It is essential that breast surgery is approached in a personal way, assessing each body individually, the skin type, the proportions of the breast, its glandular density … every little nuance is important. Likewise, all surgery contemplates a series of variables; what approach we will take, the type of implant, size… there are, therefore, as many combinations and surgeries as there are patients.
But, what is secondary breast surgery?
We refer to secondary surgery as any procedure that we perform on a previously operated region; in this case it will be on a previously operated breast.
This type of surgery is a great challenge, since the tissues have already been manipulated previously and, as is logical, there is some problem that must be solved.
What nuances should we take into account?
In general, these are patients who come with a certain distrust or dissatisfaction due to a previous bad experience, with fear that it will be repeated. This experience has made them change surgeon, which means additional work for us, and we must convey the utmost confidence.
If we analyze the technique, we must take into account that the breast has already been operated, so it will have a number of “anomalies” compared to the situation before the first intervention. It is likely that we will have fewer resources and less room for movement, so alternative resources will have to be considered to protect the breast.
Returning to the patient, we must consider that they will come looking for a better result than the one they currently have. However, it is important to clarify that, in many cases, it is no longer possible to achieve the results that would potentially have been possible in the first procedure. This may be difficult to accept, but it is logical and, of course, is another factor to add to our great challenge.
In short, the 3 issues we must take into account are:
- Emotionally charged surgery
- Technical complexity
- Expectations potentially higher than real
For all these reasons, it is vital that the surgeon is able to make a good assessment, identifying the problems and offering solutions, indicating how to act and what results can be achieved. It is essential to clarify that my work and responsibility will consist of offering the maximum result, reaching a balance between reality and the patient’s expectations.
What are the causes for secondary surgery?
Mainly, 3 reasons are identified:
- Patients with breast implant complications (rupture or encapsulation).
- Patients who have suffered a deterioration of appearance due to a temporary evolution.
- Patients who have had a bad result with previous surgery.
What are the most common approach errors?
Five variables should be differentiated:
1. Approach routes.
It does not only indicate where the scar will be located; each approach will have its own characteristics, with advantages and limitations. It is relevant since it can condition, for example, the plane, which in turn can affect the result, even in the long term.
We will have to consider whether to opt for the same approach to the previous surgery, or for an alternative approach that allows us to have the maximum resources.
2. The plane of placement
The plane of placement can have a great influence on the outcome and the potential deterioration of the result. It is important for the surgeon to master all the planes in order to be able to offer the best solution in each case.
Generally speaking, the lower the implant is placed, the more capacity we have to manage its weight and its effects on the breast; the more on the surface, the more interaction of the implant with the breast tissue, but less resources to manage the weight. For this reason, each case must be evaluated individually.
3. Implant size
Inappropriate volume can cause secondary surgery. An excessive size can trigger a negative result, that does not mean that high volumes cannot be placed, but it is vital to analyze the variables and manage them with care.
4. Type of implant
Normally, it does not generate problems in the result, but rather in the discrepancy with the patient’s desire.
It is one of the most frequent problems and my specialty. These complications are usually caused by a bad reading of the breast and its circumstances.
Ultimately, when considering a pexy with prosthesis we must understand the process to protect the breast. The approach should be as follows:
- Reduce the weight that the skin must support, reducing, if necessary, the breast tissue.
- Transfer the weight to a structure that can support that weight, placing, for example, the implant completely under the pectoralis (complete retromuscular plane).
For more information about secondary breast surgery, do not hesitate to contact a specialist in Plastic Surgery.