Breast Augmentation Revision Los Angeles and Beverly Hills, CA
Breast Augmentation Revision Los Angeles & Beverly Hills
Dr. Kenneth Hughes in Los Angeles has a great deal of experience in breast augmentation revisions, and he has authored numerous articles and chapters on these subjects (see the multitude of links below). There are a wide variety of deformities that can result from a previous surgery. Dr. Hughes can fix a wide variety of deformities. Before you give up on your breasts, come to Hughes Plastic Surgery. You will be glad that you did. Please see the breast augmentation revision and deformity correction pages to find before and after photos.
Dr. Kenneth Hughes, MD in Los Angeles has performed thousands of breast augmentations and hundreds of breast augmentation revisions. Dr. Hughes’s cosmetic fellowship in plastic surgery at Harvard Medical School’s Beth Israel Deaconess Hospital involved a great number of breast augmentation revisions referred to the Harvard Hospitals as a result of it being the preferred tertiary care center in the area.
If you have concerns about textured breast implants, Dr. Hughes has some additional information for you.
What Types of Breast Augmentation Revisions Does Dr. Hughes Perform?
Dr. Hughes fixes a wide array of issues including implant malposition due to lateralization of the implant or the high riding implant, double bubble deformity, bottoming out, symmastia, capsular contracture, implant rippling, animation deformity, and more.
What is the Cost of Breast Augmentation Revision
- $12,000 to $20,000 (determined by need for implant replacement, pocket revision, capsulectomy, and placement of a dermal matrix)
Please note that pricing for Breast Augmentation Revision may vary based on the individual needs of the patient.
Dr. Kenneth Hughes, MD Voted Best Breast Doctor in Beverly Hills and Los Angeles
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Breast Augmentation Revision
BEFORE & AFTER GALLERY
Dr. Hughes has a great deal of experience in breast augmentation revisions, and he has authored numerous articles and chapters on these subjects.
Implant Malposition and the High-Riding Implant
Breast implants can be placed and positioned in many ways. The most common malposition issues encountered by Dr. Kenneth Hughes, MD in Los Angeles, CA include lateralization of the breast implant and inadequate dissection of the inferior or inferomedial pole, leading to an implant “riding high.” The lateralized implant is easily corrected with capsulorrhaphy sutures to repair the pocket and block the implant from migrating laterally. The implant that is riding high can be corrected with additional dissection of the inferior or inferomedial portions of the muscle.
Thank you Dr. Hughes, I can’t wait until they are healed
I got breast implants 2 years ago from another surgeon and have been very unhappy with them. They were different sizes, didn’t look right on my body, and he messed up the placement of one of my nipples. I finally got them redone with Dr. Hughes. I couldn’t be happier with the results. He is focused on his work above all else, which I respect. He is also concerned for the health and safety of his patients with aftercare. Thank you Dr. Hughes, I can’t wait until they are healed. I am finally thrilled with my breasts!
Double Bubble and Bottoming Out
Double bubble and bottoming out are variants on a theme and may result from overdissection of the pocket below the inframammary fold.
Double bubble describes the condition in which the breast implant becomes visible below the natural breast fold, thus giving the appearance of two breast folds. This double bubble can be corrected by repairing the inferior aspect of the pocket with capsulorrhaphy sutures to bring the implant up to the original inframammary fold. Sometimes, an acellular dermal matrix like Alloderm or Strattice may be necessary to reinforce the repair. In cases of constricted breasts or tubular breasts or tuberous breasts, the fold must frequently be lowered to get an adequate result, and the double bubble may be an inevitable outcome or require correction by other means. Sometimes a breast lift may be appropriate to bring sagging tissue up to reduce the appearance of the second fold. Sometimes the old fold remodels without further intervention. Sometimes the old fold can be altered in other means such as fat grafting.
Bottoming out involves the implant moving below the inframammary fold over time without causing two distinct folds. Sometimes this is the result of weak patient tissues, too large an implant, or a combination of both. The repair involves suturing the pocket with capsulorrhaphy sutures and possibly adding an acellular dermal matrix for reinforcement (Alloderm, Strattice). The implant size may need to be reduced as well.
Symmastia and Its Repair
Symmastia or (uniboob) results when the implants meet in the center of the chest due to overdissection of the medial pectoral fibers. The treatment is very difficult and involves suturing the pectoral fibers back to the chest wall with or without acellular dermal matrices such as Alloderm or Strattice. The implant size will likely need to be reduced as well to eliminate pressure on the repair.
Capsular contracture occurs when the normal capsular tissue which surrounds the breast implant begins to deform the surrounding breast and can lead to pain as well. It results from an exaggerated scar response to a foreign prosthetic material. Capsular contracture occurs in 3 to 5% of primary breast augmentations.
The amount of capsular contracture can be graded according to severity.
-No palpable capsule
-The augmented breast feels as soft as a natural one.
-The breast is less soft; the implant can be palpated, but it is not visible.
-The breast is harder; the implant can be palpated easily, and distortion can be seen.
-The breast is hard, tender, painful, and cold. Distortion is often marked.
Capsular contracture remains the most common complication of breast augmentation, with rates reported between 0.5% and 30%. Despite extensive research, the cause of capsular contracture remains unknown. Two main theories address the underlying cause: subclinical infection and hypertrophic scarring. Hypertrophic scarring is thought to be secondary to a hematoma, seroma, or silicone gel bleed.
Surgical placement of the prosthesis in a retropectoral pocket has repeatedly been proved to decrease the risk of capsular contracture. This has led many surgeons to preferentially use the subpectoral plane.
Antibiotic irrigation of the implant pocket arose in response to the infectious theory of the cause of capsular contracture and the theory of biofilm as the genesis of capsular contracture.
Capsular contracture is corrected surgically by removing the capsule (anterior and posterior capsulectomy) and the implant is changed as a minimum treatment for first time capsular contracture formers. When patients form more than one capsule, acellular dermal matrices can be considered to reduce the risk of recurrent contracture in addition to capsulectomy and more form stable implants. Occasionally, the implants must be removed in severe cases or multiple recurrences that have been optimally addressed.
Dr. Hughes has performed hundreds of these difficult capsulectomy and capsular contracture revision cases, and he will give your best outcome.
Implant rippling occurs with time as the tissues are thinned by the implant in usually thinner patients.
Rippling may be observed in both saline and silicone implants. This may be more prominent in saline implants, but rippling usually occurs after a period of years after breast augmentation as the breast tissue is thinned by the implant.
Silicone is regarded to have less rippling. Implant rippling can be reduced with more form-stable implants. Gummy bear implants do not have the issues of rippling and should be considered for any patient who has rippling issues.
In some patients, a change of implants may be appropriate. However, changing the implant is frequently not enough, and the revision breast augmentation may require fat grafting (a form of natural breast enlargement that we offer) or placement of acellular dermal matrix to camouflage the implant.
This animation deformity can occur when scar tissue causes tethering of breast tissue, skin or fat to the gliding muscle plane as it moves over the implant. The treatment can involve scar release with interposition graft or matrix, change of planes for the implant, or repair of the pocket or muscle to prevent a contraction deformity.
Dermal Matrices in Breast Augmentation Revision
Complicated breast augmentations, particularly secondary, may require dermal matrix coverage. Revision augmentation that may require more soft tissue coverage from tissue thinning may be good candidates as well. Various types of dermal matrices exist that differ in intraoperative preparation, method of storage and price.
Alloderm: AlloDerm incorporates skin from a human cadaver that undergoes removal of the epidermis and other cells; this reduction in antigenicity provides for a negligible incidence of graft failure and tissue rejection. The resultant product is a biological acellular matrix that favors cell repopulation and rapid revascularization.
During the process of regeneration, Alloderm is incorporated into the pre-existing tissue in four stages: 1) Damaged tissue is targeted by circulating stem cells. 2) Once damaged tissue is located, stem cells are deposited and proceed to adhere to the matrix. 3) Differentiation into tissue-specific cell types occurs. 4) A new matrix is formed from the differentiated cells which allows for tissue regeneration.
AlloDerm has been commonly employed for wound coverage, fascial defect repair, and post-mastectomy breast reconstruction uses, but its indications are rapidly expanding into a multitude of areas in which soft tissue camouflage is required for contour defects.
Strattice: Strattice is porcine dermis denuded of cells that contributes to the propagation of an antigenic response. Strattice is a reconstructive tissue matrix that supports tissue regeneration used primarily in implant-based/tissue expander reconstruction of the breast.
DermaMatrix: DermaMatrix is human skin in which both the epidermis and dermis are removed from the subcutaneous layer of tissue in a process utilizing sodium chloride solution while preserving the original dermal collagen matrix. This reduces the incidence of rejection and inflammation. Once DermaMatrix is transferred to the patient; the collagen matrix is infiltrated by the host cells promoting neovasularization and fibroblast deposition.
Acellular cadaveric dermis has remarkably lower levels of inflammatory parameters like capsule fibrosis, vessel proliferation, granulation tissue formation, fibroblast cellularity, chronic inflammatory changes, and foreign body giant cell inflammatory reaction than native breast capsules.
This suggests that acellular cadaveric dermis exhibits certain properties that may reduce formation of a capsule and therefore provides an excellent alternative to total submuscular implant placement.
Links to Additional Beverly Hills and Los Angeles Breast Augmentation Articles at Hughes Plastic Surgery:
Article 1: The History of Breast Augmentation in the US
Article 2: The Evolution of Saline and Textured Implants
Article 3: Silicone Implants and Implant Controversies
Article 4: Evaluation of the Breast Augmentation Surgery Patient
Article 5: Determining Implant Size and Incisions in Breast Augmentation: Inframammary and Infraareolar
Article 6: Incisions and Approaches to Breast Augmentation: Transaxillary and Transumbilical
Article 7: Capsular Contracture in Breast Augmentation
Article 8: Complications of Breast Augmentation
Continue on to Dermal Matrices in Breast Augmentation Articles available:
Part I: Types of Dermal Matrices in Breast Augmentation
Part II: Dermal Matrices in Breast Augmentation
Part III: Complications of Dermal Matrices in Breast Augmentation
Part IV: Dermal Matrices in Breast Reconstruction
Part V: Dermal Matrices in Breast Augmentation Summary
View Other Scholarly Articles by Dr. Hughes Related to Breast Augmentation