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Revision Breast Augmentation

The success of an augmentation procedure depends on the doctor’s knowledge and precision; in addition, 30% of it depends on postoperative recovery and care. If capsular reaction or contracture occurs after implant surgery and breast hardening or deformity occurs after more than 6 months of breast massage, one should consider undergoing secondary breast augmentation or revision mammaplasty at an appropriate time. The human body shows temporary rejection of initially placed implants to some extent, and one manifestation of excessive response from the body to implants is capsular contracture. Mild cases can be relieved or treated with long-term breast massage. However, in severe cases, capsules may contract in a short period of time and squeeze implants, resulting in evident pain and changes in appearance and touch. Eventually, revision surgery would be needed.

The etiology of capsular contracture has not been elucidated; however, it normally occurs due to individual body conditions, improper previous surgery, postoperative bleeding or infection, scar adhesion or contracture, inappropriate choice of implants, and most commonly, improper postoperative massage. According to medical literature, capsular contracture develops in approximately 20% of augmentation mammoplasty surgeries. In most patients, capsular contractures are relieved or even cured as time elapses or with massage. However, approximately 5%–8% of patients need to undergo secondary surgery because of severe capsular contracture to mitigate the symptoms. Therefore, if patients can identify the problem and seek help early, the overwhelming majority may avoid secondary surgeries.

Although capsular contracture does not affect health and safety, it could compromise the touch and shape of the breasts, affecting patients’ self-esteem. Therefore, patients should look for a corrective solution. Mild and moderate capsules can normally be improved with long-term massage if noticed early. However, once it progresses to the severe stage, repeat surgery is the only solution. Generally, such revision surgeries are much more complicated than the first surgery, with the surgical area and method highly dependent on the severity of contracture. Therefore, surgeons and patients need to investigate the cause of capsular contracture from the previous surgery, and most importantly, choose the correct procedure for ensuring the success of revision surgery.

Revision breast augmentation

Capsular Contracture Grade (Baker’s Scale)

Grade Severity Symptoms
1 Normal Capsules may be found upon physical examination, but the breasts are soft and patients do not experience any discomfort.
2 Mild Mild capsules are confirmed upon examination, and patients occasionally experience discomfort, which can normally be relieved with massage.
3 Moderate Patients experience breast hardening or tightening, with capsule contracture confirmed by the physician.
4 Severe Breast deformity, hardening, displacement, or even evident pain.