Secondary Breast Augmentation

Abstract

Breast augmentation has been increasing steadily in popularity over the past three decades. Many of these patients present with secondary problems or complications following their primary breast augmentation. Two of the most common complications are capsular contracture and implant malposition. Familiarity and comfort with the assessment and management of these complications is necessary for all plastic surgeons. An up-to-date understanding of current devices and techniques may decrease the need to manage future complications from the current cohort of breast augmentation patients.

Revision Breast Augmentation

“…3 Many potential causes of capsular contracture have been suggested, including biofilm, subclinical infection, soft-tissue trauma, silicone implant rupture, hematoma, seroma, and radiation. 2,8,9 These all increase inflammation and immune system activation, leading to increased scar formation. 5,6 The biofilm theory is supported by both laboratory and clinical evidence and is the most widely accepted in the surgical literature.…”

“…7 Once the biofilm is formed, an ongoing activation of host defenses and chronic inflammation occurs and leads to deposition of collagen and fibrosis and eventually capsular contracture. 2…”

“…1 However, studies continue to show a high percentage of reoperation following primary breast augmentation, with rates as high as 36% in some publications. 2 Therefore, plastic surgeons performing aesthetic or reconstructive breast procedures must maintain a working knowledge on the causes of revision implant surgery and their appropriate analysis and treatment options. Some causes of reoperation are unavoidable, such as longitudinal patient factors, which include pregnancy, weight changes, and hormonal changes of the breast.…”

“…However, many causes are avoidable, such as selection of oversized implants, failure to optimize soft-tissue coverage over the implant, traumatic nonhemostatic pocket dissection, improper handling of the implant, and failure to maintain a sterile surgical field. 2 This article will explore the most common reasons for breast augmentation revision, their causes, and proper patient analysis and treatment. There are enough causes of secondary breast augmentation to supply the contents for a book unto itself.…”

“…[2][3][4][5] Surgical techniques to prevent capsular contracture are important as recurrence rates are high. 2,6 Extensive research shows patient, surgeon, and implant factors contribute to the development of capsular contracture. 3 Nonetheless, despite increasing scientific and clinical knowledge, capsular contracture remains a challenge for surgical management.…”