Although the conservative approach of surgical training encourages continuity of care with the original surgeon who performed the primary surgery, for a myriad of reasons this may not always be possible or desirable.
Revision breast surgery may include the following:
- breast re-lift,
- an increase or decrease in implant size,
- an exchange of implants, or
- a repeat breast reduction.
THE PROCESS OF PLANNING YOUR SURGERY
For your consultation, it is always helpful to have documentation on the nature of your previous surgery with you (e.g. operation notes or record, or hospital discharge summary), although we can often retrieve these from colleagues where necessary. After a discussion about the nature of your concerns, Dr Farhadieh will discuss all the options available and how they could be tailored to your needs and wants. The risks of the operation will be explained to you. Asymmetry, infection, bleeding, scarring, postoperative bleeding, leg blood clots are amongst these complications.
On the day of surgery, your breasts are marked with a surgical marker while you are awake, and any final questions are addressed. Surgery will be performed under general anaesthetic. You may be discharged on the day of surgery or may stay overnight depending on the extent of surgery and, where appropriate, personal preference.
WHAT TO EXPECT AFTER YOUR SURGERY
Long-lasting local anaesthetic infiltrated into the surgical sites at the time of surgery will help to alleviate immediate postoperative pain. Paracetamol is usually recommended for any discomfort during the early postoperative period. The incisions are closed with absorbable sutures and covered with tape. Any discolouration or swelling will disappear quickly and any residual swelling will normally resolve by 6 weeks. Straining, bending and lifting must be avoided during this time, and a supporting bra should also be worn.
You can usually go back to work within 7–10 days, but are advised to avoid strenuous physical exertion, particularly with respect to the upper body. Gentle lower body exercise can be resumed 1 week postoperatively. The breast will find its final shape within 6 months of surgery.
There is risk associated with all surgery as discussed above. Because of the previous surgery, revision surgery is often associated with added risks. Dr Farhadieh will discuss these in more detail with you fully during your consultation.
Frequently Asked Questions
There is some discomfort associated with surgery. Most patients report a ‘tightness’, rather than pain, due to the excellent modern anaesthetic pain control regimes, which includes local anaesthetic for the immediate postoperative period as well as powerful analgesics. However, its vital that you note that pain perception and recovery may be different with each individual.
In revisional surgery the rule of thumb is to replace the breast implant devices where an implant is necessary. Often this means creating new pockets not only to reshape the breast but also to reduce the capsular contracture rates.
This depends on the nature of breast surgery being considered. In some situations this helps to achieve an optimized final aesthetic outcome.
Within 2 weeks you will be back at work and able to resume most normal activities. During the subsequent weeks you will be able to return to your pre-surgery levels of activity.
As part of the preoperative assessment Dr Farhadieh will discuss and tailor the incision sites, often through previous surgery. The scars are not only camouflaged, but fade considerably within the first 12 months from surgery. Vertical pattern, short scar or classic Inverted T or Wise incisions may be used or previous inframammary incisions may be appropriate.
Dr Farhadieh believes that the relationship between doctor and patient is sacred and privileged. Our practice is based on compassion, honesty, transparency and, above all, patient welfare. We pride ourselves on making sure that you feel supported at all times. We will be available during all stages of your journey and will schedule short-, medium- and long-term follow-up appointments as part of our overall practice.
1. There are some general risks associated with ANY operation, which include:
a) Infection in surgical wound(s) with resultant redness, pain and possible discharge. In severe cases, wound(s) could break open and need to be re-sutured. Often small areas of breakdown are treated conservatively with dressings and they heal without any significant sequelae.
b) Possible bleeding in surgical wound(s) with swelling or bruising.
c) Secretions may accumulate in the lungs and cause a chest infection.
d) Deep vein thrombosis.
e) Death is possible during or after an operation following severe complications.
f) Smoking significantly increases the risk of complications. Therefore, you should completely stop smoking at least 4 weeks prior to surgery, and refrain from smoking for at least 4 weeks.
2. The following facts, risks and complications apply specifically to breast reduction/lift and augmentation operations:
a) Antibiotics are given during and after the operation, to minimise the risk of infection. The rate of infection following breast augmentation or reduction surgery is low (approx. <1%). If infection was to occur, it would be treated with the usual techniques. In severe cases, treatment may involve being admitted to hospital for intravenous antibiotics; and further surgery may be required, including the temporary removal of an infected implant.
b) Bruising and swelling is normal, but the severity can vary with each patient. If bleeding occurs after surgery, a clot (haematoma) can occur. If this occurs, it often requires surgical evacuation. The risk of this occurring within the first few days after surgery is about 0.5-1%. The risk of increased bruising or bleeding can be reduced by abstaining from medications such as aspirin, anti-inflammatory drugs, or other blood thinning agents, for at least 2 weeks prior to surgery. See Pre Op Medication Information sheet for more details.
c) The incisions will result in scar formation. Dr Farhadieh will endeavour to keep the incisions as minimal as possible, and these scars will soften and fade with time. You will be instructed as to how best care for scars to optimise results.
d) Postoperative pain experienced varies from very mild to significant discomfort. You will be given plenty of pain relieving medication following your surgery and this should keep you comfortable, no matter what your level of discomfort.
e) It is common to have intermittent mild discomfort, or sometimes, intermittent sharp pains in the first few weeks after surgery, as the swelling resolves and the nerves recover.
f) Numbness of parts of the breasts and nipples is common following surgery and is generally temporary. You may experience a change in the sensitivity of the nipples and the skin of the breast. Permanent loss of nipple sensation may occur after a reduction in one or both nipples.
g) Delayed healing can sometimes occur along the margins of the incisions; and occasionally there is some loss of the skin edges or of the nipple itself (less than 1%), requiring prolonged dressings or additional surgery for correction.
h) In all breast reduction surgery, there is the possibility of issues with the nipple areolar area healing properly. This is because the nipple areolar area will be moved to a new location during your operation and whenever anatomical regions are moved from one place to another, healing may be delayed or non-existent. At worst, the nipple/areolar may not heal at all and require complete surgical reconstruction. This risk is most apparent in smokers, which is why Dr Farhadieh does not perform this operation in active smokers and needs you off any nicotine-containing product for at least 4 weeks prior to surgery. In a non-smoking patient the chance of these issues occurring is very low.
i) The sutures used to close the incisions on your breasts are completely dissolvable, but they may be felt through the skin for up to 6-9 months after surgery.
j) Breasts may feel irregular (lumpy), firm, and uncomfortable following breast reduction surgery; however, this will in most cases subside with time.
k) Breast tissue and/or skin will be removed during breast reduction surgery. Any tissue removed during surgery will be sent to pathology for examination.
l) Most patients will need to take about a week off work. Vigorous upper body exercise or any activity that involves ‘bouncing’ of the breasts should be avoided for 4-6 weeks.
m) Your ability to breastfeed may be affected following surgery. If you intend to breastfeed after this procedure, it is important that you discuss this with Dr Farhadieh prior to your procedure.
n) It is almost impossible to get the breasts looking identical. Dr Farhadieh will make them as symmetrical as possible. Over time, some women may experience one breast growing quicker than the other or subtle changes in the nipple areolar shape or position as the body adapts to the new breasts. Asymmetry will always be more marked with any weight fluctuations you may experience over the years after surgery, or with minimal supportive bra wear.
o) The body continues to change over time. To preserve your results, it is of utmost importance to wear good supportive bras when exercising and maintain a stable weight.
p) The aim of breast reduction surgery is improvement rather than perfection. Further operations may occasionally be required to improve the results.
q) It may be that you are not with the final aesthetic outcome
r) Scar hypertrophy and keloid may form and may be permanent.
