Every woman who has had breast reconstruction following mastectomy surgery should love her results and feel comfortable in her body. Unfortunately, for most patients this is not the case. According to The American Society of Plastic Surgeons, breast implants are used in roughly 80% of traditional mastectomy breast reconstruction surgeries, however implants in the reconstructed breasts are often visible, feel unnatural and/or cold, uncomfortable, and asymmetric. 1
When it comes to unilateral breast reconstruction, differences between the reconstructed breast and the natural breast are obvious immediately, and only increase with time. Patients who have undergone previous breast reconstruction surgery can improve their initial results and their quality of life with breast reconstruction revision at Cassileth Plastic Surgery in Beverly Hills.
Dr. Lisa Cassileth, Dr. Elise Min, and Dr. Kelly Killeen employ state-of-the-art surgical techniques to make dramatic improvements to your mastectomy result. Breast reconstruction revision can help breast cancer patients feel confident and whole again—even for those who have been told they are out of options.2 We address everything from deep problems, such as the pain, muscle imbalance, and shoulder and back problems that come from cut pectoralis and serratus muscles, to more superficial problems such a symmetric and soft appearance. We also address health problems and deformity that may stem from reconstruction with prior infections, skin healing problems, and BII.
Browse our plastic surgery before and after photos to see real-life results on breast reconstruction revision patients just like you. Every breast augmentation surgery, including all breast reconstruction procedures such as implant reconstruction, diep flap reconstruction and autologous reconstruction yields a unique result, but viewing our before-and-after photo gallery is an ideal way to see the exceptional outcomes our highly experienced plastic surgeons can achieve.
*Individual results may vary
Every surgery will yield unique results, but before-and-after images are an excellent way to see the quality of natural-looking outcomes our experienced plastic surgeons are capable of providing.
Dr. Cassileth is an amazing surgeon. She is incredibly talented and a lovely human being. She really cares for her patients and it shows. Did I say she is also very, very talented? I came to her for a revision of breast reconstruction after having had a not-so-good job with my breast reconstruction surgery following a double mastectomy. She did magic. My results now look outstanding! I look incredibly natural! Going through a mastectomy-breast reconstruction is an incredibly hard experience as it is, and I believe we women deserve a plastic surgeon who can understand us and make us feel beautiful. Dr. Cassileth did just that! Also, her office is beautiful and all the staff was pleasant, professional and caring. All and all, 5 stars! I would give it 6 stars if I could.
Patients with unilateral mastectomy may find that the newly constructed breast sits higher on the chest wall and looks less natural than the natural breast. We can make the reconstructed breast look more natural, while making the natural breast look more symmetric by creating lift and upper fullness. We do this using a combination of liposuction and fat transfer to add volume to the reconstructed breast, creating a natural layer of fatty tissue. This not only hides the edges of the implant, but makes the entire reconstruction look more natural. When it comes to the remaining natural breast, we often enhance symmetry with a breast lift and augmentation with an implant to achieve two breasts that have a similar youthful appearance.
This breast reconstruction revision strategy achieves beautiful results that are also longer lasting, because they both contain fat and implants so they will age at a similar pace. Some patients prefer to avoid implants on the “real” side, and for those patients Dr. Cassileth recommends a pocket lift, in which breast tissue is supported by an internal pocket next to the pectoralis fascia, which does a better job holding up a lifted breast long term
Capsular contracture occurs when a hard capsule of scar tissue forms around a breast implant and constricts the implant to the extent that it causes the breast to feel like it’s encased in a hard shell. Severe cases of capsular contracture can cause the breast to look misshapen and be painful.
Using a breast reconstruction revision procedure called a capsulectomy can correct capsular contracture. This surgery requires removing the breast implant from the breast pocket and then removing the capsule of scar tissue entirely. Once the capsule has been removed, we place an acellular dermal matrix in the excised breast pocket to create a structure that is more natural-looking—and functions much like an internal bra. This additional support allows the breast implant to sit in the correct position and minimizes the chances of forming new scar tissue following breast reconstruction revision surgery.
This is a highly successful surgery which is typically combined with low volume fat grafting for best results. This can be performed on radiated breasts. Capsular contracture patients must also be tested for biofilms, which are low grade bacterial contaminations of the implants that must be eradicated for cure. 3
A common mastectomy outcome following unilateral breast reconstruction is a breast with a visible and unsupported implant, which can move out of position and feel heavy. Patients with bilateral implants may find that low or unsupported implants have a noticeably wide distance between them, creating an upper chest that is hollow-looking with visible rippling of the implants.
This is primarily an implant support problem. Most of these patients need a strong internal bra-like support structure to the capsule to keep the implant in position. For most patients, we use absorbable mesh to build this internal support, which does not stretch over time as much as acellular dermal matrix. We’ll also typically use cohesive gel implants as their composition minimizes visible rippling. The final step of this type of breast reconstruction revision is to add fat harvested from a donor site above and between the breasts. This provides a full and natural appearance while avoiding a visible implant step-off and cleavage gap issues.
Many mastectomy patients are sick of their implants, which may be painful, feel foreign, need to be replaced over time, or are concerned for health issues. Implants can be replaced by fat over time using serial fat grafting, and reducing the size of the implant and ultimately removing any silicone device. The surgery can take place in different ways, and it depends on the patient. For patients with very large implants, the implant is swapped for a tissue expander, and fat graft is added to the mastectomy flap. Fat is then added to the mastectomy flap, and the tissue expander is deflated with each additional mini-surgery, until the expander is flat and can be removed.
For patients with smaller implants, the total volume is lower, which makes the replacement with fat easier. In this case, the implant size is usually diminished once with a fat grafting surgery, and then the implant is removed in the subsequent surgery.
For all patients hoping to remove their implant and replace them with fat, there does need to be adequate fat on the body to harvest and place in the mastectomy flap. A good rule of thumb is that the fat in the breast area can be doubled with each surgery. Therefore, the first fat graft is the smallest amount that is placed, followed by larger and more significant amounts with each surgery and more impressive results. The surgeries are usually done 6 months apart, which allows adequate time for the fat to permanently live in the new location. Most patients require between two and four surgeries. Patients with submuscular implants will also require repair of their pectoral muscles for complete reconstruction, which is typically done on implant removal. Patients with a history of radiation are excellent candidates for replacement, as the fat graft has not been radiated and will typically restore a more normal appearance and feeling to the radiated breast.
If you would like to learn about your breast reconstruction revision options, please contact us today. We’d be happy to assist you by answering any questions you may have and schedule your personal consultation.
1American Society of Plastic Surgeons. 2019 Plastic Surgery Statistics. Available: https://www.plasticsurgery.org/documents/News/Statistics/2019/plastic-surgery-statistics-full-report-2019.pdf. Accessed September 17, 2021.
2 American Society of Plastic Surgeons. Immediate Breast Reconstruction Reduces Psychological Impact of Mastectomy. Available: https://www.plasticsurgery.org/news/press-releases/immediate-breast-reconstruction-reduces-psychological-impact-of-mastectomy. Accessed September 17, 2021.
3 Breast Cancer. Reducing infection risk in implant-based breast-reconstruction surgery: challenges and solutions. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5012596/. Accessed September 17, 2021.
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