Breast enlargement, including breast augmentation revision, is the most frequently requested procedure in my practice. Now in practice in Plano for 18 years, I am on track to perform about 150 breast augmentations this year. In large studies, approximately 95% are happy with their choice to undergo surgery, which makes breast augmentation one of the more successful cosmetic procedures. However, as with any other surgery, there are certainly risks, such as infection, bleeding, implant deflation, and capsular contracture.
Although most women are afraid of going “too big,” many become accustomed to their new, fuller breasts and wish they had gone even larger. The downside is that this requires another surgery. The upside: assuming that a. the only purpose of surgery is to go larger (i.e. you are otherwise happy with your results), b. you are not choosing an “out-of-control” size, and c. you have smooth-surfaced implants:
1. The procedure is generally straightforward. I remove your existing implants (usually through your existing scars) and place new, larger implants.
2. The results are predictably good. The existing capsules of scar tissue that surround your implant will limit further descent of the implants. What does this mean for you? More cleavage and more fullness of the upper breasts.
3. The recovery is easy. We are simply doing a “software exchange,” so the pain is limited to the site of the incision.
4.You do not have to worry about the implants starting “too high.” To a large degree, what you see is what you get. Why? The tissues overlying the implants were already stretched by the previous surgery, so no further stretching is necessary.
Now let me emphasize, once again, that the upsides listed above only pertain if we make three assumptions:
a. You are otherwise happy with your results. If you are dissatisfied with your implant position, breast shape, or something else about your breasts–besides the size, the surgery may be more complicated.
b. You are not choosing an “out-of-control” size. Remember that your body has formed capsules of scar tissue that surround and support your implants. If you choose a size that is larger than your existing scar capsules can contain, you will require a capsulotomy (surgical cut in the capsule) to make more room. While this is certainly feasible, it increases the complexity of the surgery and reduces the predictability of the results.
c. Your existing breast implants have a smooth surface. Smooth surface implants will not “stick” to the surrounding capsule, so there is generally room for further enlargement. Textured implants (the surface is textured like wallpaper) do stick to the surrounding capsule, so further enlargement will require a capsulotomy (see b. above).
The bottom line: assuming that a capsulotomy is not required, further enlargement of the breasts is generally a straightforward procedure with predictably good results and a smooth recovery.
Breast Augmentation Revision going to larger Saline Implants
**Initial breast implants placed by another surgeon
Breast Augmentation Revision going to larger Silicone Gel Implants
**Initial Implants placed by another surgeon.
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas