There are many types of breast revision surgery (capsulorrhaphy, implant exchange, capsulectomy, capsulotomy, and mastopexy revision) that Dr. Tsujimura of Scottsdale Plastic Surgeons performs to correct unsatisfactory results of a previous breast surgery or to fix an implant problem. Many patients are referred from other plastic surgeons across the country since Dr. Tsujimura has earned a reputation as a breast revision surgery expert. From old, hardened, misshapen, bubbled or malpositioned implants, our board-certified plastic surgeon utilize his artistic surgical techniques to correct, remove or replace existing implants to achieve beautiful results. He also incorporates different styles/ profiles of implants and uses biologic materials (SERI, Alloderm, Strattice) if needed. He is also able to customize lifts to existing or new implants. With his extensive experience in cosmetic and reconstructive techniques, he is able to accomplish results that others could not.
"Rhinoplasty - Scottsdale, AZ - I couldn't be happier with my new nose.I hated my nose for as long as I can remember, when I looked in the mirror or at pictures of myself that's all I saw. The first time I met with Dr.Holden he pin pointed my exact issues with my nose with out my having to tell him. He was very kind and patient and answered all of my questions. While talking to him it was obvious he knew what he was talking about and was an expert in his field. I felt so comfortable and confident with him that I canceled my other consultes (with another surgon I used in the past) and scheduled by surgery for the next week. Dr.Holden also saw me at every one of my follow up appointments, not some nurse, which was very important to me and helped with my post surgery anxiety. With being 34 years old and a mother of 3 it was very important to me for my new nose to look natural. It does. I am thrilled when I look in the mirror and the people close to me have all remarked how wonderful it looks. While people that I haven't shared my surgery haven't noticed or at least not enough to say "oh my gosh you got a nose job!" I still look like me. :)"- S. / RealSelf / Jul 30, 2015
"I Couldn't Be Happier! - Dr. Holden is a very talented physician. Not only is he exceptional at facial plastic surgery, he is kind, compassionate and caring. I am extremely pleased with my eye lift and face lift, I couldn't be happier. He makes you feel comfortable every step of the way explaining the surgery and recovery in detail. He has the best bed-side manner of any physician I've encountered!"- S. / RealSelf / Nov 28, 2018
"Dr. Holden for Rhinoplasty! - I had a rhinoplasty procedure yesterday, after years of wanting to have one, but not actively pursuing to do so. I wanted a small refinement to my profile. I chose Dr. Holden because of his warm and caring nature, and his close attention to detail. In the initial consultation and meeting with Dr. Holden, I knew I had chosen the right doc for the job. Not only is he a fantastic plastic surgeon..."- A. / RealSelf / Oct 18, 2018
"Dr. Paul Holden is a Very Gifted Plastic Surgeon. - Dr. Paul Holden is a fantastic plastic surgeon. I would highly recommend that anyone needing facial plastic surgery use him. My results were outstanding. Arizona is very fortunate to have him as a resource in our area."- D. / RealSelf / Sep 19, 2018
"Walking through the fear! - I initially went to talk to Dr. Holden in May of 2016 about straightening my septum and removing a bump on my nose from when it was broken when I was young. I got nervous and opted not to do it. A friend of mine went to see him for a similar surgery and went through with it. After seeing the results and the success that my friend had I opted to go through with it in March of 2017. Tonight I..."- B. / RealSelf / Sep 16, 2018
Patients who wish to have their implants replaced will undergo a procedure where an exchange of one or both implants may occur. These revision surgeries are generally straightforward. If scar tissue does exist around the implant, an additional step will be taken to remove or release this. Some patients may require a breast lift or lift revision during this surgery. In addition some patients require a tissue matrix device known as (Strattice , SERI, Alloderm) for added support. Still others may need their implants adjusted and the pocket repaired or released. Dr. Tsujimura is confident that the customized surgery will address and correct the issues presented. The goal of the revision process is to resolve or overcome issues in a way that satisfies the patient’s aesthetic goals. Revision surgery is magnitudes greater in complexity than primary surgery. It is critical to know that your plastic surgeon has the visualization and skill to address and correct the problem.
Breast revision surgery is performed under monitored anesthesia care (MAC) sedation as an outpatient procedure in our surgical facility. The ease of recovery will depend on exactly what was being done during the revision process. Most women are able to resume their normal work activities after a full week of rest. Exercise will be a gradual process. It may take up to a full year for the scars to begin to fade and for the newly revised breast or chest area to look and feel natural.
Plan Your Procedure
Reasons for Revision Surgery
There are various circumstances as to why a woman may decide to undergo breast revision surgery. The most common reasons are listed below:
If a saline implant ruptures, the implant device will deflate due to the leakage of saline. This will result in an obvious deflating of the breasts. Silicone implants will not deflate visibly, however a break in the shell may still occur and may cause a deformity. The only true way to detect a shell break is through an MRI, which is why routine check-ups are recommended throughout the years. The majority of implants are guaranteed for life and the manufacturer will replace them. Scottsdale Plastic Surgeons can assist in getting them replaced.
Breast rippling and/or wrinkling can occur along the side of the breast, or underneath it. This occurs within saline implants resulting in an unnatural appearance under the skin. This is most common in women who are extremely thin. Rippling is less common with silicone implants but can occur. There are other implants or procedures that can correct or minimize rippling.
Double Bubble Implants
“Double bubble” is a rare complication with women who have breast implants. This occurs when the implant drops down behind or below the natural breast crease, or it has risen and now breast tissue drapes (double folds) over the implant. When this occurs, an unnatural indention will result in a “double” breast appearance. This is usually caused by improper breast implant placement from the original surgery, capsular contracture, which shifts the implant from is position or movement of the implant out of position “bottoming out”. One of the most common causes of this deformity is not performing a lift at the original surgery when it was needed.
Breast Implant Removal
Some women may decide later in life they no longer wish to have breast implants in place. Breast implant removal is a procedure that removes the implants and tightens the skin around the breasts to create a natural look. In the majority of cases a breast lift (mastopexy) is necessary.
Some women will be unhappy with their breast size following breast augmentation surgery. They may desire a secondary surgery to replace the implant with one of a different size, texture or shape. Some women may want to go from saline to silicone, or vice versa to achieve the results they desire.
Scar tissue that has formed around the implant may create a capsular contracture. When this occurs, excessive tightening of the capsule will result in a hard feel of the breast. This can lead to distortion and pain. Sometimes, in order to correct this, a capsulectomy must occur. This is the removal of scar tissue from around the implant. In other situations release of the capsule, capsulotomy, is all that is needed. In general, silicone implants have a higher incidence of capsular contracture (approximately 10-15% chances) than saline implants (5% chance).
Implant Bottoming Out
This can occur post-surgery when an implant shifts or moves from its original location to an inferior position. This can occur with aging, gravity, trauma to the chest, or not utilizing proper support. The most common cause is not wearing enough support with high impact activities (running) or working out the chest muscles. This deformity will need to be repaired (capsulorrhaphy) primarily or with an internal sling (SERI, Alloderm, Strattice).
Some women will need their breast lift revised. Either the nipples/areolas are too low or too high. A breast implant may also be added. Some issues are more complex than others. Experience and planning are critical in correction.
Experience of the surgeon reduces this risk. Some women are not good candidates for breast augmentation surgery alone. Women who have sagging breasts and undergo breast augmentation will have suboptimal results. The breasts will continue to sag, and the implant will either drop low or the breast tissue will droop over the implant. It is crucial to recognize when a lift and what type of lift is necessary to produce the desired outcome. Also choosing the right implant is important as well.