Breast Reconstruction Revision in Beverly Hills

Implants only come so large, and for some women with larger breasts even the biggest one available is smaller than the breast that was removed. If you already have the largest implant and want more volume, rounds of fat grafting can add size and help the two sides match.

A mastectomy removes the breast tissue that gave the breast its shape, so some women find their reconstructed breasts too small or too flat. A revision can exchange the implants for a slightly larger or more projecting style to restore some fullness.

When one breast is reconstructed and the other gets an implant to match, the two sides usually don't look even right away. The side that hasn't had surgery before has more settling to do, especially if its implant goes under the muscle. Things usually even out by about six months, so it is worth waiting before judging the result. More on why the two sides settle differently.

A radiated breast tends to sit higher and stay firmer than the other side. Often the better approach is to work on both sides: add support on the side that wasn't radiated, often with an absorbable scaffold (an off-label use in the breast), and soften the radiated side, so the two come together. More on a radiated side that is firmer and higher.

A radiated breast usually feels a little firmer than the other side, and that alone is expected. A breast that has become hard, or is changing shape, may have a capsular contracture, which can be treated even after radiation. The first step is working out which one you have. See capsular contracture treatment.

If your implants sit under the chest muscle, the breasts can move or distort whenever you use your arms or chest, and after a mastectomy that movement can be easy to see. If it bothers you, a revision can move the implants on top of the muscle, often with an absorbable scaffold for support (an off-label use in the breast), and Dr. Killeen repairs the muscle. Over the muscle, the upper edge of the implant can show more, which fat grafting can soften later. Some women are happy with their implants under the muscle and choose to leave them.

Every implant can ripple, and after a mastectomy the tissue over the implant is thin, so ripples and the upper edge of the implant can show. The usual fixes are a more cohesive implant, which ripples less but also feels firmer, and fat grafting to thicken the cover. One round of fat is often enough, and very thin mastectomy skin may need more. For rippling in general, see breast revision.

An implant reconstruction doesn't have to look round or obvious. In a revision, a different implant style or position, and fat grafting to soften the upper edge, can give a more natural slope.

Dog ears are small folds of skin that stick out at the ends of a mastectomy scar, most often when the nipple was removed through a scar across the front of the breast. They often flatten as the skin stretches, so the first step is to wait. If they are still there after a fair wait, the fix is to lengthen the incision and follow it around the curve of the breast so the skin lies flat under clothing, which surgeons call chasing the dog ear. More on dog ears after mastectomy reconstruction.

Give a reconstruction time to settle before judging it. The two sides often heal unevenly at first and usually even out by about six months, and after radiation the skin needs time to recover too. Dr. Killeen times a revision around both. If skin ever breaks down over an implant, contact your surgeon right away rather than waiting.

Dr. Killeen revises implant reconstructions done at other hospitals and practices. She looks at each thing that bothers you, such as size, uneven sides, firmness or implant movement, and explains what she would change. If you are partway through reconstruction with another surgeon and have concerns, a consultation can give you a second opinion on where things stand and what your options are.

Fixing only the side with the problem is a reasonable choice. When one side was radiated or the two sides have aged differently, working on both often gives a closer match, and Dr. Killeen talks through both options with you. You decide together how much surgery and risk feel right.

A 3D consultation can show the difference between your two sides and help plan size and shape. The office has a Vectra system, and Dr. Killeen mainly uses Crisalix, which also lets you start with a virtual visit from home.

If your nipple was reconstructed or tattooed, Dr. Killeen usually plans a revision through a new incision in the crease under the breast, so the nipple isn't disturbed. For nipple options after mastectomy, including 3D tattooing, see nipple reconstruction options.

A revision usually can't bring back feeling. In Dr. Killeen's view, nerve grafting is not the right procedure for someone who already has an implant reconstruction and is numb. If you are still planning a mastectomy, see breast reconstruction.

• Operative notes from your mastectomy and reconstruction
• Your implant cards, or the implant maker and size
• Any recent breast imaging
• A summary of your cancer treatment, including radiation dates
• If you smoke, a plan to stop before surgery

In most cases, revising a reconstruction is covered. The federal Women's Health and Cancer Rights Act (WHCRA) requires group health plans and insurers that cover mastectomy to also cover all stages of reconstruction, surgery on the other breast to create a symmetrical appearance, prostheses and treatment of physical complications of the mastectomy. Some church and government plans are exempt, and deductibles and coinsurance still apply, so check the details with your plan. If your implants were placed after breast cancer or a preventive (BRCA) mastectomy, revision surgery, including implant removal, capsule removal and a replacement implant, is typically covered, and a scaffold may be too.

A phone answer that a procedure is covered is usually a general one, not a decision that you meet the plan's criteria. It is easier to get approval before surgery than after, and Dr. Killeen's billing team submits pre-authorizations. Covered still means your deductible and coinsurance apply.

The cost depends on what your revision includes, such as a new implant, capsule removal, internal support, fat grafting or work on the other side, along with anesthesia and facility fees. Dr. Killeen provides a personalized quote at your consultation.