is directly transferable to all types of breast revision, whether reconstructive or cosmetic.
Revision breast surgery may include a range of procedures including revision of breast implants, reshaping breasts that have previously been lifted or reduced, or correction of unsightly scars.
The results of breast reconstruction can change over time particularly with implant reconstruction and revision can involve a variety of techniques from fat grafting to taking down the reconstruction and starting again with a different type of reconstruction.
Breast revision surgery is always more difficult that primary surgery as we are working in an area that already has scars and tissue removed or altered. While there are no guarantees regarding the outcome, my goal is to create the most aesthetic outcome from the tissue I have with the best possible symmetry and a natural result that is proportional to the rest of the body.
The type of revisional surgery appropriate for you will depend upon what surgery you had in the past, your specific problems and your aspirations. Some ladies will have changed body shape since their original surgery and now simply wish to be adjusted to be more in keeping, in others, complications of their previous surgery have led to the results have deteriorating over time and a very small sub-set of ladies were never really happy with the results of the original surgery. Whatever your circumstances the plan for revision will be tailored to your individual anatomy and desires. Your individual treatment plan may involve one or a combination of the following.
Removal and Replacement of Breast Implants
Breast implants are not like car tyres; they do not need to be changed every few thousand miles. In the rare event breast implants have ruptured, they should be removed with or without replacement. If you remain happy with the results and there are no issues, then there is no need to have further surgery at any specific time point. It is however, not uncommon for changes in your weight, your physique or capsular contracture around the implant, to alter the results and at this time you may wish to exchange your implants to improve your shape or proportions. This may involve a change in size or shape of the implant and at initial consultation I will go over in detail the various options for implant types, shapes and sizes that are most proportional and best suited to your body and your desired outcomes. I may suggest adjustments to the implant pocket to optimize results, or even sometimes a change of plane to above or below the muscle.
Removal of Implants with or without Mastopexy (breast lift)
Many women may wish to have their implants removed for a variety of reasons (personal preference, weight gain or increased age). Removal of breast implants is fairly straightforward, however in the same way that removing air from a balloon leaves the shell deflated, the breast shape can be somewhat flat and deflated when implants are removed. I therefore often recommend a mastopexy (breast lift) to reshape the breast tissue and leave a pleasing yet natural breast shape.
Capsulectomy
Capsular contracture occurs when the scar tissue around the implant has contracted and causes a change in shape or position of the implant, visible rippling, hardening of the implant or even pain. Surgical removal of the capsule around an implant is called a capsulectomy and is often done as part of breast implant revision.
Correction of Animation Deformity of Sub-Muscular Implants
Some ladies that have previously had sub-pectoral breast implants are troubled significantly by animation deformity. This is often seen in ladies who do lots of upper body exercises such as gym work or other sporting activities. The result is that the breasts move or twitch with certain movements making the implants look obvious rather than natural. It is possible to replace the pectoralis major muscles back to their anatomical location on the chest and to place new implants on top of the muscle. This eliminates animation deformity and often reduces discomfort related to the muscle contracting over the implant. The breasts look and feel more natural, and ladies are able to resume all upper body workouts without restrictions at 6 weeks post-op.
Re-do Mastopexy (Breast Lift)
If you had surgery at a younger age, or have previously had implants, changes in the body due to having children or significant weight change or simply as part of aging can result in a droopy appearance of the breast with the nipple and areola lying low. A mastopexy will reshape your breast tissue and raise the nipple to a more aesthetic position. A previous mastopexy will have done this but it only resets the clock it doesn’t stop it; therefore the impact of aging and body changes may have affected your results in the longer term.
Breast Scars
Some ladies request scar revision following previous surgery. The development of a poor scar is multifactorial but for the most part is genetically determined. Enlarged, stretched or unsightly scars resulting from prior breast surgery may be improved by revision. At consultation I will explore the history of your previous surgery, any delayed wound healing and any infections as well as examining any other scars that you have. Revision of unsightly scars may be part of a total breast revision or may be the primary goal of surgery. If you are prone to poor scars additional outpatient treatments will be discussed with you.
Conversion of Implant-Based Reconstructions to Flap Reconstructions
Many ladies choose implant breast reconstruction at the time of their cancer diagnosis as it is relatively quick, a shorter recovery and often at that stage they do not have tissue to allow reconstruction. Some ladies find an implant based reconstruction unsatisfactory either because it has not met their expectations or because it has changed post-radiotherapy. A few years down the line some ladies find that they have the time and energy to commit to a flap reconstruction, or that they now have tissue to allow it.
Fat Transfer
Occasionally both cosmetic breast surgery and breast reconstruction can be improved by minor touch-ups to improve contour. Fat transfer utilises liposuction techniques but instead of throwing away the removed fat, it is processed and the fat cells extracted and re-injected into contour defects. This can improve contour, disguise rippling and may the results appear more natural.
Nipple inversion:
Nipple inversion is usually secondary to shortening of breast ducts and the counteractive forces of the fibrous breast preventing full projection of the nipple. Causes It is present in 2% of women and will present for treatment if aesthetics or an inability to breast feed is a concern. In a significant number, inverted nipples are hereditary and are noticed during breast growth as a teenager. When the nipple inverts after it has been everted as an adult, it is advisable to see your GP and be assessed in a Breast Screening Unit to ensure that there is no underlying pathology such as Paget’s disease or Breast Cancer.
Breastfeeding; Most women with inverted nipples who give birth are able to breastfeed without complication, but inexperienced mothers may experience higher than average pain and soreness when initially attempting to breastfeed. A baby that latches on well may be able to evert an inverted nipple. The use of suction devices such as Avent Niplette or a breast pump during breast feeding may help to draw out inverted nipples.
Risks; Although surgery is normally performed as a daycase procedure and patients are able to go home after few hours following the surgery. Patients are advised to avoid driving immediately after the procedure because they will be still under the effect of anaesthesia, therefore it is best to be driven home by a friend or relative. The recurrence rate is between 10-20% and very occasionally a re-operation may be required. To reduce recurrence especially as the scar contracts, you must massage the scar. Nipple sensation is altered in over 40% of women having this procedure and this may be permanent in approximately 20% of patients. The response of the nipple to cold or sexual stimulus may be reduced. Women who are keen to breastfeed, should avoid this operation, as she may not be able to breastfeed as some of the milk ducts are divided during surgery along with the fibrous bands. The main side effects of surgery are pain, swelling and sensitivity in the nipple area which can last for up to two weeks after the procedure has been performed. Other problems that can occur include scars within the nipple area which generally settle well over 12- 18 months, bleeding, haematoma (collection of blood), bruising and occasionally infection.
Dressing; You will have a bulky dressing which will consist of a sponge around the nipple and a tie-over to keep the nipple everted. This will be covered with a waterproof cover. Prior to your discharge from hospital, an appointment will be made for you to be seen in the clinic 7-10 days after surgery. The dressings will be removed. Sutures do not have to be removed as these dissolve.
Recovery time is different with each patient. Patients can generally go back to work in a week after the surgery. Immediately after the procedure the nipples will more likely feel sore. The soreness should diminish over few weeks. Painkillers to help with the discomfort.
