Reconstruction Revision

A breast reconstruction revision is a procedure that addresses aesthetic issues that come about after the first reconstruction post-mastectomy. It may involve removing and replacing implants and/or correcting implant positioning, asymmetry, loose skin, and nipple positioning. Before finding the right approach, surgeons must consider the type of initial reconstruction, the available breast tissue, and even the kind of breast cancer treatment they underwent. Patients with breast implants likely will require revisions at a certain point, but for those with a flap reconstruction, revision rates over the long term are very low.

The goal of a secondary procedure is to help women feel as confident and as comfortable as they can be with their breasts. As a hallmark of femininity, the breasts are an integral part of a woman’s appearance; reconstructive surgeons must have incredibly intricate knowledge of breast anatomy to produce the long-lasting results that patients desire. 

If you have undergone reconstruction and have been unhappy with the outcome, there is a solution. Dr. Michael Howard is a board-certified plastic and reconstructive surgeon who specializes in complex breast surgeries such as the DIEP (deep inferior epigastric perforator) flap and many others. This type of all-natural breast reconstruction involves transferring extra tissue from the lower abdomen to form new breasts. No matter your needs, Dr. Howard will consider your unique body structure, medical history, and other aspects before performing an implant-based or DIEP flap revision. 

To get started with a consultation, call (224) 271-4250 or visit one of his offices in Chicago, Lake Forest, or Glenview. Your journey toward renewed body confidence can begin today! 

Before and After Photos

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Cosmetic Issues that Arise After Breast Reconstruction

The overall goal of reconstructive surgery is to help you feel whole again- not create a source of self-consciousness. If you have noticed some changes in your breasts over time or were not pleased with the results to begin with, these concerns deserve attention. Cosmetic issues can range from mild to severe deformities and result from surgical mistakes and complications during the healing phase. If you only have one reconstructed breast, you may be displeased with how it does not symmetrically match with the other. Luckily, secondary breast reconstruction can resolve a wide variety of problems, regardless of if they appear months or decades after the initial surgery. Common reasons to undergo another surgery include: 

Capsular Contracture 

Capsular contracture is the abnormal buildup of scar tissue around an implant used in reconstruction. Some scar tissue secures the implant in place but too much poses a significant problem. Though it cannot pose any medical harm, it can harden the breast and even physically deform it in severe cases. If you underwent radiation therapy after receiving implants, you are at higher risk of developing this type of scar tissue.

Implant Discomfort

If you experience discomfort or awkward movement of your implants during exercise, you may have dynamic distortion or “breast animation.” This is caused by the implants’ subpectoral placement– a placement method in which the surgeon inserts them underneath the chest muscle. As the chest muscle flexes, it pulls unnaturally on the  overlying skin. 

Maintenance Replacement 

Many surgeons estimate that modern implants last about 20 years, but others recommend removal and/or replacement sooner. ⁽¹⁾ At some point, if you have implants, you will require a removal procedure to prevent the development of implant structural problems. 

Asymmetry 

Whether you underwent autologous reconstruction or have breast implants, asymmetry can be disheartening. If you underwent a lumpectomy during your cancer treatment, you are much more likely to feel dissatisfied with the imbalance between your breasts. Dr. Howard will work to make sure the reconstructed breast matches well with the unaffected one.  

Rippling and Sagging Breasts 

Overly large implants can cause issues like premature sagging and loose skin. Dr. Howard may use breast lift techniques and place smaller implants if the patient desires. To accommodate larger breasts, he may use a mesh-like material within the breast to provide more support for larger implants. He can also remove the scar adhesions that develop and result in external rippling. ⁽²⁾

Abnormal Nipple Positioning 

After a nipple-sparing mastectomy, the nipple-areola complex may descend due to aging or the effects of a previous reconstruction. Depending on your unique case, Dr. Howard may be able to reposition it to a more aesthetically pleasing location, reconstruct a new nipple with skin from another part of your body, or create a realistic-looking nipple tattoo. 

Significant Scarring

Dr. Howard may be able to revise scarring and ensure that all revision scars are placed inconspicuously, such as under the breast or in the armpit.

Symmastia 

Symmastia is an extremely rare condition in which the implants merge into one subcutaneous pocket and eliminate any breast cleavage. Dr. Howard typically recommends autologous DIEP flap reconstruction for this problem. 

Personal Consultation

During your consultation with Dr. Howard, you will be able to communicate your concerns and what improvements you would like to see after your reconstruction revision. He will evaluate your breast tissue and ask you about your previous reconstruction and the recovery process. He will make sure you are a healthy candidate for surgery by reviewing your medical history and any underlying conditions. He will discuss his proposed revision techniques, ensuring that you understand everything involved with your procedure. He will go over the topic of anesthesia and provide you with personalized preparation instructions and a rough timeline of your recovery. If you have any remaining questions, Dr. Howard will answer them with the care and thoroughness you deserve. 

To take the first steps toward feeling good about your body once again, get in touch with Dr. Howard’s staff at (224) 271-4250. He has Illinois office locations in: 

Breast Implant Reconstruction Revision 

Dr. Howard will personalize your breast implant reconstruction revision according to your aesthetic needs and any reported discomforts. For this type of revision, Dr. Howard will most likely recommend general anesthesia. He will ensure that the scars follow the incision lines of the previous reconstruction surgery to prevent creating new scars.

Implant Deformities

Most revisions will require implant removal and replacement, and revision of the internal breast pocket will vary. In cases of capsular contracture, he will have to remove both the implant and surrounding capsule as one piece, a procedure called a total capsulectomy. In some cases, he may be able to remove the implant and preserve some of the surrounding implant capsule. For issues with mobility due to implant displacement, he will have to remove the affected implant/s and use a pre-pectoral placement, a technique in which Dr. Howard will place the implant over the chest muscle, not under. 

Size Changes

To accommodate smaller implants, he will have to surgically adjust the implant pocket so that the new pair fits securely. If there was a “double bubble” deformity in which the implant descended and created a bulge over the breast fold, he may need to strengthen and modify the internal breast fold so that the new implants settle in the correct place. To help patients adapt to larger implants, he may need to insert a tissue expander before inserting the true implants at a later procedure. Dr. Howard will discuss all of these options with you at your consultation.

DIEP Flap 

If you are considering a reconstruction revision that will not require a follow-up procedure in the following years, you can consider implant removal and DIEP flap. With DIEP flap, Dr. Howard will collect a section of skin, fat, veins, and arteries from the lower abdomen- called a “skin island”- and use microvascular techniques to connect the island’s blood supply to the chest before forming a new breast. The outcome is a more sculpted abdomen and natural feeling breast tissue. This procedure is only suitable for women with enough abdominal fat. 

Flap Reconstruction Revision 

The DIEP flap is currently the most popular flap breast reconstructive procedure that allows for better strength preservation of the abdominal muscles than the TRAM (transverse rectus abdominis muscle) flap. ^(3,4) Revision to the results of these procedures consists of relatively minor adjustments compared to the initial surgery. Depending on the extent of the revision, you may require general anesthesia. These adjustments may include one or more of the following:

Recovery and Results  

Immediately after your procedure, Dr. Howard will send you to the post-anesthesia care unit to ensure you recover well from the effects of anesthesia. His surgical team will help you manage dizziness, nausea, and drowsiness with oxygen, rehydration with IV fluids, and other medications to help you feel better before you go home.

In general, you should expect to experience swelling and bruising, but the effects should not be as severe as those you experienced after your primary reconstruction procedure. Dr. Howard will guide you through the Northwestern Enhanced Recovery Pathway (ERP) to promote a faster, more comfortable recovery. This will involve advice on incision care, a comprehensive guide on when you can return to certain activities, pain management, and other personalized instructions. Part of this plan will include frequent follow-up appointments for Dr. Howard to monitor progress. 

Cost of a Breast Reconstruction Revision in Chicago 

The cost of your breast reconstruction revision will depend on the techniques Dr. Howard recommends for the aesthetic enhancements you want to attain. It will vary greatly depending on whether or not implant replacement is required and other minor adjustments. Dr. Howard will give you a breakdown of the total costs involved during your consultation appointment. 

Feeling beautiful in your skin is possible with the help of Dr. Howard’s breast surgery techniques. To ask a question or request your consultation today, call (224) 271-4250 at his Chicago, Glenview, or Lake Forest locations. If you want to learn more before calling, read through our blog.

References

1. Fardo D, Sequeira Campos M, Pensler JM. Breast Augmentation. PubMed. Published 2021. https://www.ncbi.nlm.nih.gov/books/NBK482206/#:~:text=The%20risk%20of%20complications%20is 
2. Faenza M, Lanzano G, Grella E, Izzo S, Ferraro G. Correction of Rippling in Implant-based Breast Reconstruction with Serratus Fascia Flap. Plastic and reconstructive surgery Global open. 2023;11(3):e4862-e4862. doi:https://doi.org/10.1097/gox.0000000000004862 
3. Tomita K, Kubo T. Recent advances in surgical techniques for breast reconstruction. International Journal of Clinical Oncology. 2023;28(7). doi:https://doi.org/10.1007/s10147-023-02313-1 
4. Hyun Jun Cho, Hyo Jeong Kwon, Moon SH, Young Joon Jun, Jong Won Rhie, Deuk Young Oh. One-stage nipple and breast reconstruction using a deep inferior epigastric perforator flap after a skin-sparing mastectomy. Archives of Plastic Surgery. 2020;47(01):26-32. doi:https://doi.org/10.5999/aps.2019.00598