Breast Implants Revision

Bilateral Implant Exchange for severe Capsular contracture and mastopexy (breast lift)

Capsulectomy or Excision of capsule for hardness

It is not fully understood the reason for this occurrence of this condition. Capsular hardening or contracture is more common in certain ethnic groups such as Asians and Africans. It can however affect any racial group. The hardening is caused by excessive scar tissue forming around the implants. It can occur as early as 6 weeks after surgery and as late as 10 years. The best way of preventing this is to massage the augmented breasts in the postoperative period so the capsule forms softly around the implant. The breast hardening process or capsular contracture can have both cosmetic and pain implications.

Capsulectomy operation removes the hard capsule and the new implants are inserted in a fresh pocket preferably behind the pectoralis muscle. In these situations the use of Polyurethane coated implants are recommended.

There are many reasons why one would opt for change of implant pocket.

A. Rippling and Implant Edge Visibility are hard to get rid of. One sure way is for the patient to be a small amount of weight around her breasts. Exchange of implant to smooth high filled implant &/or going behind the muscle also can be very helpful manoeuvres.

B. Placing the implant behind the pectoralis muscle can create an issue namely "winking". In most patients this is not a major issue but in some women with strong muscles, flexing the pecs can create a pull effect that may look undesirable. I normally recommend no surgery for this condition, but some may want to opt to have the implant placed in front of the muscle.

Change of Implant Pocket

Implant Pocket Re-adjustment or Capsulorrhaphy

Implant Pocket Re-adjustment or Capsulorrhaphy

Implant Malposition & Displacement/: Migration can occur from time to time usually in patients that exercise excessively. If the condition doesn't respond to taping then a formal pocket re-adjustment or new pocket formation needs to take place.

Excessive Cleavage Gap

Between breasts creating eg "Tori Spelling" & "Posh Spice" boobs. This condition usually arises from poor choice of implant and inadequate submuscular dissection.

By further dissection and appropriate use of a broader based implant this condition can be improved. Please note that some women are prone to having this issue as a result of the poor curvature of their chest wall.

This condition is described where there is no cleavage or very tight cleavage. Patients can be born with this condition or acquire it after Breast Augmentation.

If apparent immediately after breast augmentation it occurs as a result of overdissection centrally and/or use of very large based implant so that the implants are left too close in the middle. It can also develop months later but overzealous use of "push-up" bras creating thinning of tissue centrally. Eitherway the condition of Symmastia is very distressing to patients.

Surgical treatment is possible but needs complex re-adjustment of the pockets using permanent suture technique and smaller size implants with narrower base.

In Mild cases a Thong Bra (www.thongbra.com) maybe all that is needed and avoiding push up bras.

In Moderate cases if the implants are submuscular the choices are either to suture down the tissues centrally with permanent sutures and dissect the pocket laterally so the implants have room to shift outwards. If the implants are subglandular the implants need to be placed in a new submuscular pocket.

In Severe cases the implants have to be removed for 6-12 months and replaced after pocket healing has taken place.

Post operatively ALL patients need to wear a Special Bra for 3 months with no activity.

Correction of Congenital Symmastia

Correction of Congenital Symmastia

Correction of Symmastia using suture technique

For poor scarring such as Hypertrophic scar or Keloid. Prior to scar revision I recommend the FRAXEL laser technology to improve the quality of the scar. Failing the latter then formal surgery on the scar by re-cutting and suturing will certainly improve the scar.

For size issues (usually for bigger size) or content (usually Saline To Gel)

This is a condition where the implant and the native breast are in completely different anatomical levels. Routine subpectoral mammary augmentation in women with a small breast lower pole deficiency often results in poor late results with the appearance of a double-bubble deformity. The surgical correction is complex and requires the need for a series of a. excision of breast tissue, b. pocket adjustment or capsulorrhaphy and c. exchange of implants or any combination of the above.

Correction of "Double-Bubble" syndrome

Correction of "Double-Bubble" syndrome

Thailand Breast Augmentation creating a severe case of Double- Bubble and now corrected by Dr Tavakoli

Correction of "Double-Bubble" syndrome by Dr Tavakoli

Reconstruction after Removal Of Infected Implant

Implant infection is extremely rare but as this overseas breast job demonstrates they can occur.

Reconstruction was successfully performed in this case demonstrated by Dr Tavakoli.

Breast Implant Bottoming Out

This condition is a form of Implant migration. Although can be seen with all types of augmentation it is more common with smooth implant.

The treatment is very complicated and involves pocket repair/exchange.

Ruptured Implant

Although ruptured breast implants are usually rare, the topic has received an enormous amount of press in 2012 as as result of the faulty French manufacturer PIP. Dr Tavakoli has NEVER used these implants but in the photo attached has removed a PIP implant late in 2011 from a patient visiting from London. As you can appreciate the implant is completely disintegrated highlighting the extremely poor manufacturing standards of PIP implants.