Cosmetic Breast Surgery Revision, Part 2
Breast surgery revision continued
This post will go into the reasons for secondary surgery.
Excessive movement of the chest wall
Some patients are made of the right stuff—thick skin, strong muscles—and then they go and use that stuff to dig a ditch or shovel rocks or even exercise, causing the breast implant capsule to stretch and the implant to move out of its normal position under the breast mound.
Typically, the breast implant falls under the armpit and the cosmetic patient will complain of having the breast get in the way of arm movement. Also, many patients have pain where the capsule has stretched and pulled away from underlying tissues. Another “Ryan”-type procedure is necessary to correct this complication.
Effect of time on breast tissues
With the passage of time, the weight of the breast implant, be it silicone or saline, will have its effect on the tissues of the chest and breast. The extra weight will actually stretch the tissues out and lead to all of the above!
Scarring inside the body can affect breast shape and cause malposition.
I have learned to be prudent when seeing patients who have some malposition of their breasts implants. I have also learned to be more forgiving to myself and to know my limitations as well as those of my patient’s bodies. I have learned not to operate on all cases of malposition.
Patients who have a small difference between the breasts after surgery usually had the same difference before breast augmentation. Accepting the difference and making sure the patient understands this beforehand will make things much easier for the plastic surgeon and the patient, but it is amazing how few patients remember that part of the consultation.
I perform revision surgery for cases of gross malposition or when the patient has pain.
Patients undergoing revision of breast enlargement surgery should be fully informed that they will have the same risks or even greater risk of an initial breast surgery (capsular contracture, bleeding, infection and malposition).
Although in the great majority of secondary breast surgery the results are excellent and the problems are solved, some cosmetic patients will require a third or fourth surgery. I have one patient about to undergo her fifth procedure. That’s why I feel like a fool who should have left well enough alone and not tried to achieve perfection.
The Persian flaw
For those of you who don’t know, I am of Iranian or Persian heritage. In older Persian architecture, construction and even carpet-weaving there is a thing known as the “Persian flaw.” The workman/workwoman will purposely place a faulty brick or knot in their work to ensure that it is not perfect. It would be a sin for a human to achieve perfection—that is reserved for the domain of the gods.
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