Dealing with Post-Breast Augmentation Issues – A Plastic Surgeon’s View
By: Dr. Juan A. Brou, Board Certified Plastic Surgeon in Oklahoma City
In my 20 years of private practice as a board certified plastic surgeon in Oklahoma City, I have encountered numerous patients with a wide variety of problems that can arise after breast augmentation surgery.
Initially, I dealt mostly with patients who had ruptured silicone breast implants and wanted to change to saline implants. The first and second generation silicone breast implants were prone to ruptures particularly 12 to 15 years after implantation if not sooner. This was at about the same time that a scare arose among patients that prompted an FDA moratorium on silicone breast implants for augmentation – a moratorium now lifted following extensive study into the safety of silicone implants.
I later dealt with the dissatisfaction of breast augmentation patients with retro-glandular saline implants (placed behind the breast tissue, but over the muscle). Retro-glandular implants seem to work well initially and the majority of patients have good long term results. However, those patients who experience weight loss or pregnancies tend to do poorly in the long term due to stretching of the skin or capsular contraction (a condition characterized by scar tightening around the implants that makes them hard to the touch or that causes an uneven shape) or both. The result is an augmentation that is obvious or simply not natural.
It is because of this dissatisfaction that I progressively opted to do more and more of my patient’s augmentations retro-muscular (behind the muscle). The retro-muscular augmentation is much more demanding in terms of exact placement of the implants. The symmetry is also more challenging. That is why the skill of the plastic surgeon is critical.
Common problems that can occur include:
- Breast implants that are placed too high;
- Developing the “double bubble”effect (this occurs when the muscle still attached to the underside of the breast produces a visible crease across the bottom half of the breast);
- And the breast implants may migrate laterally over time into the armpit, thereby losing the projection in front and desired cleavage.
I call these less-than-satisfactory results “secondary breast deformities.” As mentioned earlier, weight loss or pregnancy may be to blame. Unfortunately, I am also seeing far too many cases that are the result of a poorly done surgery by an inexperienced surgeon. Secondary breast deformities can also occur when an experienced surgeon refuses to update his skills and techniques, relying on outdated methods that do not produce the best results for patients.
It is through detailed and methodical study of these less-than-satisfactory results, which I call “secondary breast deformities,” that I discovered a methodology designed to best prevent these problems in my patients and also to correct these issues in patients referred to my practice. I call this corrective breast surgery.
One of the saddest things I deal with is a patient who not only has a bad result, but one who has been mistreated and humiliated by an arrogant surgeon incapable of admitting his/her mistakes. A classic sign of that is a doctor who blames the results on the patient, saying things like “you didn’t massage your breasts as I told you” and other more creative versions of this “blame game.”
The fact is that even the best surgeon may occasionally have a result that is less than ideal. The difference is that a qualified, competent and caring plastic surgeon will take the time to work with the patient and develop a plan for the appropriate corrective action.
Another typical mistake made by some surgeons is to try to correct sagging breasts by using very large implants. I see this quite often. Sometimes, the patient was promised a smaller implant, but the surgeon switched it to a larger one in surgery using the excuse that the smaller implant would not look good. The patients wind up very unhappy because they never wanted to have breasts that large. They often feel self-conscious and even embarrassed.
Once breast tissue has been stretched by an oversized implant, I have found that a breast lift or a small breast reduction needs to be considered in order to fit a smaller implant naturally and produce the results the patient had sought initially.
Other problems worth mentioning here are:
- Poorly selected breast implants in terms of shape and form
- Over-inflated saline breast implants
- Implants that slip under the breast
- Ugly scars
- Breast asymmetry – one breast bigger than the other.
I now consider myself an expert in corrective breast surgery due to the sheer number of patients whom I have had the honor to help in this regard. It is amazing to see the boost in self image and self confidence this brings to these patients.
Another exciting procedure gaining more attention among board certified plastic surgeons is use of fat grafting for correction of secondary breast deformities, as well as for breast reconstruction after cancer surgery. Fat grafting has produced wonderful age-erasing results when used for facial rejuvenation. I am very excited to apply my experience with fat grafting to breast surgery and will keep you posted of my results.