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Breast Implant Revision Surgery / Corrective Breast Implants

Dr Kourosh Tavakoli Member Of Australian Society Of Plastic Surgeons, International Society of Aesthetic Plastic Surgery, Australasian Society of Aesthetic Plastic Surgery, UNSW Australia, Fellow of the Royal Australasian College of Surgeons

Dr Tavakoli’s Philosophy on Corrective Breast Surgery & The Internal Bra Technique

Poor outcome after breast surgery is devastating and can cause the patient severe psychological issues. Dr Tavakoli has a great deal of experience in correcting post breast augmentation complications.  Around 20% of Dr Tavakoli’s practice is dedicated to performing breast revision surgery on patients who have received poor outcome or have had implants for 10 years or more are and due to have them changed.

Most of these unsatisfactory outcomes occur as a result of poor patient selection and inadequate surgical skills to deal with difficult breast conditions. Other problems can occur as a result of poor healing and scarring of the patient. Please note that the fees/costs for corrective surgery are higher than primary augmentation.

Dr Tavakoli is widely renowned in Australia for his Breast Augmentation Work. Dr Tavakoli has performed by far the most number of Breast Implants in Australia. Patients travel from Interstate, New Zealand, Asia and USA to our clinic. With over 5,000 cosmetic breast procedures, you know you are dealing with an experienced Cosmetic Plastic Surgeon you can trust. Whether it is dealing with very difficult droopy or tuberous breast shapes needing complex mastopexy procedures, or simply wanting breast enlargement Dr Tavakoli aims to provide you with surgically safe and artistically natural looking breasts.

Dr Tavakoli has a large referral base of women with poor breast augmentation outcome from other centres in Australia. These terrible complications or undesired outcomes are very rare in experienced hands but no plastic surgeon in the world including Dr Tavakoli has a zero complication rate. However as Breast Augmentation is becoming more and more popular the number of inexperienced surgeons performing this procedure has increased exponentially and hence the rise in complications and poor outcomes.

Unfortunately in great majority of revisional cases patients are psychologically affected and counselling is required to help patients through the corrective surgery. Dr Tavakoli ‘s team can organise counselling for patients undergoing corrective breast surgery.

Almost half of patients seeking breast augmentation for the first time can get a good result by any surgeon here or overseas. The other half require a super specialised Plastic surgeon with a very specific knowledge of breast variations and a wide variety of technique.

Please note that “Bargain Boob jobs” are performed by junior doctors with small amount of surgical experience. Lack of experience in Breast Implant surgery almost invariably can lead to poor outcome requiring costly revisional surgery to fix. Enquire about your doctor’s level of experience before undergoing Breast Augmentation.



Woman tells of Thai surgery nightmare
Another Thai breast augmentation surgery disaster that Dr Tavakoli will now take on as a patient to salvage.


Model tells of surgery holiday nightmare
An Australian model claims her career has been ruined after a “surgery holiday” to Thailand that left her with botched breast implants. patient to salvage.


Revision Breast Augmentation & Re-do Implants Breast Procedures:

Internal Bra Technique Pioneered  by Dr Tavakoli, FRACS
The principles of corrective surgery are complex & set out below (One step operation or two step operation):

  1. Recognising the initial problem using old photos, operation reports, implants used etc.
  2. Rectifying the implant pocket or creating a new implant pocket
  3. Replacing the incorrect implant size & dimension with the correct ones
  4. Addressing the overlying breast skin with possible Breast Lift skin tightening procedure & Nipple re-positioning
  5. Using Acellular Dermal Matrix  (ADM) or second skin (made from Human cadaver) where needed to replace tissue excessively removed
  6. Extensive use of permanent Barbed sutures to re-create the implant pocket
  7. Use of Fat graft technique to camouflage& correct breast asymmetry

Please note that Revisional Surgery can take up to 4 hours & therefore the fees/costs for corrective surgery are higher than primary augmentation.


 View: Breast Implant Revision Before and After Images

  • 1. Capsulectomy or Excision of capsule for hardness

    The incidence of this condition has dropped from 35% down to 5% in most International studies. In Dr Tavakoli's series of patients this figure is around 2%. Dr Tavakoli uses a super sterile technique to insert lightly textured Mentor implants in mostly Dual Pocket. This helps reduce the incidence of capsular contracture.

    It is not fully understood the reason for this occurrence of this condition. Capsular hardening or contracture is more common in certain ethnic groups such as Asians and Africans. It can however affect any racial group. Theories range from Biofilm related to bacteria Staph Epiderdimis to serum production as a result of body's reaction to the implant covering.

    The hardening is caused by excessive scar tissue forming around the implants. It can occur as early as 6 weeks after surgery and as late as 10 years. The best way of preventing this is to massage the augmented breasts in the postoperative period so that the capsule forms softly around the implant. The breast hardening process or capsular contracture can have both cosmetic and pain implications.

    The capsulectomy operation removes the hard capsule and the new implants are inserted in a fresh pocket preferably behind the pectoralis muscle.

     

    Bilateral capsular contracture breast implant exchange and mastopexy

    Bilateral Implant Exchange for severe Capsular contracture and mastopexy (breast lift).

     

    Capsulectomy or excision of capsule for hardness

    Bilateral Implant Exchange for severe Capsular contracture and mastopexy (breast lift).

     

    Change of implant pocket

    Change of Implant Pocket.

     

  • 2. Change of Implant pocket and Breast lift (Mastopexy)
    43yo female, removal of implants, followed by bilateral breast reduction & lift using CPG Mentor 445cc-332, anatomical implants.

    Case Study 1: 43yo female, removal of implants, followed by bilateral breast reduction & lift using CPG Mentor 445cc-332, anatomical implants.

    Bilateral Re-augmentation to correct capsular contracture and change of pocket from subglandular to submuscular. Bilateral breast lift was performed to remove excess skin and reposition and resize the areola.

    Case Study 2: Bilateral Re-augmentation to correct capsular contracture and change of pocket from subglandular to submuscular. Bilateral breast lift was performed to remove excess skin and reposition and resize the areola.

  • 3. Implant Rippling correction using Fat Graft
    Fat Grafting (35mL) to cleavage to correct rippling of implants. Implants removed and replaced with Mentor CPG 332-350cc anatomical, tall height, moderate plus projection, anatomical implants placed in a dual plane pocket.

    Fat Grafting (35mL) to cleavage to correct rippling of implants. Implants removed and replaced with Mentor CPG 332-350cc anatomical, tall height, moderate plus projection, anatomical implants placed in a dual plane pocket.

  • 4. Excessive Cleavage Gap

    Excessive Cleavage Gap between breasts creating eg “Tori Spelling” & “Posh Spice” boobs. This condition usually arises from poor choice of implant and inadequate submuscular dissection.

    By further dissection and appropriate use of a broader based implant this condition can be improved. Please note that some women are prone to having this issue as a result of the poor curvature of their chest wall.

    Internal bra diagram. Technique pioneered by Dr Kourosh Tavakoli.

     

    Case Study: 25 yo old female, 350cc High profile smooth round gel implants with excessive cleavage gap, Dr Tavakoli up-sized to 485cc High Profile anatomical silicone gel implants with fat grafting to the sternum.

     

    Excessive cleavage gap correction

    Excessive Cleavage Cap.

     

    Excessive cleavage gap correction

    Excessive Cleavage Cap.

  • 5. Symmastia or Synmastia or "Mono-Breast" or "Uni-Boob" or "Kissing Implants"

    Symmastia is a  condition is described where there is no cleavage or very tight cleavage. Patients can rarely be born with this condition (congenital) or commonly acquire it after Breast Augmentation.

    Acquired Symmastia

    Grade 1 tenting: Internal Bra
    Grade 2 kissing: Internal Bra +/- ADM
    Grade 3 kissing & tenting: 2 stage reconstruction

    Risk factors:

    -Narrow chested patients & Cleavage webbing
    -Overdissection of pocket medially
    -Use of wide based implant typically
    -Usually Moderate Projecting round implant
    -Overuse of postoperative Bra

    If apparent immediately after breast augmentation it has occurred as a result of over-dissection centrally and/or use of very large based implant so that the implants are left too close in the middle. It can also develop months later but overzealous use of “push-up” bras creating thinning of tissue centrally. Eitherway the condition of Symmastia is very distressing to patients and difficult to fix.

    Surgical treatment is possible but needs complex re-adjustment of the pockets using permanent suture technique and smaller size implants with narrower base.

    In Moderate to Severe cases if the implants are submuscular the choices are either to suture down the tissues centrally with permanent sutures and dissect the pocket laterally so the implants have room to shift outwards. If the implants are subglandular the implants need to be placed in a new submuscular pocket.

    In Severe cases Dr Tavakoli prefers the 2 stage technique. The implants have to be removed for 6-12 months and replaced after pocket healing has taken place.

    Post operatively ALL patients need to wear a Special Bra for 3 months with no activity.

    Congenital Symmastia:

    This is a rare condition. Patients present with excessive breast tissue in the midline without a discernible cleavage line adhered to the bony sternum. The midline feels spongy and there is no apparent clefting. This means the congenital symmastia patients have no cleavage demarcation boundaries. This condition is very distressing to patients and most patients need psychological counselling.

    Congenital Symmastia Repair

    Congenital Symmastia Repair.

    Correction of Congenital Symmastia

    Correction of Congenital Symmastia.

    Correction of Congenital Symmastia

    Correction of Congenital Symmastia.

    Acquired Symmastia: Case Studies

    Correction of Symmastia using suture technique

    Correction of Symmastia using suture technique.

    Correction of Acquired Symmastia

    Correction of Acquired Symmastia.

    Correction of Symmastia

    Correction of Symmastia.

     

  • 6. “Double-Bubble” Deformity

    This is a condition where the implant and the native breast are in completely different anatomical levels. Routine subpectoral mammary augmentation in women with a small breast lower pole deficiency often results in poor late results with the appearance of a double-bubble deformity. The surgical correction is complex and requires the need for a series of a. excision of breast tissue, b. pocket adjustment or capsulorrhaphy and c. exchange of implants or any combination of the above.

    Correction of double bubble syndrome

    Correction of "Double-Bubble" syndrome.

    Correction of double bubble syndrome

    Correction of "Double-Bubble" syndrome.

    Thai breast augmentation double bubble correction

    Thailand Breast Augmentation creating a severe case of "Double Bubble" and now corrected by Dr Tavakoli.

    Correction of double bubble

    Correction of "Double-Bubble" syndrome by Dr Tavakoli.

    Double bubble and rippling correction by Dr Kourosh Tavakoli

    31yo female, 3 previous surgeries by another surgeon resulting in Double Bubble and rippling. Dr Tavakoli sutured down the breast pocket and complex Double Bubble repair, and removal and replacement of breast implants with Lolly-pop lift using 480cc Ultra High Profile silicone gel textured round implants placed in Dual Plane pocket, type 2. Patient photographed 4 weeks post op.

    Double bubble implant failure correction clinical diagram ADouble bubble implant failure correction clinical diagram B

    Double bubble implant failure correction clinical diagram CDouble bubble implant failure correction clinical diagram D

  • 7. Change of implant pocket

    There are many reasons why one would opt for change of implant pocket.

    • A.    Rippling and Implant Edge Visibility are hard to get rid of. One way is for the patient to put a small amount of weight and increase the padding around her breasts. Exchange of implant to smooth high filled implant &/or going behind the muscle also can be very helpful manoeuvres. Fat grafting is also emerged as a possible solution but again best that the patient puts on small amount of weight.
    • B.    Placing the implant behind the pectoralis muscle can create an issue namely “winking”. In most patients this is not a major issue but in some women with strong muscles, flexing the pecs can create a pull effect that may look undesirable. I normally recommend no surgery for this condition, but some may want to opt to have the implant placed in front of the muscle.

     

    Case Study 1: Capsular Contracture 8 years post op. Implant pocket change from Sub glandular to Sub muscular with no breast lift.

    Bilateral removal and replacement of breast implants. Pocket change from subglandular to submuscular using the internal bra technique to create lower pole fullness.

    Case Study 2: Bottoming out 4 years post op with smooth implants. Implant pocket change from Sub glandular to Sub muscular.

    Bottoming out implant pocket change - sub glandular to sub muscular

    Exchange of implants
    For size issues (usually seeking a bigger Cup size) or content (usually Saline To Gel).

    Case Study: 33yo, 2 pregnancies

    Exchange of breast implant

    Implant removed - Mentor 295cc round silicone gel in a sub glandular pocket.

    Simple exchange of breast implant

    Implant inserted - Mentor 455cc Ultra High Profile round silicone gel textured implants in a sub muscular pocket.

     

  • 8. Correction of breast implant bottoming out

    This condition is a form of Implant migration. Although can be seen with all types of augmentation it is more common with smooth implants.

    The treatment is very complicated and involves pocket repair and exchange with polyurethane coated implants.

    Breast implant bottoming out correction.

    Breast implant bottoming out.

    Breast implant bottoming out correction

    Breast implant bottoming out.

    Breast implant bottoming out correction

    Breast implant bottoming out.

  • 9. Replacement of ruptured implant

    Plastic Surgeon Dr Tavakoli’s carries out complex corrective Breast Augmentation surgery on patients Mindy B and Lauren G who had botched surgeries performed in Thailand and Malaysia respectively.

    MEDICAL TOURISM ALERT: Travelling overseas for cosmetic surgery just to save money can lead to poor outcomes, often with avoidable complications, little or no recourse to return for additional revisional treatment, and sometimes resulting in tragic consequences.

    Image of ruptured breast implant

    Ruptured Implant.

    Breast correction after implant rupture

    Breast Correction after Implant Rupture and Capsulization. Original surgery done overseas in 2006, 26 yr. old female presented to Dr Tavakoli unhappy with the shape of her breasts following a severe accident. Dr Tavakoli performed a capsulectomy/removal of ruptured gel implant on the left breast. New sub muscular pocket created, 400cc HP round mentor textured implants inserted.

     

    Before and after photos of ruptured breast implant replacement - front view

    Before and after Replacement of Ruptured Implant.

    Before and after photos of ruptured breast implant replacement - side view

    Before and after Replacement of Ruptured Implant.

  • 10. Removal of breast implants
    29yo female, bilateral removal of breast implants.

    29yo female, bilateral removal of breast implants.

     

    Case Study: Bilateral Breast Implant Explantation, Bilateral Breast Lollypop Mastopexy performed, Mentor Siltex Round HP 500cc Implants Removed.

    Case Study: Bilateral Breast Implant Explantation, Bilateral Breast Lollypop Mastopexy performed, Mentor Siltex Round HP 500cc Implants Removed.

     

  • 11. Reconstruction after Removal of Infected Implant

    Breast implant infections are extremely rare but they can unfortunately occur. Dr Tavakoli has successfully performed reconstruction following this condition in the past.

    before-breast-reconstruction-after-removal-of-infected-implant-by-Dr-Kourosh-Tavakoli-in-Double-Bay-NSW-2028after-breast-reconstruction-after-removal-of-infected-implant-by-Dr-Kourosh-Tavakoli-in-Double-Bay-NSW-2028

  • 12. Breast augmentation after breast reduction

     

    Breast augmentation and bilateral mastopexy after breast reduction

    Breast Augmentation and Bilateral Mastopexy 3 years after breast reduction.

  • 13. Scar Revision after Breast lift

    Scar revision may be needed for poor scarring such as Hypertrophic scar or Keloid. Prior to scar revision I recommend the FRAXEL laser technology to improve the quality of the scar and /or a course of intralesional steroid injections. Failing the latter then formal surgery on the scar by re-cutting and suturing will certainly improve the quality of the scar.

    Scarring around nipple-areolar area correction

    28 year old with previously poor scarring around the nipple-areolar area white stretched scar) and Symmastia has had both issues resolved after corrective surgery by Dr Tavakoli.


Dr K TAVAKOLI, FRACS Plastic Surgeon, regularly performs breast implant corrective surgery in Sydney, Australia. To book an appointment call 1300 368 107 or fill in the form on the right.