Scottsdale – Revision breast surgery includes some of the most challenging procedures a plastic surgeon is likely to see.  With the increase in popularity of breast implants, we have seen  an increasing number of patients who present for revision surgery at a later time. Revision surgery is most often performed for late complications associated with breast augmentation, including capsular contracture, rippling, deflation and many others.

A surgeon must use techniques available to manage the situation as best as possible. This is sometimes hard to do because the breast tissue may be severely stretched or weakened by extremely large implants. A article has been published demonstrating a technique for breast implant exchange that can help patients and surgeons achieve better results. The article published in Aesthetic Surgery Journal describes the 4-year experience using the “neopectoral pocket” and the results are impressive.

The “neopectoral pocket” technique is well described in the article. All the patients had their implants exchanged to mostly textured silicone into the new subpectoral pocket.  A large number of patients, 56 in all, required the addition of acellular dermal matrix to improve the shape of the breasts.

What impresses me the most is the ability of this technique to significantly improve or eliminate capsular contracture. Contracture of the capsule is the most common long-term complication of breast implant related surgery. Historically, once a contracture sets in, it is very difficult to eliminate or improve with current techniques. What is impressive about the “neopectoral pocket” techniques is that it is a relatively simple addition to what most plastic surgeons already perform. The investigators began with 198 patients and with 138 of these presenting with capsular contracture. After 26 months of average follow up, 97.5% of the original 198 patients had a soft, normal breast pocket capsule. Only 3 patients developed contracture and of these only the mild grade II capsules were seen. Importantly, no grade III or IV capsules were seen in this study.

The techinque is also useful in improving the aesthetics of the breast. Patients with bottoming out, symmastia, and implant malposition were improved using this operation. A large proportion of the patients had a breast lift (94) at the same time of the revision. This is important as it shows that simultaneous procedures can be performed in the breast revision population safely and maintain a low complication rate. The complications seen in the study included bleeding and implant malposition.  Patients should know that these types of complications generally mean a return to the operating suite with its associated increased costs. However, the very low number of complications and revision procedures is impressive. This article is an excellent on breast implant exchange and an excellent contribution to the plastic surgery literature.

I have been using this technique since the authors published their original article in early 2008. I have been impressed with the results and find that it helps to make revision breast surgery more predictable. I am happy to see this study published as it supports the observations I have made in my clinical practice. The large number of cases and the long-term follow up presented in the article demonstrate the efficacy and safety of the technique nicely. I recommend this procedure for patients contemplating breast implant exchange in the future.