Revision Breast Surgery Gallery

Before and after bilateral breast augmentation revision in a 30-year-old woman. Her previously placed under-the-muscle silicone implants had developed Grade IV capsular contracture: painful, constricting and deforming scar tissue around them. She had ultrasound imaging at a freestanding clinic that suggested right breast implant rupture. She was right-hand dominant, which is important to note with submuscular implants.

In general, MRI imaging is viewed as the gold standard imaging modality to detect implant rupture, but in this case, the ultrasound turned out to be accurate. I personally have seen a higher rate of breast implant rupture in implants placed under the muscle (especially on the dominant side, as this arm and muscle is contracted more frequently) – this is one of many reasons why I prefer to place implants on top of the muscle. Chronic muscle contraction over an implant creates motion and folds in the implant, which theoretically increases the risk of a “fold flaw” in the implant shell, which can eventually cause breakdown and leakage/rupture of the implants.

Other benefits of a subglandular/subfascial implant include no “animation deformity”, no risk of a “waterfall/Snoopy deformity”, no “double bubble deformity”, very low risk of “bottoming out” and very little pain postoperatively. I only recommend to my patients what I would personally want for my own body, and this is why I chose a subglandular breast augmentation myself! If you haven’t read my blog series about my own breast augmentation experience, you can find it here.

This patient was looking for a softer, fuller, more voluptuous breast augmentation result with nicer cleavage and a more natural look overall. Her existing inframammary fold scar was used to access the submuscular implant space. The left implant was intact, but her right implant indeed had an intracapsular rupture. This means that silicone has left the implant shell but remains within the breast pocket. Silicone is not permeable in the body and cannot travel remotely, causing any problems.

The implants were removed, and a special solution was used to clean the old pocket of any old silicone material. Her pectoralis major muscles were separated from the undersurface of the breast tissue and were reconstructed back to the chest wall (the sternum and the ribs). A new pocket was created on top of the muscle, in the subglandular position. A temporary saline sizer was used intraoperatively to try out different volumes and size out her breast; a larger, higher profile implant was selected.

After surgery, she avoided activities that involved chest muscle engagement for a full month so as to not disrupt our muscle repair to the chest wall. Follow up photos are shown 6 weeks after surgery.