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It literally means performing breast augmentation again. There are many reasons a second breast augmentation is done, mostly severe capsular contracture, lead to chest deformation, hardening, and unleveled breasts. If you are not satisfied with your augmented breasts, and the problem has caused psychological distress and stress in life, you may consider undergoing secondary breast augmentation.

♦The skin is thin and the breast implant material is unfitting, causing the outer edge creasing to be clearly visible.

Before the Ministry of Health and Welfare granted the legal use of jelly silicone breast implants, saline bags are the only option available. When undergoing breast augmentation using saline bags, some skinny women or women with a thinner skin thickness may easily feel creases at the edges of the saline bags, and such creases can sometimes even be seen by the naked eye. In other times, the over-expansion of saline bags filled with water may make the bags hard to the touch, appearing like flying saucers. In the past, when situations like these occur, there was no other way to effectively improve the problem than eating more to gain weight.

Creases are easily produced on the saline bags.

♦Improvement Method

Nowadays, the legal use of jelly silicone breast implants has substantially improved the problem. In terms of softness, naturalness, and breast shape, the jelly silicone holds a substantial advantage over saline bag breast implants in terms of satisfaction.The surgery was originally carried out in the armpits. Using the endoscopic technique, the old saline bags are completely removed and then new jelly silicone breast implants are placed. Since the space for artificial implant placement is already available, the postoperative pain is much lesser than that of the first augmentation, neither is there the tight pain felt after the first surgery. If one wants to increase the cup size, all one has to do is place larger jelly silicone breast implants.

♦Uneven Breast Size

Everyone’s left and right breasts are not completely symmetrical in terms of volume, fat layer thickness and muscle size. Many people are more concerned about size but fail to notice that breast implants with the same volume tend to result in asymmetrical left and right breast sizes. The size difference in the early stage after surgery is not easily noticeable due to the swelling, but it tends to gradually show after swelling subsides. If the left and right breasts are at least 1-2 cups apart in size, surgery may be considered to adjust the size.

♦Improvement Method

1.Communicate with the surgeon in detail regarding the breast size.

2.Replace breast implants that have different left and right breast sizes.

Many people are too shy to talk to their doctor about their breast shape and size, whether they want a natural C-cup, a busty D, E, F, or G… , a busty cup, a teardrop, a sphere, the breast shape and size, who wants the size (you or him), etc.

A case once demanded busty and spherical shaped breasts, because her boyfriend wanted breasts that cannot be fully grasped with one hand. One year later, she returned to the clinic and asked to replace those breasts with a natural and water crop cup, because her boyfriend thought her breasts were too large. Fortunately, her breast implants were fully removed through the endoscopic technique and new jelly silicone breast implants in a smaller size were placed. Bear in mind that it is in women’s nature to be beauty-conscious. Please specify the size you want, as “from small to big” is always easier than “from big to small” when breasts becoming saggy and flabby have to be taken into account.

Some people implant breast implants in two sizes, as they are born with uneven breast sizes, especially for women with scoliosis. A bigger or more elevated breast implant can be placed into the smaller or flatter breast to achieve a symmetrical breast size.

Another case came to the clinic to undergo Secondary Breast Augmentation. Scoliosis symptoms were found, the left chest wall was more prominent, the outer edge of the right side of the breast showed fat atrophy, and congenital uneven breast sizes were seen. The uneven breast size can be improved by injecting saline solution (cc). However, since the skin is thin, jelly silicone breast implants were chosen for implantation. If the left and right breast implants are one size apart, they will be a little less than normal; if they are two sizes apart, the right side will be slightly bigger. Originally, 275cc of breast implant was scheduled to be placed in the left breast, while 300cc of breast implant was scheduled to be placed in the right breast, so as to ensure left and right asymmetry when underwear is worn in the future. However, the case was concerned about size symmetry when viewed externally naked. After thorough communication, 275cc of breast implant was placed in the left side, and 325cc was placed in the right side. The case was highly satisfied with the postoperative result.

3.Failure to Naturally Present the Cleavage

Many breasts that underwent breast augmentation surgery showed “disconnection between two sides”. In addition to the surgeon’s skill and approach related factors, the absence of correct massaging is also a major factor contributing to the phenomenon.

Traditional breast augmentation not only relies solves on the surgeon’s experience due to the invisibility of chest tissue conditions, artificial breast implants that blindly strip the pectoralis major using a stripper, due to occasional failure to cut off the ligament of the pectoralis major attached to the ribs and sternum, the pectorals major stripping maybe inadequate, completely or partially placed in the “space” at the location of the breast implants. Instead, the ligament attached to the ribs and sternum takes a temporary break. After sometime, all or some of the remaining muscles’ memory is restored, and the pseudo-cleavage disappears.

Another type is that the breast implants on both sides are overly concentrated in the center, as if they are slots of a swipe machine. The two towering balls protrude, unable to naturally expand even when lying down and unable to form the natural teardrop shape, the result of breast implants being to large, too wide, and too high placed in the narrower chest wall.

Another type is the “inter-linking” between the left and right breasts. In order to make breasts appear more natural after augmentation surgery, the tissues of pectoralis major and the ribs must be stripped for breast implant placement. However, if there is excessive stripping to the point that piercing occurs on the other side, the “inter-linking” forms. Another example is if an individual has sustained multiple breast augmentation failures and has thin skin that is over-massaged, the skin in the middle of the thorax gradually protrudes, resulting in interlinked breasts.

♦Improvement Method

1.The endoscopic breast augmentation surgical procedure is adopted to enter through the original wound for improvement.

2.Thorough Communication with the Surgeon Regarding Breast Implant Size Prior to Surgery.

The endoscopic breast augmentation surgical procedures used to enlarge the interior tissue structure of the original would location through endoscopic images, allowing the surgeon to see the organization of the muscles and the direction of the nerves and blood vessels within the tissues. With a clear view, a specially manufactured special elongated electrocoagulation wire loop is used to cut off the ligament of pectoralis major attached to the ribs and thorax while retaining the nerves, completely removing the old breast implants, strip ping enough space to bring the breasts closer to naturally present the cleavage. Of course, the surgeon must be well experienced and demonstrate mastery in endoscopic surgery.

Thoroughly communicate with the surgeon prior to surgery to choose suitable breast implants based on your height, weight, and width of chest wall. It is essentially impossible to choose a suitable size through “self-decision during surgery”. When you are under the anesthetized state, not completely conscious and with chest swelling during surgery, you will not be able to precisely a suitable size for yourself. It is therefore better to thoroughly communicate with your surgeon prior to surgery.

There was a case whose chest skin was thin. She had undergone traditional breast augmentation below pectoralis major at the clinic twice, namely, one breast augmentation under the areola and one endoscopic breast augmentation under the fascia. When the case visited the clinic, her breast implant size was so large that her breasts appeared saggy. Moreover, one corner of the breast was almost pierced by the breast implant due to capsular contracture. Therefore, the endoscopic breast augmentation method was adopted to remove the old silicone breast implants through the original wound and remove the part with severe capsular contracture. Then, a space was created under pectoralis major to place the breast implants and cautiously take care of the skin in the chest. Excessive massaging and squeezing was avoided. After several months, the case once again had natural and soft breasts.

4.Uneven Heights of Lower Edges of Breasts

It is the most commonly occurring problem in traditional breast augmentation. For many traditional breast augmentation surgeries, during the surgical process of tissue stripping, the situation of chest tissues cannot be seen, solely relying on the experience of the surgeon. The arc and blind spots in the chest tissues cannot be fully grasped. Therefore, inexperienced surgeons ay encounter problems such as inadequate stripping space range or excessive stripping, resulting in uneven heights of the lower edges of both breasts.

♦Improvement Method

1.The endoscopic breast augmentation surgical approach can improve the uneven heights of the lower edges of both breasts by entering through the original wound.

2.Excessive stripping may result in the lower edges of both breasts being too low. After surgery, a girdle or underwear may be worn to fixate the lower edges.

By entering through the original wound using the endoscopic augmentation surgical approach, the endoscopic images are used to enlarge the internal tissue structure, allowing the surgeon to have a clear view of the inner muscular structure and the direction of the nerves and blood vessels. Using a specially made elongated electro-coagulation wire loop, the old breast implants are fully removed while retaining the nerves, whereas the ligament of pectorals major attached to the lower edges of ribs is cut off, stripping the lower edges of both breasts. The breast implants, by principle is one third above the nipple and two thirds below it, making breasts appear as a natural teardrop. Of course, the surgeon has to be well experienced and demonstrate mastery in endoscopic surgery.

5.Rupture or Leakage of Breast Implants

Generally speaking, artificial breast implant rupture is unlikely, about 1%. According to some reports, there are incidences of saline solution breast implants that ruptured after 10 years of use due to saline solution leakage, which led to breast reduction by at least one cup size, accounting for 5-10%. External impacts are the major causes, such as car accidents, acupuncture, and so on. Once problems like these occur, the ruptured breast will quickly deflate within 1-4 hours, causing booth breasts to have obvious differences in appearance.

♦Improvement Method

Breast Implant Replacement through Only One Surgical Procedure

There is no need for concern if the saline solution artificial breast implant raptures or leaks, as saline solution can be absorbed by the body without causing immediate life-threatening situations. Contemporary silicone artificial breasts or the new jelly silicon breast implants, once ruptured, will not be absorbed by the body. They can be removed through endoscopic surgery to replace a new artificial breast implant and restore the original breast form. We recommend that replacement be done sooner, as delays may increase surgical difficulty.

I am most impressed with one case who had undergone breast augmentation three times. The first time the case underwent breast augmentation and saline solution breast implant in another clinic was seven or eight years ago. Due to an external impact about two years ago, one side of the saline solution bag ruptured. So, the case returned to the clinic to undergo second traditional breast augmentation surgery and replace a pair of alien solution bag breast implants. After the surgery, the surgeon did not show her the old saline bags. After the surgery, she felt her breasts were uneven and that something was “stuck” ‘in her chest without a soft feel. Six months ago, the saline solution bag in the other side ruptured. She came to our clinic for consultation through a friend’s referral and decided to undergo endoscopic breast augmentation surgery to remove and replace the ruptured breast implant. Under an endoscope during the surgery, she saw clearly the internal tissues and was shocked to discover that in addition to the saline solution bag and capsule placed during the second surrey, thee saline bag without liquid from the first surgery was left. She found it unbelievable. Possibly because the first two surgeries were traditional breast augmentation, and the previously placed saline solution bag had integrated with the tissues. During the second traditional breast augmentation, the capsule adhesion in the lower side was too tight. Therefore, instead of removing it, only the water was sucked out. The old saline solution bag breast implant was not removed, and a new one was placed, resulting in the odd circumstance of having to live with four breast implants and inadequate breast softness, shape, and unsightly arc heights. Fortunately, the endoscope gave a clear view of each tissue layer. Eventually, we removed the saline bag and capsule and reconstructed a pocket big enough. This special case is without a doubt a lesson learned.

6.Severe capsular contracture leads to breast deformation.

Capsule is not a Synonym for Contracture-  One of the most common causes of breast deformation due to a breast augmentation do-over is breast contracture. Just what is “capsule”? The so-called capsule is based on the teachings medical books and the definitions of “capsule” released by medical associations.

Dr..BakerBecker’s classification of Capsular Contracture：(Becker’s classification of Capsular Contracture)
                                                                                                                      

♦Cause of Capsular Contracture

Factors causing capsular contracture have not been ascertained so far, but it is said to be associated with the body’s more intense reaction towards implants and the production of excessive connective tissues (capsule). An excessive and overly thick capsule leads to contracture leads to breast deformation and uneven breast shapes. The growth of bacteria may also result due to excessive blood and blood clots during surgery, thus stimulating capsular contraction and thickening or the capsule, and the formation of different grades of capsules. In severe cases, augmented breasts may appear abrupt, unnatural, asymmetrical in height, and result in external expansion and other outcomes.

♦Does the capsule have to be fully removed

The human body has a natural defense mechanism (immune function) against foreign invasion. When foreign bodies implant, such as breast implant, artificial nose bridge, artificial chin, etc. is implanted into the body, the body’s immune function will produce a film (scar tissue), and this capsule will form a pocket to encapsulate the implanted foreign body for protection. This “film” or “pocket” is a “capsule”. A perfect breast augmentation or nose lift surgery includes the existence of a Grade 1 capsule, but this capsule is soft, normal, and undetected.

When a foreign body is implanted into the body, the body will gradually produce a capsule to encapsulate the foreign body by the second or third day after surgery. Therefore, frequent and early massage is required after breast augmentation surgery to avoid the capsule encapsulating the foreign object from being not soft enough, becoming unusually fat and thick, and abnormally proliferating, which eventually leads to capsular contracture and breast deformation. If secondary breast augmentation surgery is need, by cutting open the tightly encapsulated capsule and removing the breast implants, the tightened capsule is incised to loosened to restore the open space of the “pocket”. The vacant space of the cut or removed capsule will be replaced by a newly formed capsule after two or three days. Massage is intended to protect and maintain the tenderness of the new capsule. In case or unusual capsular thickening or proliferation, the abnormal parts may be fully or partially removed to retain only the good capsule (smooth and soft capsule). Undesirable capsule is removed because a “pocket” will definitely form.

To replace breast implant material, simply replace the saline bag with jelly silicone. If the “pocket” is in sound conditions, there is absolutely no need to cut or remove the original capsule, because the original “pocket” without an additional wound will not lead to the formation of a new capsule. If the capsule is arbitrarily removed, there ill be an additional wound (with a greater area) and a greater likelihood for a thicker and harder capsule to emerge. This is not only unnecessary but also increases and prolongs the patient’s recovery period. Of course, if the capsular contracture is very serious, it is another story. Many surgeons that are unfamiliar with breast augmentation surgery, especially endoscopic surgery, when capsular contracture is encountered, they often advise patients to completely remove the capsule. This is a bad move as far as the “good capsule” is concerned, because the capsule that later emerges may be a “bad one” (possibly thicker and harder), which may increase the likelihood of patients’ having to encounter capsular contracture.

                              Fat and Thick Capsule Removed from Secondary Endoscopic Breast Augmentation Surgery

♦Improvement Method

Grade 1 and Grade 2 capsular contracture can usually be improved through more frequent massaging. If Grade 3 and even Grade 4 capsular contracture are formed, the problem can only be resolved through surgery. The endoscopic breast augmentation surgical approach can be adopted to enter through the original wound and cut the capsule loose or partially remove the capsule. In severe cases, fat and thick capsule is completely removed to restore the tenderness of the breasts, although proliferation and hardening in the future are possible.

♦Capsule Removal Method

Endoscopic surgery is conducted throughout. An incision is made on the wound in the armpits. Through the lens terminal connected to a monitor with images, the surgical site images are transmitted to the TV screen. The muscular structure and the direction of the nerves and blood vessels within the tissues can be clearly seen through the endoscope after they are enlarged 20 folds. Under the clear view, the integrity of the breast implants can be examined, the breast implants can be completely removed, and the unwanted thick capsule can be carefully removed. In addition, stripping may be performed again on areas with adequate space or asymmetry, thereby restoring soft and natural breasts.

♦Case