Breast Implant Revision

A breast augmentation is a surgical procedure to increase the size and volume of an individual’s breasts using implants. Breast augmentation is one of the most common cosmetic procedures performed today. Dr. Tregaskiss understands that being happy with the size and shape of your breasts and the contour of your body is very important for your confidence and sense of wellbeing.

A good candidate for a breast augment often has one or more of the following concerns:

• Unhappiness with the current breast size.
• A change in breast size and volume following significant weight loss or after having children and breastfeeding.
• Asymmetry between the breasts. Nearly all women naturally have a difference in size between their breasts, but for some women this is much more noticeable than others. This can be corrected using implants in both or just one breast.

A mastopexy (breast lift) is a surgical procedure that lifts breasts that are drooping to an optimal position on the chest wall. A breast lift can be performed in combination with an augmentation using implants if desired.

Many women ask us “what cup size will I be after the surgery”, or “I would like to be a c-cup”. The difficulty with thinking in terms of cup-size is that it is a very subjective measure, varying widely between individuals and even bra manufacturers. A 36C in one manufacturers bra can be a 34D in another. This is why we prefer to talk about shape and proportion. Our goal is to have breasts that you are happy with and that fit with your individual body size and shape so that your breasts look proportional to the rest of your body.

The best ways to understand what you will look like after your surgery is firstly by using Vectra 3-D imaging and simulation and secondly by trying on sizers (see below) with a bra and clothing. We will use both methods during your consultation to ensure the correct implant size is selected for your individual requirements.

As discussed above, cup-size isn’t the best way to understand how your body will look after surgery. During your consultation we will provide you with some different sizers (a variety of trial breast implants) that you can try on with a bra and clothes. This helps you to appreciate how different sized breast implants will look in relation to the rest of your body. When trying sizers there a few different things to consider, such as your body frame, height, weight, and the width of your shoulders and waist. Women who are taller and have a broader chest and shoulders will likely need a bigger implant to achieve a balanced look than a shorter woman with narrow hips and narrow shoulders. Implant sizes refer to the amount of fluid or gel inside the implant. They can be as small as 125cc and go up from there.

Some important things to remember when considering the best implant size for you:

• There will not be a size that is the perfect fit, rather there will likely be a range of implant sizes that will work and then it is based on your personal preference.
• Bigger is not always better and choosing a size that compliments your body size is the best way to prevent you from looking “top heavy” after the procedure.
• Some larger implants may not fit your skin and Dr. Tregaskiss will advise you on whether a chosen implant is feasible for your individual circumstance.

The procedure takes between 1.5 and 2 hours and requires a general anesthetic. The exact procedure will depend on the individual and their specific needs. A small incision is usually made in the crease underneath the breast, (which helps to hide the scar). Sometimes an incision is also made around the areola to move the nipple into a higher position (breast lift/mastopexy). The implant can be placed either under the pectoralis major muscle or on top (a decision made by you and Dr. Tregaskiss pre-operatively). Once the optimal position is achieved the opening will be closed. Surgical drains are not used. The sutures (stitches) that are used to close the incisions at the end of the operation are dissolvable and don`t need to be removed.

• For smokers, smoking must cease at least 6 weeks prior to surgery and for at least 4 weeks postoperatively.
• All herbal remedies taken orally must similarly be stopped 6 weeks prior to surgery. Many such herbal remedies have been linked to increased risk of bleeding and many others simply have not been studied well enough to know their effects.
• No alcohol for 24hrs before your surgery
• Discuss with Dr. Tregaskiss whether to take any regular prescribed medication the day of surgery
• Nothing to eat or drink on the day of your surgery from midnight
• Notify Dr. Tregaskiss’s office if you develop a cold or illness before your surgery
• Use the chlorhexidine scrubbing brush (provided by our office) when showering on the morning of your surgery

First night after surgery:

Following surgery, you need to have a caregiver escort you home and stay with you for the first 24-48hrs hours. For patients from out of town we recommend staying in the local area for 3-4 nights after surgery to allow for a post-surgery consultation with Dr. Tregaskiss.

Support bra:

You will be provided with a front-fastening support bra before being discharged home. This is worn continuously for 6 weeks. The use of the support bra will help minimize discomfort, protect the wounds and prevents movement of the implant until it has settled into place and all incisions are completely healed. After 4 weeks if you prefer to use a supportive sports bra that is OK. You should not wear an underwire bra for 6 weeks after surgery.

Dressings:

At the end of surgery, showerproof dressings are applied that must stay in place until your first post-surgery appointment with Dr. Tregaskiss. If there is some blood or blood/straw colored fluid showing through the dressing this is ok.The dressing can be reinforced with gauze to prevent it from soiling your support bra. These dressings will be removed and replaced at your appointment with Dr. Tregaskiss.

Pain relief:

Most patients will experience some pain after their procedure, more so in the first few days after your surgery. The severity of pain experienced varies between individuals based on their tolerance for pain and the surgical technique used. Some women feel little to no pain whereas others will have to manage their pain level using prescription painkillers. Prior to and during surgery you will receive a combination of analgesics (painkillers) and local anesthetics to minimize post-surgery pain. Typically the operation causes minimal to modest pain. This pain can be well controlled with tablet analgesics that will be prescribed before discharge from the surgery centre. Some pain medications can cause constipation so please remember to stay well-hydrated and consider a stool softener to help.

Nausea and sickness:

Some people find that the anesthetic medication used during surgery can cause them to feel nauseous. You can try taking ginger drinks or Gravol tablets from the pharmacy, but if it persists a prescription for stronger anti-sickness medication can be provided. Even if you are feeling sick it is important to keep taking fluids to prevent dehydration and constipation.

Showering and bathing:

Showering can commence the day after surgery as your dressings are showerproof.Do not shower in very hot water, rather use a more moderate water temperature. At the end of the second week it is usually OK to start taking baths, if Dr. Tregaskiss is happy with your healing.

Exercise:

Very light regular daily activities are allowed by day 2 after surgery, but these may be sore initially. Depending on the recovery and the first post-operative visit, you can increase your activity level after the first 2 weeks.You should not do any activity that increases your heart rate above 120 beats per minute for the first 4 weeks. It is important to ‘listen’ to your body: if an activity hurts or causes much discomfort then wait longer. Do not participate in any strenuous activity until 6 weeks after your surgery. This includes: heavy lifting/weight lifting, extreme stretching exercises such as yoga, strenuous sporting activities.

Driving:

You must not drive for 48 hours after a general anesthetic. Driving can typically begin again 5-7 days post-surgery.

Sleeping:

Make sure to sleep on your back and prop yourself up with pillows. This will help facilitate getting in and out of bed. Avoid sleeping on your belly or side for 6 weeks following your procedure.

Work:

Return to work depends very much on the individual and the type of work activity you perform. Most individuals can return to work in some capacity 1-week post-surgery.

Follow-up:

Follow-up is tailored to the individual case but typically occurs, 1-2 weeks post-surgery, 4-6 weeks, and 3-6 months post surgery.

Scars:

Scarring after breast augmentation and mastopexy surgery is permanent. Dr. Tregaskiss will however place the incision in low visibility areas, typically under the breast fold. If a breast lift is also required there is additional scarring around the areola. We will provide you with a scar-minimizing silicone gel to use after surgery and Dr. Tregaskiss will explain how to gently massage the incision lines to minimize scarring. It is important to not expose your incision lines to the sun for the first 6 months as the sunlight can prevent the scars from fading. If you are tanning then cover your incision lines with a high-factor sunscreen (factor 60 or greater).

Implant Settling:

Immediately after your surgery it is very normal for the breasts to feel hard and to sit in a very high position on the chest. Over the course of 6-12 weeks after your surgery your implants will ‘settle’ into the optimal position on your chest.

Smoking:

Smoking should be avoided in the first 6 weeks after surgery. Smoking significantly increases the risk of complications such as infection and delayed healing. Even more seriously it can cause skin death (necrosis), including nipple necrosis!

• Hematoma: a collection of blood trapped within the breast affecting 1-2 % of cases.
• Infection: very rare, less than 1% of cases.
• Decrease or increase in sensitivity of the nipple. 15% of patients may experience this, typically temporary in nature.
• Necrosis (loss) of the nipple: a very rare risk of augmentation-mastopexy procedures.
• Delayed healing: incisions that take several weeks to heal rather than the normal 1-2 weeks. Seen occasionally with augmentation-mastopexy procedures.
• Asymmetry/Unevenness of the breasts: typically associated with patients who have pre-operative asymmetry.
• Deep vein thrombosis/Pulmonary embolus: blood clots in the leg and lung respectively.

• Implant rupture: 1% of implants per year can rupture
• Capsular contracture (excess scar tissue around the implant): leads to hardening and discomfort of the breast. 1% of implants per year effected.
• Rippling of skin around implant (more problematic with large implants)
• Malposition of implant: implants moving out of their original position (much more common with large implants)
• ALCL: a rare form of lymphoma associated with textured breast implants affecting up to 1 in 3,000 textured implants. Tregaskiss never uses textured implants and this complication is listed here in the interests of being comprehensive.
• Re-operation: approximately 20% of all patients who have had cosmetic breast surgery have a further breast surgery within 10 years of their original surgery. Reasons for re-operation include complications such as capsular contracture, rupture, malposition as well as patient choice e.g. change of implant size, breast lift required as the breast ages and droops.
• Hypertrophic/keloid scar formation: thick, lumpy, itchy scars. Uncommon.