Breast Reconstruction Procedures

Many women who have implant-based breast reconstruction procedures experience one or more types of postoperative problems. These problems occur frequently after traditional two-stage expander surgery when the submuscular pocket is either stretched too little or too much.  Surgery that utilizes acellular dermis can repair these problems and help to prevent them from recurring.

Capsular Contracture

Once an implant is in place, the body surrounds it with a capsule of  fibrous tissue; this is the body’s natural response to a foreign object, and every woman who has implants has a capsule formation. Some women develop a contracture or squeezing to some degree that may develop within a week following the surgery or years later. For most women, this isn’t problematic and their breasts remain soft and look natural. If the contracture squeezes the implant and affects the pocket shape, however, the breast may become distorted, hard and painful.

Massage or medication cannot reverse or eliminate capsular contracture. When it causes pain or distorts the breast shape or size, Dr. Salzberg can perform a capsulectomy to remove the hard capsule of tissue and replace the implants. The placement of acellular dermis or AlloDerm seems to be an answer to this puzzle. Although Dr. Salzberg has recreated more than 700 breasts with his One-Stage with AlloDerm procedure, very few of his patients have required repair for capsular contracture. Dr. Salzberg uses a similar procedure for breast augmentation patients who have capsular contracture.

Rippling and wrinkles

Rippling or wrinkles occur more often with saline implants, but may also occur when silicone implants are used. Women with very thin skin may have more visible rippling or wrinkling, because their skin doesn’t adequately cover the implants.

Dr. Salzberg can correct rippling and wrinkling by adding AlloDerm to further support the implant or to provide an additional layer between the implant and the breast skin.  In cases of excessive rippling or wrinkling the implants may be replaced. Dr. Salzberg has pioneered new techniques for each of these problems.

Poorly-positioned implants (Malposition)

Sometimes the body heals in an unexpected way and implants end up being a bit too high, too low or uncentered. Even implants that have been well-placed sometimes shift over time. If implants are too low (“bottoming out”), too high or are positioned too closely together (symmastia), Dr. Salzberg can revise the pocket or replace the implants to greatly improve positioning and symmetry.

Revision surgery and recovery

Revision surgeries are performed with twilight or general anesthesia and are usually completed in about one or two hours in the hospital or as an outpatient procedure, depending on the length and complexity of the procedure.

Making revisions requires a high degree of experience and skill, because it involves modifications to a patient’s internal anatomy. As the pioneer of the One-Stage procedure, Dr. Salzberg has performed more of these procedures than any other physician and is most qualified to rectify cosmetic problems to his patients’ satisfaction.

During a pre-operative consultation appointment before your revision surgery, Dr. Salzberg will explain how he can correct your problem and what you can expect.

Recovery from a revision procedure is usually quicker than the initial surgery. Patients may initially have some swelling, bruising and soreness for two to three days. Most women can return to work in two to five days and resume more strenuous activity in about two weeks.