Failed breast surgery: more common than you would think...
On this page you will find examples and discussions of the following complications:
- Failed implant reconstructions
- Failed (free) flap reconstructions
- Failed breast augmentations
- Failed breast lifts (mastopexy)
- Failed augmentation mastopexies
Failure to obtain beautiful results in both reconstructive and aesthetic breast surgery is often related to
Most failed breast surgeries can be solved or at least dramatically improved. My long-term experience in both reconstructive and aesthetic breast surgery, where I am able to apply all known techniques of implant procedures and soft-tissue transplantations, enables me to offer my patients superior results.
Because many of these patients have been operated several times before, it is sometimes not possible to achieve the expected result in one single surgical procedure. Sometimes two or more smaller procedures are necessary to get to the final result. Every woman, every case is different and during the pre-operative consultations a personalised, custom-made surgical strategy/solution will be proposed and discussed. Your own personal input and desires are important and will be taken into account as far as they are achievable.
- unexpected and non-intentional post-operative complications (f.e. bleeding or wound infection)
- excessive reaction to breast implants or other foreign bodies introduced behind the breast gland or pectoral muscle, most often resulting in severe capsular contracture
- failure of the (thin) tissues covering a breast implant
- migration of the implant or failure (rupture) of the implant
- irradiation of the chest wall
- insufficient vascularisation of the remaining breast tissue or free flap reconstruction
- hyper-laxity of the soft tissues of the breast or surrounding tissues
- wrong choice of technique
- technical mistakes during the surgical procedure
Most failed breast surgeries can be solved or at least dramatically improved. My long-term experience in both reconstructive and aesthetic breast surgery, where I am able to apply all known techniques of implant procedures and soft-tissue transplantations, enables me to offer my patients superior results.
Because many of these patients have been operated several times before, it is sometimes not possible to achieve the expected result in one single surgical procedure. Sometimes two or more smaller procedures are necessary to get to the final result. Every woman, every case is different and during the pre-operative consultations a personalised, custom-made surgical strategy/solution will be proposed and discussed. Your own personal input and desires are important and will be taken into account as far as they are achievable.
Failed implant reconstructions: lack of skin
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A breast reconstruction can fail because the wrong technique has been chosen or unexpected complications presented themselves in the post-operative phase. Implant reconstructions tend to do well immediately after the reconstructive procedure. The chronic inflammation around this foreign body will finally lead to capsular contracture and distortion of your breast. This process can take years. In general, post-operative irradiation can have a negative influence on the aesthetic result of your reconstruction. Severe deformations as shown in the picture to the left need to be solved by free flap tissue transfers like a DIEP flap. The main problem here is the shortage of skin. Skin can only be added by the use of free flaps. |
Failed implant reconstructions: implant displacement and implant animation
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Even if there is sufficient skin envelope, implants can shift from their original position. This can be caused by contraction of the pectoral muscle or by improper surgical technique. (left breast in the picture to the right)
Regularly implant animation is observed: the implant itself is in the right position when the pectoral muscle is at rest but moves every time the pectoral muscle contracts with every movement of the shoulder. (right breast in picture to the right) Severe capsular contracture is however the most important reason for implant displacement. It is accompanied by chronic pain, shape deformation and firmness of the breast. For women with recurrent capsular contracture, shortage of breast skin and young patients, free tissue transfer often provide the best solution. |
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Failed (free) flap reconstruction
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The use of body-own tissue provides the highest quality of breast reconstruction with long -term stability. Possible complications occur immediately after surgery. Partial flap necrosis or even total flap loss is possible but rare (resp. 4% and 0,3% in my hands). While partial tissue loss can be solved by conventional techniques, total flap loss may require more invasive secondary procedures. With the modern techniques of perforator flap reconstructions (DIEP, SGAP, LAP flaps...) the competence and strength of the skeletal muscles at the donor site are fully preserved. |
Failed (free) flap reconstruction: consequences of radiotherapy
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Most (free) flaps support post-operative irradiation pretty well but some flap reconstructions may suffer from strong fibrosis and shrinkage. This complication is rare. Nowadays this problem is treated with the regenerative effect of stem cells that are isolated from liposuction material. Elasticity and softness returns together with an improved colour of the skin. |
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Failed Breast Conservative Surgery
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The term "breast conservative therapy" (BCT) implies light to moderate changes to the shape and volume of the breast after removal of the tumor. In reality, it is impossible to predict how a patient will react to the post-operative irradiation that is necessary in all cases of breast conservative surgery. Variable deformations or even mutilations present themselves often years after irradiation.Even if there is no oncological risk, the aesthetic appearance and symmetry between both breasts can be dramatically impacted. Frequently light to moderate deformations can simply be treated with lipofilling. More severe deformations might need more aggressive techniques like free flaps.As the breast has been irradiated, patients after breast conservative surgery, that eventually would need a mastectomy, cannot undergo implant reconstruction later on. This is related to a high complication rate. |
Failed Breast Augmentation: implant displacement
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In breast augmentation the most frequent problems are severe capsular contracture, implant migration or rotation, implant animation, insufficient soft tissue coverage, oversized implants, etc. Upward implant displacement is caused by contractions of the pectoral muscle (if implant is placed behind the muscle), capsular contracture or technical issues during placement of the implant. Correction consists of a pre-pectoral placement, use of smaller implants and substitution of implant volume by lipofilling. Downward displacement is caused by large implants, mostly in a pre-pectoral position in which the ligaments of the infra-mammary crease have been intentionally (patient's request to put in a large to very large implant) or accidentally (over-dissection and undermining of the infra-mammary crease) cut. Repair consists of placement of smaller implants and repair of the ligaments of the infra-mammary crease. |
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Failed Breast Augmentation: visible edges, implant rotation, rippling and wrinkling
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Capsular contracture can create waves or folds in the implant. If the soft tissue coverage is thin, these changes may become visible. When the soft tissue layer is thick these changes are felt but not seen. It is normal to feel the edge of your implant at the lower and outer border of your breast. When an anatomical shaped implant rotates in its pocket, this will become visible by an important change in shape and an increased asymmetry. Round implants that rotate cause no problem. These problems are often solved by increasing the thickness of the soft tissue layer covering the implant combined with the placement of smaller implants. |
Failed Breast Augmentation: failure of soft tissue coverage
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The most frequent reason for poor results after breast reconstruction is soft tissue failure. What it basically comes down to is that the soft tissues in between the implant and the skin becomes so thin and worn out that the implant is no longer held in place, capsular contracture becomes very obvious and the aesthetic result becomes very unpleasing. These are often complex cases that need multiple procedures to get to an acceptable and symmetric result. The example to the right shows what one can obtain after one single procedure. |
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Failed Breast Augmentation: capsular contracture
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Every implant will cause a foreign body reaction and the creation of a capsule, which is basically a thin layer of scar tissue around the implant. This capsule becomes thicker over time. At a certain moment this capsule will start contracting and deforming the implant. In more advanced stages these shape changes will become visible.
Symptoms of capsular contracture are: chronic pain, increased firmness of the implant, displacement of the implant, shape changes, increased asymmetry. The formation of a capsule and eventual capsular contracture occurs in 100% of patients that have received breast implants. Solutions may consist out of capsulotomies, capsulectomies, the use of capsular flaps, the use of smaller implants eventually combined with lipofilling and/or total removal of the implant and replacement of volume by (repeated) lipofilling. There are preliminary data indicating that lipofilling around the capsule of an implant may improve the grade of severeness of capsular contracture, certainly if combined with a smaller implant. |
Failed Breast Lift (Mastopexy)
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Breast lifts or mastopexies are rarely associated with severe complications. The operation is pretty straight forward and when the operation is well executed, symmetrical results should be expected.
Mastopexies, just like breast augmentations are nowadays always combined with lipofilling in the upper poles to ensure fulness of the décolleté-area. This is called 'composite mastopexy'. Complications after mastopexy occur mostly over the long-term:
Solutions may be offered by either increasing the volume of the breast (implant or lipofilling) or by a second breast lift, putting more tension on the lower skin envelope. Often the same scars can be used. |
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Failed Augmentation-Mastopexy
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Augmentation-mastopexy combines both the tightening of the skin envelope of the lower poles of the breast in order to lift the breast and the increase of volume of the breast by implants and/or lipofilling. Lipofilling of the upper poles is always combined to ensure fulness of the décolleté area.
The combination these two counter-forcing surgical acts makes this operation probably one of the most difficult procedures to perform. The most frequent complications seen after augmentation-mastopexy are:
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