Breast Reconstruction and Revision
Many patients require reshaping or repositioning of the breast. Examples of conditions that require reconstruction are:
1) Sagging or drooping breasts. This happens to all women eventually. Stage 1 (mild) and stage 2 (moderate) drooping may be corrected with a breast sling procedure. In this case, a breast sling functions like an inernal bras. Often, breast lift requires breast implantation as well. Severe drooping (stage 3) requires a formal mastopexy using the inverted T technique.
2) Breasts are different sizes. Liposuction will reduce a large breast, breast implants will enlarge a small breast.
3)Tuberous Breasts. Here the breasts have an abnormal shape. This is a very common congenital condition.
4)Synmastia or "unibreast" is a condition where there is inadequate cleavage between the breasts.
5) Breasts or implants are in the wrong location (too high, too low, too lateral, etc.). This may happen to breasts with or without implants. Wearing proper support and performing exercises prevents this condition. All patients who have breast surgery are instructed on proper support and exercises.
6)Rippling is a condition that occurs to some women with breast implants. This is more likely to occur with larger saline implants, but can occur with silicone implants as well. Below muscle implants have less rippling towards the cleavage but may ripple laterally and can migrate.
Traditionally, fat transfer to the rippled area has been used to fill in rippled areas, however fat transfer to the breast may not be absorbed, which would cause recurrence of the rippling.
More recently, we have used tissue expanders, tocorrect this problem. Tissue expanders are typically used in breast cancer patients, but we have used them recently on some rippled breasts with good early results. The rippling shown below was corrected with Strattice porcine graft implant.
If the condition is caused by a capsule, a capsulotomy will be needed in addition to an implant.
7)Breasts feel very hard "like a rock". This is caused by excessive scar tissue after breast implantation. In these cases a capsulectomy (removal of the capsule), capsulotomy (disrupting the capsule) with or without a tissue expander is the treatment of choise.
8)Nipple Reconstruction. After pregnancy, some women have large diameter areolae, droopy areolae, or very long nipples. Dark discoloration is also common after pregnancy. These effects may be corrected surgically. The lady shown below had ptosis (drooping) as well as long nipples. The ptosis was corrected and the nipples were shortened.