It is known as secondary surgery, the surgical intervention that has to be carried out in a patient who has previously been operated on with a breast prosthesis. This type of surgery is always a challenge, since the breast tissues already show scars from the previous surgery, and it is even more complex when the patient has been operated on by another surgeon and it is not known for sure what type of implant and surgery was done.
Secondary surgery is always a challenge and requires a more than meticulous search and selection of the surgeon, since it is not only about correcting a problem, but on many occasions, patients are very frustrated by a bad previous surgical experience and place their hopes in this surgery. For this reason, it is very important to take time to understand the patient, as well as an exquisite planning of the new intervention and execution with skill and professionalism.
Implant replacement surgery is usually indicated in the following cases:
- When the implant presents a complication such as a break, a capsular contracture, a rotation, a sagging known as bottoming out or a loosening where one chest looks higher than another.
- When the patient feels that her implants are old and wants to change them for more modern or lighter ones.
- When, due to the passage of time, the breasts have aged and sagged, the aesthetic result deteriorates, and a new breast lift surgery is needed to reposition the breast. Usually in these cases, if several years have passed, new implants are put in.
- Changes in size: the patient wants larger implants (the most common) or smaller implants, in which case if there is excess skin, a small reduction of the breast is required to adapt to the new implant.
- If the patient has macrotextured implants and she wishes to remove it due to the minimal risk of suffering from anaplastic large cell lymphoma in the future. And also, placement of microtextured or smooth implants.
In this type of surgery, the aim is to rejuvenate the appearance of the breast, which will have aged over time, as well as to readapt the skin and gland that are usually more flaccid on the new implant. In many cases, the patient takes the opportunity to go a size larger than the previous one and rarely goes to a smaller size.
The surgery takes place under general anesthesia for safety. The most important thing for us is your safety and that is guaranteed by general anesthesia. In this, you will fall asleep at the beginning of the surgery and wake up at the end of the surgery, without remembering anything and without having felt any pain. Depending on the state of the breast at the time of surgery, the type of incision to be made will be chosen.
If the breast is not sagging, then the scar from the previous surgery will be used to perform the new surgery. On the contrary, if the breast presents some type of fall, some new scars will be necessary in order to perform the breast lift. One of the problems that this type of surgery usually presents, is that the pocket where the implant is differs from one side due to contractures or mispositioning, so it requires a degree of experience and surgical dexterity, to be able to recreate a new pockets that are symmetrical and accommodate the new implants. Generally, the patient stays in the hospital for one night, but it is also possible that she will go home the same day in the afternoon. In the case of significant capsular contractures, a complete capsulectomy must be performed, which consists of removing the entire capsule. This procedure can cause a small bleeding, which is why it may sometimes require drainage for two or three days.
On many occasions and due to the poor condition of the tissues because of poor planning in the previous surgery, the placement of fat grafts is necessary to improve the thickness and quality of the skin, as well as to improve the décolleté area.
As for recovery, it takes about three or four weeks and we could divide it into two parts. The first part, in which all stress activity or driving should be avoided. A second part in which the activity is reintroduced in a progressive and controlled way. In addition, depending on where the implant is placed, if it is below or above the pectoral muscle, some of the times and care may vary. In consultation we will provide you with all the details. Postsurgical garments should be used in the manner and time indicated to improve the results of your surgery.
The realization of this type of intervention must be performed by a plastic surgeon with experience in breast surgery. Currently, many patients come to our practice for secondary surgery, seeking to correct a bad result of a previous surgery, and this is partly thanks to the fact that Dr. Ospina is very up-to-date in new techniques such as the use of fatty tissue grafts , hybrid surgeries, the use of top-quality, cutting-edge technology implants, as well as modern materials to repair and reinforce tissues internally. On the other hand, Dr. Ospina dedicates part of his surgical activity to breast reconstruction, which gives him a great knowledge of the anatomy and shape of the breast.
This type of intervention must be performed in a hospital that meets all health requirements and has an intensive care unit. Cosmetic surgery is a very regulated surgery with fewer complications, but in case they appear, it is essential to have the support of a good hospital. Hence, low-cost surgeries try to save money on this and are performed in small clinics where these safety conditions are not covered.
Before the intervention it is important to avoid tobacco consumption four weeks before and not to consume any type of medication without consulting us. You should rest and eat well the days before so that you are the best prepared for the surgery. You should not be very tanned, as it can negatively influence the evolution of the scar.
After your surgery, we will give you all the written instructions regarding medication and care that you should have, as well as what you cannot do. The first days you may notice discomfort, tightness, and some areas with altered sensitivity, but all this will disappear as the days go by. To return to your work, it will depend a lot on the type of surgery performed and the job you have. We will discuss it in consultation, and we will indicate the periods.
“My work philosophy in breast surgery is different, it is based on ethics and honesty. I like to explain to the patient all the advantages and disadvantages of the decisions made now, give her a natural and personalized result, but above all we choose a surgery based on science and modern techniques and implants, so that the result is long-lasting over time, avoiding future complications.” Dr. J. Ospina