A breast revision is a secondary procedure to correct issues from an initial breast procedure; breast augmentation, previous augmentation with a breast lift, breast lift alone, breast reduction, breast asymmetry correction or a breast reconstruction. Patients who have had cosmetic or reconstructive breast implants or breast lifts and implants at the same time sometimes experience less than satisfactory outcomes that do not meet their aesthetic expectations.

In addition to corrective surgical procedures after unsatisfactory results, natural aging, sagging, misshapen, or asymmetrical breasts can also severely affect your sense of femininity and leave you feeling unattractive. The initial procedure may have been performed very well, but ensuing changes with time may need to be revised even if you do not have any serious complications, you deserve to feel your best. Therefore, a breast revision procedure becomes necessary to achieve the best cosmetic results.

If you are looking for lasting results that match your vision for your ideal breasts, book a consultation with Dr. Mossi Salibian, a board-certified plastic surgeon serving Beverly Hills and surrounding Los Angeles areas. During your first appointment with him, he will listen intently to your concerns and offer a personalized solution that meets your needs.

Call his office at (310) 550-0750 or use his contact form to get in touch today.

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About Breast Revision

I have encountered patients with a range of issues following their primary breast enhancement surgery. These include a poor choice of implant size and shape that does not best match the patient’s chest dimensions, bad scarring, and implant deformities due to capsular contracture, a condition in which too much scar tissue develops around each implant.

At times, the implants themselves are intact and do not require an exchange, but the results of a previous breast surgery require revision for a more cosmetically pleasing shape, outcome, and symmetry. Sometimes, patients complain about implant displacement and deformity during movement and exercise, a condition called dynamic distortion.

Revisional breast surgery may therefore entail the whole gamut of both cosmetic and reconstructive breast surgery including, but not limited to:

What is ADM?

ADM or acellular dermal matrix is a decellularized, meaning no human cells or cellular materials present, piece of collagen matrix that is harvested from human cadavers. People who have consented to have their body parts donated for transplantation, scientific research or to medical industry upon their passing are fully tested for infectious and other ailments prior to being deemed safe for processing.

There are several biomedical companies in the United States who have products such as ADM for transplantation, such as AlloDerm, AlloMax, and FlexHD. They provide this biological matrix that can integrate into patients’ tissues and act as supporting material as in the use for reinforcing abdominal wall hernia repairs, and as off label use for patients who experience recurrent breast capsular contracture. These manufactured matrices have been proven to reduce the likelihood of this breast condition. ⁽¹⁾

Procedure Techniques

Removal and Replacement

There is no true established guideline as to when an implant should be replaced for the saline or for the current FDA approved silicone implants. ⁽²⁾ To remove and replace implants, I typically use the original incisions to access the old implants and the breast capsule. If any internal revisions are required, such as an internal pocket lift or tightening, these procedures can also be performed through the original incisions. Depending on the amount of capsular scarring, I will remove some or all of the internal capsule and scar tissue around each implant. The internal breast capsule, if not diseased, can sometimes be used to reinforce the new revised internal breast pocket instead of discarding this capsule. New implants are inserted from the same incisions as well, commonly called an R & R (Removal and Replacement) procedure. In some cases, alongside the removal and replacement procedure and any necessary internal capsular adjustments, a breast lift revision may be required to address sagging and achieve a perkier, more uplifted, and fuller breast appearance.

Implant Repositioning

I can perform a “site change” or reposition the implants from the subglandular to the partial sub pectoral position to decrease the chances of a future recurrent capsular contracture. Often the internal capsule would also need to be addressed at the same time. This could involve a combination of opening the tightened areas of the internal breast envelope by performing serial scoring along the inside pocket and / or internally tightening stretched areas to prevent an implant malpositioning problem in the future. The intricacies of breast implant repositioning are numerous and highly individualized per patient, and moreover per breast as one breast may need a set of different procedures than the other to achieve the best symmetry and long-term aesthetic outcome.

Capsule Removal

Depending on your needs, I can partially or fully remove the implant capsules when performing a revision. A total capsulectomy removes all of the breast capsule when indicated; whereas a partial capsulectomy removes only a portion of the capsule. To resolve symptoms of the rare condition known as Breast Implant Illness (BII), I will perform an “en bloc” capsulectomy, a procedure in which both the scarred breast capsular tissue and implant is removed as a single unit. ⁽³⁾

Acellular Dermal Matrix

ADM pieces are FDA-approved human collagen matrices that are used as devices. Their role is to provide greater support for weakened natural implant capsules and to help reinforce the internal lower breast pocket to prevent downward migration of the implant. These biocompatible devices are often called “internal bras” since they work to “lift” and support the tissues from within. They integrate into the human body in a matter of three to six months and are revascularized and replaced by the patients’ own collagen. Although internal supports can be expensive for cosmetic breast revisions, they are often more effective in this setting compared to fully artificial or bioabsorbable mesh materials, which tend to integrate and then dissolve or become fully absorbed within a short period of time and lose their intended function.

Cost of Breast Revision in Los Angeles

The cost of breast revision surgery will vary based on the complexity of your case, the specific surgical techniques employed, and other factors unique to your situation. Prices may range from fifteen thousand to greater than twenty-five thousand depending. Breast revision can transform your self-esteem and restore a youthful silhouette to your overall look.

To contact Dr. Salibian’s office today, call (310) 550-0750 or fill out his online form, and his staff will help you schedule your consultation.

FAQ

References

1. Liu J, Hou J, Li Z, Wang B, Sun J. Efficacy of Acellular Dermal Matrix in Capsular Contracture of Implant-Based Breast Reconstruction: A Single-Arm Meta-analysis. Aesthetic Plastic Surgery. 2020;44(3):735-742. doi:https://doi.org/10.1007/s00266-019-01603-2
2. Fardo D, Sequeira Campos M, Pensler JM. Breast Augmentation. PubMed. Published 2021. https://www.ncbi.nlm.nih.gov/books/NBK482206/#:~:text=The%20risk%20of%20complications%20is
3. Metzinger SE, Homsy C, Chun MJ, Metzinger RC. Breast Implant Illness: Treatment Using Total Capsulectomy and Implant Removal. Eplasty. 2022;22:e5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9097901/