This category is primarily for women following breast implants. As a specialist in breast surgery and breast augmentation, Dr. Greenberg is referred many difficult issues with breasts. Dr. Greenberg did a breast fellowship after her plastic surgical training. She has published on breast surgery. This is a particular focus of her practice. Why do a revision? The reasons vary:
She uses Vectra 3D imaging and in office deflation to help patients with decision making. The consultation is very informative, and she will be help advise on the best option.
“I had 40 year old breast implants that were ruptured and Dr. Greenberg removed them and gave me a lift too. My breasts have never looked so wonderful and I know that if others were to see my before and after pictures her already busy office would be over flowing.” – S.R., Mill ValleyView More Testimonials*Individual results may vary
Breast implants are fallible objects. They don’t last forever. When implants leak it doesn’t tend to be a fireworks and excitement kind of thing. It can be a rapid change or a slow one, where you wonder, “Does it look different?” Sometimes a leak is something seen on mammogram or MRI. and you didn’t notice a thing.
So what do you need to do?
FIRST: Breathe.
An implant leaking is not a 911 emergency. It is something you want to fix soon, so you don’t go around lopsided, but you will be fine. Call your plastic surgeon and make an appointment. This is something you want to fix in the order of weeks if possible, but it doesn’t usually mandate you go into surgery tomorrow.
SECOND: Get a copy of your operation report or have your implant card.
If you have the information on hand, awesome. If you don’t, you want to get the information because it will help your operating doctor know exactly what you have: brand, size, width, projection. If it is within 10 years, you may still be under warranty, which could defray the costs of surgery and a new implant.
THIRD: What to do if you don’t have the operation report or implant card.
FOURTH: Timing of the next surgery
Again, it tends not to be a 911 emergency, but you want to fix it sooner instead of later. This surgery tends to be a lot easier and less painful than the first surgery, so the recovery tends to be faster. Some of my patients just take Tylenol after this surgery. My issue with these patients tends to be keeping people from being too active. (ahem. ahem my Bay Area over achieving super athletic women who can’t sit still.)
And remember to go back to step ONE.
One of the biggest reasons women need to replace silicone gel implants is capsular contracture. Capsular contracture manifests by having a hard, elevated, breast. This can cause distortion of the tissue and asymmetry with your other side. When an implant turns “hard,” it is not the implant. Your body responds to any foreign object by forming a thin layer of scar around the implant. Everyone with an implant has a capsule. If it is thin and larger than your implant, you will not feel it. If the capsule thickens, calcifies, or gets tight around the implant, then you will see the issues. How do you know if you have a capsular contracture?
Do not live with capsular contracture. Use this as a time to figure out if there is anything you want to change. Did you like your size? Were you even? Did you like the width? Are you droopy? Use this as an opportunity to tweak things.
The fix for it is to remove the capsule, what is called a capsulectomy. I try to to do a total capsulectomy en bloc, to remove the entire capsule. A new implant is then placed. If you desire, you can remove the implant with no new placement, or do a lift if needed.
Why does the capsule contract? There are many potential reasons for capsular contracture. The studies indicate the likely culprit is biofilm or issues with capsule formation because of inflammation. Some think it is due to silicone gel bleed. It may herald a leak of your implant. Dr. Greenberg will review all the risk factors and what can be done to prevent it in the future. See her breast augmentation page for further information. Skin preps, antibiotics, Keller funnel, incision site, placement behind the muscle-there are many things which can be done to optimize your results and prevent a recurrence.
It is no fun to have to do another surgery, but look at this as an opportunity. Were you happy with everything? Think about this checklist:
This has become a large part of my practice. A common story: in your 20s/30s/40s you had breast augmentation. You were happy. As you have aged, you find one of a couple things. 1. You are bigger than you want to be. Over the years, after a few kids or menopause, your breasts went from a C cup to a DD. You want smaller. 2. You had implants placed, but you are in a different place now, and you are over it. You want to go back to natural.
What to do?
First we need to remove the implant and the capsule around it. A total capsulectomy is done to remove the capsule. The implant is also removed. This can be done through your old scar if it is not in the armpit. Why do we remove the capsule? The capsule is a scar like substance- it is not “sticky.” When we remove your implant we want the tissue to heal back together.
Do you need a lift? or can you just take out the implant? What will it look like?
Ah. The million dollar question. As you remove volume from your breast, the breast tends to droop. This is something I cannot advise on until I see you. How droopy are you? How thick is your natural tissue? What scarring are you okay with? For breast lifting please see my page on mastopexy. I use the short scar vertical lift.
See my page on implant removal HERE.
These surgeries can be difficult, though many are simple. Every patient is different.
This is only an option for those with saline implants, Dr. Greenberg can deflate your implant before surgery to help you decide on sizing.
This is a simple procedure done in the office. No big anesthetic. The results are incredibly helpful to assist you in figuring out what you want. When doing a breast revision, Dr. Greenberg’s goal is for you to get what you want. Sometimes you just need to see it. Try a shirt on with it. In office deflation has proven to be a great help for her patients in their decision making.
What is ADM or Mesh?
ADM = “Acellular dermal matrix.” Think of it as an extra layer of tissue, made from dermis. Think Strattice, Alloderm,
Mesh = a man made mesh, usually a material that is replaced or incorporated by your body tissue. Galaflex is the newest on the market.
Why would you use either of these? These are used to reinforce your natural tissue, particularly when your tissue is too thin, has stretched, your implant has migrated so it is in a bad position, your skin is droopy, or you have a capsular contracture.
How do you pick one over the other? ADM was the workhorse of many of our breast revision and breast reconstructions for years. The issue with ADM is that it truly gets incorporated over time, so its strength can wane with time. It is also expensive, which when you are doing elective cosmetic surgery, can add a lost of cost to the procedure. Mesh is relatively newer. It is cheaper, does not require drains, and seems to be stronger. We do not have the same years of experience with it as we do with ADMs, but currently many plastic surgeons are favoring mesh.
The negatives? Anytime you are adding something else, there is always the risk of a new and exciting issue. Things can encapsulate, get infected, wrinkle, have palpable edges, and they add more cost. So the real question is – do you need it? You need to weigh the risks vs. benefits.
My thoughts? It depends on your tissue, your budget, your risk tolerance. I tend to use things only when I really need to. If you have had implants and had an issue, you may need some extra help. There are some patients who are high risk for an issue- think: Major weight loss patient, droopy breast skin, and wants a moderate to large implant. That patient is at huge risk for the implant to stretch the skin over time, which will cause droop and loss of the cleavage fullness. Mesh may help prevent that.
This intrigued me, as breast revision surgery is all over the map in terms of what is needed. Real self had an estimate of cost, which ranged from $2,900 to $12,725 for the cost. Big range! Why is it so wide?
Breast revision surgery varies widely in terms of cost because there is a big range in terms of what is needed. Did you have a simple saline implant deflate, and all that is needed is a simple implant exchange? Do you have 30 year old silicone ruptured implants which require an en bloc capsulectomy and breast lift?
What affects the cost of a breast revision?
Breast revision is a surgery where I recommend getting a few opinions, and see surgeons who are board certified and specialize in breast revision surgery. Get a copy of your prior operation report. Get a copy of your implant statistics (type, manufacturer, size). Think about the questions I pose above– what do you like? dislike? There is a law of diminishing return with more surgeries. You want to try to fix it right in one surgery.