Definition & Overview

Some breast cancer patients opt to undergo mastectomy and subsequently, breast reconstruction to regain the form of their breasts using natural or synthetic implants. These patients are the candidates for breast reconstruction revision.

After a skin-sparing mastectomy, the surgeon typically leaves a tissue expander in the gap left by the removed tissue. This expander is later removed and replaced with permanent implants. Synthetic implants can contain silicone gel or are filled with saline solution. In some cases, the graft for breast reconstruction is harvested from another part of the patient’s body, like the stomach, back, thigh, or buttocks. These are called autologous microvascular free flaps.

A good number of mastectomy and breast reconstruction patients undergo revision surgery to correct or enhance the results of the previous reconstruction process. The revision could be done for cosmetic purposes or for the simple reason of improving the look and feel of the affected breast. If only one breast underwent reconstruction, the aim of the revision process is to make both breasts as similar as possible. Breast reconstruction revision is also done to correct any adverse side effects being experienced by the patient, such as the formation of scar tissue.

Who Should Undergo and Expected Results

Women who underwent mastectomy and breast reconstruction can take advantage of the revision surgery if they wish to improve the overall appearance and feel of their reconstructed breasts. It is also done as a necessary step in removing the temporary tissue expander placed during mastectomy and replacing it with permanent silicone or saline implants.

The procedure can also be performed for breast reconstruction patients who are experiencing adverse side effects like necrosis or death of the graft tissue.

Patients with breast implants can also undergo revision surgery if scar tissues develop around the implant. For some patients, this may not cause any symptoms but in some cases, it can lead to discomfort since the tissue shrinks. Scarring can also be visible on the surface of the skin.

Breast reconstruction revision helps correct any defects observed after the initial reconstruction surgery. It has high success rate and helps patients cope with the mental distress of losing a vital part of their physical anatomy. In most cases, revision surgery is done in an outpatient setting. Patients can go home after the procedure and are advised to rest for just a day or two.

How is the Procedure Performed?

Revision surgery can be performed three months after the initial breast reconstruction procedure.

Depending on the need, the patient could be placed under local or general anaesthesia. The surgical area is then cleaned and sterilised, with the surgical area clearly marked. The surgeon then makes an incision, preferably on the site where the initial incision was made during breast reconstruction. If the patient only had one breast removed and reconstructed, the goal of the surgery is to improve the symmetry of both breasts. The surgeon can opt to harvest fat tissue from the healthy breast to reduce its size and make it more similar to the affected breast. The nipple and areola complex are left intact and untouched. This procedure is called breast reduction. If there is a need, the fat harvested from the healthy breast is refined and transferred into the affected breast through injections. This will help achieve symmetry and improve the contour of the affected breast. The patient may be asked to sit up so the surgeon can evaluate the improvement being done.

If the healthy breast does not need reduction, the surgeon can perform liposuction to harvest healthy fat tissue from other parts of the patient’s body. The harvested fat is refined, placed in several syringes, and injected into the affected breast until the desired contour, shape, and fullness is achieved.

If there is a need, the surgeon can also reposition the nipple. This can be done by making an incision over the original incision and adjusting the skin flap until the desired location for the nipple is achieved. When satisfied, the incision is closed with sutures.

For patients who had tissue expander implanted in their breast, the surgeon will also make an incision over the original incision to take out the tissue expander. The surgeon will then proceed to insert the permanent breast implant and place it in the gap where the tissue expander used to be. The incision is then closed with sutures.

In cases where a capsule of scar tissue has formed around the breast implant, the surgeon would need to perform another surgical procedure to remove the scar tissue and possibly the implant. Several small incisions are made on the skin, and the scar tissue is separated from the rest of the surrounding tissue. This will release the other tissue from the tension caused by the tightening of scar tissue. The tissue is then removed, along with the implant. A new implant is then positioned and the incisions are closed using sutures.

Recent advancements in the field of breast reconstruction and revision surgery involve the use of acellular dermal matrix. This is a type of soft tissue substitute derived from human skin. The dermal matrix is stripped of the epidermis and any other cells that might cause an inflammatory or antigenic reaction. The acellular dermal matrix is placed below the breast implant to provide additional support. This tissue substitute also helps prevent skin rippling on the surface of the breast.

Possible Risks and Complications

There is a risk of excessive bleeding and infection in the surgical site. Also, unsightly scars can still occur even after breast revision surgery, which might add to the mental distress and anxiety of the patient. Patients can potentially lose sensation in one or both breasts, depending on the extent of the revision surgery. Desensitisation can also occur in the nipples. The fat or skin grafted into the surgical site could be rejected and would need to be removed.

Reference:

  • American Society for Plastic and Reconstructive Surgeons: “Breast Reconstruction.”
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