SECONDARY BREAST AUGMENTATION
– NEWPORT BEACH, CA –Breast augmentation is often assumed to be simple in nature and execution, but it actually requires a great deal of attention.
Appreciation of subtle breast asymmetries, proper surgical planning and execution, and attention to detail are essential for achieving superior results. Unfortunately, these details are often overlooked.
Thus, breast augmentation does not always produce the desired results. This may be due to
poor implant selection, incorrect surgical planning, and inferior surgical techniques.
Corrective breast surgery — also known as secondary breast augmentation — refers to a wide range of procedures that Dr. Siamak Agha performs to fix breasts affected by either a previous surgery or breast augmentation complications.
Many of these previous breast augmentation patients are unhappy with their results and wish to improve their breasts.
It is important to realize that breast augmentation revision is more complicated than initial augmentation, and the proper time for the correct operation to be performed is the first time.
However, Dr. Agha has developed considerable experience with the correction of breast augmentation problems and will make every attempt to improve your results.
What Problems Does Secondary Breast Augmentation Solve?
When a problem arises in your breasts’ appearance, the most crucial first step is diagnosing its cause.
Sometimes, it is due to an excessively large implant that stretched and thinned out your breast skin and tissue, resulting in implant show and rippling. Other times, the problem may be due to an implant that shifted into an unsightly position.
Excess scarring, breast drooping, asymmetry, or any combination of these problems can also contribute to a suboptimal breast appearance.
Secondary breast augmentation is necessary for solving a myriad of problems or issues that Dr. Agha has broadly categorized as follows:
- Problems with final breast size
- Problems that are created surgically or arise due to poor post-op care
- Problems with neglecting a patient’s tissue characteristics
- Problems that come with using breast implants
Explore these problems one by one below.
Presentation: Undesired implant size
Cause: Patient finds the implants too large or too small for her body
Reason: Poor planning
These are typically related to problems with implant pockets.
Presentation: Implant asymmetry
Cause: Uneven implants
Reason: Poor surgical technique or poor post-op care
Presentation: High-riding implants
Cause: Implants that are too high
Reason: Poor surgical technique, capsular contracture, or non-settling of implants after surgery
Presentation: Bottoming out
Cause: Implants that are too low with high nipple areola
Reason: Weak inframammary fold or released inframammary fold
Presentation: Synmastia
Cause: Implants that are kissing one another over the chest bone
Reason: Poor surgical technique
No cleavage
Presentation: Implants too spaced apart
Reason: Poor surgical technique
These arise from breast shape or size asymmetry, too little or too much breast tissue.
Presentation: Continued breast sagging over implants
Cause: Breast sagging that was not corrected
Reason: Inappropriate surgical plan
Presentation: Continued breast asymmetry
Cause: Overlooked breast asymmetry
Reason: Inappropriate surgical plan
Double Bubble Deformity
Presentation: Large sagging breasts over properly placed implants
Reason: Poor planning
These are inherent problems with the use of implants such as implant deflation and capsular contracture.
Presentation: Capsular contracture
Cause: Contracture of the implant capsule causing breast shape distortion and pain
Reason: Implant-associated
Presentation: Implant leak or rupture
Cause: Implant rupture
Reason: Implant-associated
Implants Rippling
Presentation: Implant in a subglandular pocket. More common with saline implants with thin breast tissue coverage
Cause: Visible implant ripples
Reason: Implant-associated
Breast Implant Illness
Presentation: Joint pain, unwellness, fatigue
Cause: Unknown, probably bacterial
Reason: Implant-associated
BIA-ALCL
Presentation: Lymphoma of the implant capsule
Cause: Due to the texture on some implants
Reason: Allergan’s textured implant-associated
How Does Dr. Agha Perform Corrective Breast Surgery?
Although corrective breast surgery is a complex and challenging endeavor, it is one that Dr. Agha enjoys helping with. Improvements are usually very dramatic and life-changing for the patients.
Additionally, these surgeries fully utilize the array of skills that Dr. Agha has developed since each patient requires a unique combination of techniques to maximize their aesthetic outcome.
These techniques include, but are not limited to:
- switching the implants from over the chest muscle to under the chest muscle
- tailoring and reconfiguring the breast pocket to better fit and support the implant
- changing the implant size and composition (exchanging saline implants to cohesive silicone gel implants)
- adjusting areolar size and position
- revising scars
- lifting the breasts
Each breast will often require a different set of approaches to achieve final symmetry. Depending on your problem, here are the techniques that Dr. Agha uses for secondary breast augmentation:
Undesired Implant Size
Large-scale studies have shown that up to 15% to 20% of women wish that their breasts were larger after a primary breast augmentation.
In fact, dissatisfaction with the implant size — either too small or too large — is the most common reason women have a second breast augmentation. Most elect to change their implant for a larger size.
This is why Dr. Agha spends a considerable amount of time with you discussing size, trying implant sizers, and selecting an appropriate implant size for you.
It is very rare in our practice that patients come back to change their implants for a larger size or regret their chosen size.
Oversized Implants
Breast implants can be too large for the patient’s size and weight. This can result in stretching out the breast tissue and skin.
Over time, the breast tissue thins out, and the breast droops and sags over the upper abdomen.
Before
After
This patient presented to Dr. Agha for corrective breast augmentation. Her primary breast augmentation was performed by a non-plastic surgeon four years ago.
After the second year of her breast augmentation, she returned to her surgeon for implant drooping. According to the patient, the surgeon placed additional saline in her implants during an office procedure.
When presenting to Dr. Agha four years after her primary procedure, the patient had 450 cc saline implants in a subglandular plane, despite weighing only 90 Ibs. Her large saline implants in a subglandular plane had resulted in significant thinning of her breast tissue, skin damage, and stretching of her nipple-areola complex.
The patient underwent a corrective breast augmentation procedure that involved removing her implants, reconstructing her lower inframammary fold, placing silicone implants (275 ccs chosen by the patient) in a submuscular plane, and periareolar mastopexy to remove stretched out skin.
Overlooked Breast Sagging
This happens when the plastic surgeon attempts to correct breast drooping through breast augmentation.
If a patient has sagging breasts, the best procedure is a breast lift. It can be done before or with a breast augmentation to correct the breast shape.
Some surgeons may use a large implant or place the implant lower than ideal to avoid a breast lift. Neither of these approaches is effective in creating a nicely shaped breast.
Placing an implant low distorts the inframammary fold, and sooner or later, the patient will need implant pocket correction and a breast lift.
This patient had a breast augmentation by a non-plastic surgeon after her pregnancy using implants in a subglandular plane.
The correct procedure would have been to combine a breast augmentation with a breast lift.
Overlooked Breast Asymmetry
Most breasts differ from one another, sometimes considerably. They may vary in size, shape, form, or position and are rarely perfectly corrected during surgery.
However, asymmetries should be diagnosed appropriately preoperatively to ensure that it is corrected as much as possible during surgery.
Size asymmetries can be easily corrected with different-sized implants. However, asymmetries in shape may require a breast lift to make the breasts look similar. It can also be fixed best with breast fat transfer or a combination of breast fat and implant placement.
Before
After
This patient presented to Dr. Agha for breast augmentation.
The patient had subtle breast asymmetry, with the right breast being smaller and than the left. This was appropriately corrected with the use of different-sized implants.
Double Bubble Deformity
Usually, an implant should be placed perfectly under the breast so that the nipple and areola are centered over the implant.
Double bubble deformity represents a mismatch between the implant location and the location of the majority of breast tissue. It may occur soon after your breast augmentation or years later on one or both sides.
Double bubble deformity typically results from implants placed too low on the chest while the breast tissue sits on top of the implant. This creates a double bubble look.
It is corrected by closing the lower implant pocket and reconstructing the inframammary crease, thus elevating the implant into its correct position.
Alternatively, a double bubble deformity may result from a well-positioned implant, but the breast tissue is too low on the implant. It can also occur soon or years after as breast tissues continue to sag gradually in response to gravity.
This specific form of double bubble deformity can be fixed by performing a breast lift to raise the breast tissue over the implants. If the implants are in a subglandular pocket, it would be necessary to change the pocket and place them in a submuscular pocket.
Double bubble deformity is best prevented during the primary augmentation by planning the correct surgery and executing it flawlessly.
Implant Asymmetry
Implant asymmetry occurs when one implant is higher than the other, or one implant is more central (medial) or more lateral (outer) with respect to the other.
These asymmetries can also result from the use of different-sized implants, pockets that are dissected unevenly, or poor post-op care after breast augmentation.
To correct implant asymmetry, it is necessary first to understand what has caused the asymmetry. Is this because of different implant pockets, implant migration, or different implant sizes?
If the pockets are different, pocket correction and repair may be needed.
High-Riding Implants
High-riding implants are the ones that remain too high postoperatively and do not “drop” or “settle” into the correct position.
Correcting a high-riding implant requires revision surgery to lower the implant and center it under the nipple-areola complex.
Before
After
This is a patient who had asymmetrical implants, with the right one being higher than the left.
Dr. Agha performed a revision procedure that lowered the right implant, releasing the lower aspect of the implant pocket and the inframammary fold.
Implant Bottoming Out
This occurs when implants are positioned too low, and the inframammary fold is released or damaged too much. The implants appear too low and unattractive, preventing you from being comfortable when braless.
Over time, the implants shift into an unsightly position due to weakness of the inframammary fold. The implants move down onto the upper abdominal region, resulting in distortion of the breast shape and nipple-areola complexes that point up.
This complication occurs more often with subglandular implant placement, huge implants, and inaccurate implant pocket dissection.
Correction of implants that are low or have bottomed out is a complicated endeavor. Sometimes, a pocket change from a subglandular pocket to a submuscular pocket is all that is needed.
Other times, if the pectoralis muscle has been released and the inframammary fold is weakened, the latter will have to be reconstructed to create support for the implant and prevent it from migrating low. Inframammary fold reconstruction can be done internally or through an external incision when combined with a breast lift.
Dr. Agha has significant experience in this area and has performed over 100 inframammary crease reconstructions, mostly done with a reverse tummy tuck. This combination elevates the breast unit on the chest when the breasts are on the lower third of the chest rather than the middle third.
Before
After
This patient presented to Dr. Agha for corrective breast augmentation. Her primary breast augmentation was performed by a non-plastic surgeon three years prior.
Both her breast implants were placed in a subglandular plane and were too low due to overzealous dissection of the inframammary fold.
Implant positions are asymmetrical, with the right implant lower than the left. She also had rippling of her right implant.
The patient underwent a corrective secondary breast augmentation procedure by Dr. Agha, as well as a tummy tuck.
A breast revision surgery involved removing the implants, reconstructing the lower inframammary fold, and placing silicone implants in a submuscular plane.
Synmastia
Synmastia represents implants that touch one another centrally.
It is caused by over-dissection of the medial region or inner aspect of the breasts over the breastbone (sternum) or release of the medial attachment of the pectoralis major muscle from the sternum to create cleavage.
This surgical maneuver should simply not be done, as it is a difficult problem to correct. Like an implant bottoming out, the implant pocket is over-dissected centrally and has to be repaired.
Depending on the presentation of the synmastia, Dr. Agha will perform one of the following procedures:
- If the implants are over the muscle, he will create a submuscular pocket and move the implants into this newly dissected pocket.
- If the implants are in a submuscular pocket, the pocket has to be modified and reconstructed correctly. He will first remove both implants, then reattach the skin and muscle that have been released over the sternum back to the ribcage, thus reconstructing the pocket’s medial edge. In this manner, the implants can be shifted to a correct position.
This patient presented to Dr. Agha for corrective breast augmentation. Her primary breast augmentation was performed by another surgeon four years prior.
Both her breast implants were placed in a subglandular plane and were too medial due to overzealous dissection over the chest sternum.
Unfortunately, the patient did not wish to pursue corrective breast surgery.
Lacking Desirable Cleavage
This happens when the implant pocket is over-dissected laterally or outwards, resulting in implants placed too widely apart, falling under the armpits.
Correction of this problem requires closure of the outer pocket to shift the implants more towards each other. Also, the medial pocket may need to be opened up to allow the implants to move closer together.
Implant selection plays an integral part in creating cleavage. To create cleavage, the base diameter of the breast needs to be increased. It sometimes uses slightly wider implants than the breast’s actual diameter so that the augmented breasts are made broader and closer to one another.
Implant Show
Implant show is when one can see the outline of the implants through the skin.
This is mainly seen in a thin patient when the implants are placed in a subglandular pocket. It is also more noticeable in firmer saline implants.
Implant show can be corrected by changing the implant type to a silicone implant or changing the implant pocket into a submuscular plane.
If the patient has a super thin breast and chest muscle, additional implant coverage in the form of an extracellular matrix may be necessary.
What Corrective Breast Procedures Does Dr. Agha Perform?
Depending on your specific problem, a specific solution or a set of techniques may be employed during your breast augmentation revision.
These may include the following:
Get Your Secondary Breast Augmentation in Orange County and Los Angeles
Just because you had breast augmentation before doesn’t mean you have to live with results that don’t make you happy. With secondary breast augmentation, you can attain the breasts you’ve always wanted and achieve superior results.