Secondary breast surgery

Every so often I feel like a fool who should have known better.  I know that you have had the same feeling. In my case, I had the feeling when trying to achieve perfection in breast augmentation surgery, where perfection is not possible and disaster shadows your every stitch.

Surgical complications of breast enlargement surgery with implants

There are a number of surgical complications that can occur with breast enlargement surgery with saline or silicone implants. These complications are inherent in the procedure, and all surgeons who have performed these surgeries have seen them in their cosmetic patients. They include:

  • Infection
  • Bleeding
  • Breast implant deflation
  • Breast implant malposition

 Of all of the above complications, it is malposition of the breast implant and its subsequent revision surgery that is the trickiest.

Causes of breast implant malposition

  • Uneven breasts
  • Surgical technique effect
  • Thin or weak chest tissues
  • Excessive movement of breasts/chest after surgery
  • Effect of age on tissues
  • Capsular contraction

Uneven breasts before surgery

This is the single most common reason that I find leads one down this harrowing path.

The patient has:

  • two differently sized breasts
  • two differently shaped breasts
  • two different positions of the infra-mammary line (the line under the breasts)
  • all of the above or any combination of them

The cosmetic plastic surgeon wants to achieve symmetry and two identical breasts with placement of breast implants. Although the amount of saline can be changed in saline breast implants to achieve some symmetry in volume, the other differences will always persist.

Surgical technique

The plastic surgeon may try surgical maneuvers to improve the symmetry. These involve changing the abnormal anatomy and creating a better-corrected anatomical shape to the breasts and the implant pocket. These attempts can succeed but can also fail immediately. If when the dressings come off the breasts are obviously very different from each other, the cause may be due to surgical technique.

Thin or weak breast and chest tissue


 This patient had surgery initially elsewhere and came to see me with a terrible results which i was able to correct for her. Some patients are just made of different stuff than others. The surgery may have gone perfectly, the implants may be well matched and all may be well post-op until after a period of a few weeks to months.

Then the tissues of the chest and breast start to give way and the weight of the implant stretches out the weaker tissues at the lower end of the breast where it joins the stomach muscles at the bra line. The saline or silicone implant may actually droop into the abdominal area. This happens a lot more commonly than you would think. There is even a name for the surgery needed to correct the defect—a “Ryan procedure”—where the chest wall skin and muscle has to be sutured back onto the ribs.

This discussion will be continued in the next see here – Part 2

Need more information on breast surgery? Find it here:

Morad Tavallali, M.D., FACS

Cosmetic Plastic Surgeon