TORONTO — Although some complications of breast augmentation are best addressed through prevention, others can be corrected through careful use of revision procedures such as creating a neosubpectoral pocket in cases involving implant malpositioning, says one Toronto surgeon.
For starters, he says, "The best 'revision' is no revision — trying to prevent problems in the first place." Other basic principles include proper patient and implant selection and doing one's utmost to prevent postsurgical complications, he says."Select patients who are healthy, are good candidates for surgery and don't have risks for wound-healing complications," he says. He also advises choosing patients with realistic expectations and requests. "They're looking for outcomes that match their body and what their body will allow in terms of tissue coverage."
In this regard, "Very common mistakes include selecting implants that are too large for the patient," Dr. Brown says. "Implants that are too large are more likely to increase stretch of the tissue and create rippling, palpability of the implant edges, malposition and asymmetry. Small implants can yield small problems; big implants can yield big problems."
Some re-operations in elective breast surgery stem from patient dissatisfaction, Dr. Brown says. "Sometimes they're dissatisfied because you didn't give them what they expected, because you didn't understand what they expected," he says. "Size change would be a good example. A patient requesting a different implant size postoperatively demonstrates a failure of communication between me and my patient."
Dr. Brown says he tries to avoid these problems by taking a very careful history, understanding what his patient's expectations are, doing a physical examination and then going through a significant education process to help patients understand why and how one selects implants.
"There's no other medical device in the human body that a surgeon would insert without appropriate attention to the anatomy in which they're inserting it," he says, adding that patients also need to know up front what's expected of them in terms of caring for their breasts and breast implants postsurgically.
In some cases, though, "No matter what you try to do, there will be times where complications and problems arise" that make revision necessary. Along with size changes, common examples include capsular contracture (CC) and implant malposition, he says.