The vast majority of patients undergo a planned revision procedure after their initial major reconstruction. Unlike elective cosmetic breast surgery, which is performed in a single stage, there are many more variables affecting your aesthetic outcome with breast reconstruction surgery. The goal of the major reconstruction stage (placing implants, flap reconstruction) is to establish a strong foundation on which your breasts can be perfected. By separating the finetuning procedures from the major reconstruction, we are better able to see how your body handled the healing process and to better understand what techniques to employ to achieve your aesthetic goals. Revision procedures are generally performed 3-6 months after your last reconstructive surgery but can also be performed well after that timeframe. Some patients may benefit from multiple revision surgeries, depending on their aesthetic goals.

Overview & Why Choose Dr. Chang

Breast Reconstruction Revision

Patients Completely Healed from Their Breast Reconstruction Surgery

Revision surgery is only performed after you are completely healed from your last reconstructive surgery. The healing process varies greatly with different patients and different surgeries. Waiting until you are fully healed (no residual swelling, bruising, scar tissue beginning to mature) is critical in properly assessing if a patient is a candidate for revision surgery and how to best plan a revision surgery. For most patients, this is between 3-6 months after their most recent surgery, but in some cases, Dr. Chang may recommend delaying until 12 months after surgery.

Realistic Expectations

Dr. Chang views surgery as a partnership between the patient and him. It is important trust and confidence go both ways. Together, we will discuss your goals and if we can reasonably achieve those goals based on your anatomy. The goal of breast reconstruction revision surgery is to improve the appearance of your breasts and try to reduce the visible sequelae of having had breast cancer. Unfortunately, not all patients are able to be returned to their pre-cancer breast appearance.

Who Is a Candidate for Nipple-Areola Reconstruction?

Clinical photographs from multiple views will be taken of your breasts. These photos are used to plan for your individualized surgery and compare before and after surgery. No photographs will be published online without your written consent.

Clinical Photographs

Dr. Chang will perform a physical examination of your breasts. This will include an evaluation of the quality and amount of breast skin, the breast position, shape, and texture, the location and integrity of breast implants, and the quality and thickness of the subcutaneous fat and/or autologous flap.

Breast Examination

Pre-operative

Scar Revision

A scar revision is one of the most common and simplest revision breast reconstruction procedures. Often times, after your initial mastectomies or reconstruction, there may be scars that are uneven, asymmetric, hypertrophic, or not well concealed. A scar revision aims to better blend your scar burden with natural transition zones of your breast and body to help reduce the stigma of your breast cancer and subsequent reconstruction.

Mastopexy

Mastopexy is another common revision breast reconstruction procedure. The goal the mastopexy after breast reconstruction is to help aesthetically tailor your breast skin to create a better-shaped breast mound. This may involve adjusting the position of the nipple areola complex for patients who underwent nipple sparing mastectomy.

Fat Grafting

Fat grafting is the most common way to add targeted breast volume in patients who underwent implant-based breast reconstruction and volume overall in patients who underwent autologous reconstruction. Liposuction is performed on your abdomen, thighs, or arms, and the collected fat is processed to facilitate injection back into the breast. The fat can be injected into targeted areas of depressions or irregularities, especially the transition between your mastectomy flap and the top of the implant, or all throughout the autologous breast mound.

Breast Reconstruction Reduction

For patients with autologous reconstruction, sometimes the reconstructed breast is larger than desired. The reconstructed breast can be reduced to a size that is more suitable to you.

Implant Exchange

For patients with implant-based reconstruction, sometimes the implants may be smaller or larger than desired or not ideally shaped. Your previous implants can be exchanged for ones that better meet your aesthetic goals.

Capsulorrhaphy

Implants cause your body to form a capsule of tissue around them. This is your body’s way of protecting itself from something foreign. The capsule size and position is the major long term determining factor in where your implants sit on your chest. Sometimes the implant pocket is too small, too big, or asymmetric. A capsulorrhaphy is a common revision procedure after implant-based breast reconstruction to adjust the position of the implants to achieve a more aesthetic and symmetric result.

Capsulectomy

The capsule around your implants may become abnormally thickened. This can cause your implant to shift positions or become distorted and can cause you physical discomfort. A capsulectomy removes this thickened capsule in the hope that the new capsule that forms is thinner and non-distorting.

Options for Breast
Reconstruction Revision

Unmet Expectations

Despite thorough pre-operative planning and discussions, you still may not be fully happy with your aesthetic results.

Need for Revision Surgery

Some patients may need another revision surgery to address an aesthetic concern if this revision procedure failed to correct it.

Asymmetry

No one’s breasts are perfectly symmetric. While the goal is near-perfect symmetry, there will be some asymmetries in your reconstructed nipple position, shape, and size.

the Risks of Breast Reconstruction Revision

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