Breast Revision

Patients are sometimes concerned with their breasts being uneven or unbalanced for several reasons, including rib asymmetries, volume and projection differences, drooping, and other similar issues. Dr. Gray can use multiple techniques to correct these, often by using subtle differences between implants to find the most balanced result. A breast lift procedure may also be recommended for some patients.

Surgical removal of capsular contracture has made considerable strides in terms of recurrence rates. Whereas the rate of having another contracture used to be around 50%, this has drastically dropped to less than 1% in past decade in Dr. Gray’s practice. This is largely due to procedural and material advancements, including Dr. Gray’s own patented development of the collagen-coated breast implant. Developed by Dr. Gray in 1983 while he was at Stanford University, this research implant showed a lower rate of capsular contracture. This finding led Dr. Gray to use Strattice in his Capsular Contracture Breast Augmentation Revision cases.  With the use of Strattice, as mentioned above, Capsular Contracture recurrence rates have decreased in his experience from greater than 50% to less than 1%. Furthermore, new techniques, betadine use, and other improvements have made this concern more unlikely. It should also be noted that each implant company now offers a warranty for contracture patients.

This largely depends on each patient’s unique situation. Sometimes it will be mostly left in place, and sometimes it will need to be removed. Dr. Gray will gladly discuss your breast implant removal concerns and options in consultation.

Your breast implant revision surgery cost will depend on many factors that will be unique to your circumstances. We will provide you with an estimate after you have been evaluated by Dr. Gray.

Dr. Gray is renowned throughout San Francisco, the Bay Area, and beyond as a cosmetic breast surgery specialist. In addition to breast revision surgery, his specialties include breast augmentation, breast lift, breast augmentation with lift, and the non-surgical breast lift. You can learn more about Dr. Gray’s extensive education and experience by visiting his about page. 

Capsular contracture is the abnormal growth of overdeveloped scar tissue around breast implants. It can be uncomfortable and disfigure your breasts. The only way to properly address capsular contracture is through revision surgery. Dr. Gray corrects capsular contracture by removing the scar tissue capsule and replacing the implants with new ones, leading to a decreased risk of recurrence and stunning results.

Since breast implants aren’t lifetime devices, we don’t recommend reusing them. The need for new implants depends on your reasons for pursuing revision surgery with Dr. Gray. If you’re exchanging your implants for a different size, or if you experience rupture or rippling, Dr. Gray will replace your old implants with new ones. Some patients choose to exchange their saline implants for silicone ones or vice versa.

The price of your revision surgery depends on several factors, including hospital and surgeon fees, your chosen implant material, the amount of scar tissue you have, the anesthesia used, and the cost of any medications or other supplies you need while you recover. The best way to get an accurate estimate of how much your procedure will cost is to schedule a consultation with Dr. Gray. After an examination and discussion of your goals, Dr. Gray and our finance department can provide you with a more precise cost breakdown.

Deciding to have a breast revision is an entirely personal decision based on many contributing variables. If you’re suffering from capsular contracture, a ruptured implant, or rippling, a breast revision is the best option to help you resolve these issues and live more comfortably. This surgery can also help you achieve your aesthetic goals if you’re unhappy with your current implant size or placement.

At Bay Area Plastic Surgery, we specialize in surgeries to improve the appearance of the breasts and have been practicing them for many years. If you are considering breast revision, Dr. Gray will explain the process and options available to you so you can make the most informed decision.

Breast implants aim to enhance your breast size and shape, but they do very little to address sagging tissue or skin. If your breasts appear flattened, with downward-pointing nipples, you’ll likely need a lift to elevate them into a more youthful position on your chest. Dr. Gray can perform a combination breast revision surgery and a lift in one procedure. Many women choose to have implants inserted for the first time during a breast lift procedure.

Combining breast revision and breast lift surgery offers many benefits, including:

• Less downtime, as you’ll only need to recover from one surgery instead of two
• Eliminate sagging and replace implants in one surgery
• Fewer incisions and reduced scarring
• Cost efficiency – you’ll only need to pay surgical and anesthesia fees once

Breast augmentation revision to change size involves a surgical procedure to alter the size of breast implants. This can include replacing current implants with larger or smaller ones, adjusting the implant placement, and making necessary changes to achieve the desired size and appearance.

Breast augmentation revision for pocket repair or pocket revision is a surgical procedure aimed at adjusting the implant pocket created during the initial breast augmentation surgery. The implant pocket refers to the space where the implant is positioned within the breast tissue.

This type of revision might be necessary if the original pocket was not created correctly, leading to issues like implant displacement, asymmetry, or bottoming out (implants sitting too low). During the revision, the implant will be repositioned within the pocket. The pockets will be reinforced with sutures. In some cases, a new pocket must be created to achieve better symmetry and positioning.

Galaflex Lite is a type of bioresorbable scaffold or mesh that is sometimes used in breast augmentation revision surgeries, particularly in cases involving pocket revision or repair. It’s designed to provide additional support to the breast tissue and help maintain proper implant positioning over time.

The GalaFLEX scaffold is made from a material that gradually breaks down and gets absorbed by the body, while simultaneously promoting tissue integration. This may be used to reinforce the implant pocket, correct issues like bottoming out or lateral displacement, and enhance the long-term stability of the breast implants.

Combining permanent sutures and Galaflex Lite in pocket revision repair is a strategy to enhance the durability and stability of the repair over time. Here’s how this combination works:

• Permanent Sutures: Permanent sutures are stitches that are not intended to dissolve and remain in the body indefinitely. When used in pocket revision repair, they are strategically placed to reinforce and secure the breast tissue in the desired position. These sutures provide immediate support to the tissue while it heals and integrates with the surrounding structures.
• Galaflex Lite (GalaFLEX 3D): Galaflex Lite is a bioresorbable scaffold or mesh that gradually breaks down and gets absorbed by the body over time. When used in combination with permanent sutures, it provides additional structural support to the repaired pocket. It encourages the growth of new tissue and helps prevent issues like bottoming out or implant displacement, as it breaks down naturally while the body’s tissue adapts and strengthens.
• By combining permanent sutures with Galaflex Lite, the repair is supported both in the short term and as the body’s healing process progresses. This approach aims to achieve better long-term results, minimizing the risk of complications and maintaining the desired breast implant position.

Capsular contracture occurs when scar tissue forms around a breast implant and tightens, potentially causing discomfort and distortion. At one time, the recommendation was to simply remove the capsule and then replace it with a new implant. However, Dr. Gray from Bay Area Plastic Surgery created a collagen-coated breast implant at Stanford University, and it was found to have a lower rate of contracture, so he patented it. Additionally, by incorporating Strattice, a collagen sheet derived from pig sources, into the surgical procedure, he found a way to significantly reduce the recurrence rate of capsular contracture. This method provides additional support to the implant pocket, helping to prevent excessive scar tissue formation and maintaining a more natural and comfortable appearance.

Dr. Gray’s approach highlights the importance of continuous research and development in the medical field, as well as the potential for cross-application of existing technologies to address different challenges. My innovative use of Strattice in conjunction with breast implant revision surgery has not only led to a remarkable decrease in recurrent capsular contracture but has also been documented through published research.

His unique perspective and experience have contributed to improving the outcomes for patients undergoing breast augmentation revision for capsular contracture. Collaborative efforts between medical professionals, researchers, and companies can lead to breakthroughs that positively impact patient care.

Bay Area breast augmentation revision surgery for deflation involves addressing the situation when a breast implant, typically filled with silicone gel, experiences a rupture or leak, resulting in deflation of the implant. The procedure aims to replace the deflated implant and restore the desired breast size and appearance.

During the revision surgery:

• Removal of Old Silicone: Old silicone is removed from the breast implant pocket. Thorough cleaning of the pocket is crucial to ensure that any residual silicone or debris is cleared away.
• Cleaning the Pocket: Betadine-soaked lap sponges are used to clean and disinfect the implant pocket, creating a sterile environment for the new implant.
• Capsule Consideration: Depending on the condition of the existing capsule (scar tissue that forms around the implant), the surgeon may decide to remove the capsule as well. This step helps prevent potential complications and ensures proper positioning of the new implant.
• Implant Replacement: A new implant is then inserted into the cleaned and prepared pocket. This new implant should provide the desired volume and appearance to match the patient’s goals.

If the implant is saline, removal involves only the removal of the implant shell.

It’s noteworthy that all the breast implant companies offer warranties that cover implant deflation. These warranties often include free replacement implants for the lifetime of the patient and financial assistance for a specified period. This provides patients with peace of mind knowing that they are protected against unforeseen deflation issues.

For breast augmentation revision involving an infected breast implant, the standard recommendation is to remove the infected implant. Additionally, any materials within the implant pocket, such as sutures or other substances, should also be removed. This is done to eliminate potential sources of infection and prevent the continued spread of bacteria within the breast tissue.

Removing the infected implant and associated materials is essential to effectively treat the infection and minimize the risk of complications. After the removal, the patient’s health and the condition of the breast tissue will be closely monitored. Once the infection has been successfully treated and the breast tissue has healed, it may be possible to consider a new implant placement after a minimum of 6 months.

The waiting period is crucial for several reasons:

• Healing: Allowing sufficient time for the breast tissue to heal and recover from the infection is essential to minimize the risk of complications following the replacement surgery.
• Scar Tissue Formation: Waiting gives the body time to naturally soften and reduce excessive scar tissue, which can contribute to a more comfortable and natural-looking result.
• Infection Clearance: Ensuring that the infection is completely cleared before considering a new implant placement is crucial to prevent recurrence.

Generally, breast lift is considered when the patient has grade 2 ptosis or the nipple is below the inframammary fold. At the time of this breast augmentation revision, oftentimes the pockets are repaired and the implant of the patient’s choice is placed. This is followed by the breast lift. Dr. Gray’s favorite lift is a vertical lift where the scarring is less than with an inferior pedicle, and it has internal support by sewing breast tissue to breast tissue, so it tends to stretch less.

The breast lift procedure can be combined with breast augmentation revision to achieve the desired results. Typically, the approach involves the following steps:

• Implant Placement: During the breast augmentation revision, your Bay Area board-certified plastic surgeon addresses any issues with the implant pocket and places the desired implant.
• Lift Procedure: Following the implant placement, the breast lift procedure is performed. Dr. Gray’s preference is a vertical lift. This method involves creating an incision that extends around the areola and vertically down to the breast crease. Excess skin is removed, and the breast tissue is removed at the lower pole. The nipple and areola are elevated to a higher, more youthful position. The vertical technique tends to result in less scarring compared to traditional methods like the inferior pedicle technique.
• Internal Support: At closure, internal support is obtained by sewing breast tissue to breast tissue in the lower pole of the breast. This provides lasting support within the breast and helps minimize stretching over time, contributing to longer-lasting results.