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Revision Breast Augmentation Houston

Revision Breast Augmentation


AlloDerm is an acellular dermal matrix derived from donated human skin tissue. Since AlloDerm is regarded as minimally processed and not significantly changed in structure from the natural material, the FDA has classified it as banked human tissue. AlloDerm is frequently used in conjunction with symmastia repair, capsular conjunction, pocket correction and many other revisionary breast surgeries. Dr. De La Cruz sometimes utilize acellular dermal matrix for revision breast augmentation on an individual basis.


Over 85% of women have asymmetry of their breasts prior to any breast surgery. Asymmetry resulting from a breast augmentation may occur with regards to size of the breast implant placed. Adjustments can be made with the implants to try to achieve as much symmetry as possible after breast enhancement surgery. There are several ways to achieve breast symmetry; different types of implants may be used, different volumes may be used, or changes in the pocket dissection may be used to help achieve as much symmetry as possible. Asymmetry of the breasts after a breast augmentation can be avoided with the usage of a breast implant sizer during surgery. Dr. De La Cruz routinely uses a breast implant sizer to avoid and minimize any asymmetry with regards to size.

Bottoming Out

Bottoming out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the inframammary fold is too great. It is the loss of internal implant support can cause a slow downward migration of the implants. This is because support of the implant by the skin alone is not always enough to prevent downward migration of the implants. Also, over-dissection of implant pockets at the time of surgery may cause immediate bottoming out. This is corrected by reconstruction of the inframammary fold using internal sutures.

Capsular Contracture

After breast augmentation surgery excessive scar tissue may form around the breast implant which causes the breast implants to harden (similar to what a contracted muscle feels like). There are different grades of capsular contracture ranging from mild to severe. With severe capsular contracture, the patient may experience breast pain. Capsular contracture risk may be reduced by placing the breast implant underneath the muscle or with the dual-plane technique. Antibiotic irrigation of the breast implant pocket has been shown to reduce capsular contracture risk as well. When a capsular contracture of the breast implant occur, revision breast augmentation with a combination of techniques (such as capsulectomy, implant replacement, alloderm/strattic usage, change in implant pocket, etc.) may be needed.

Figure 1: Left breast capsular contracture.  Revision Breast Augmentation Before & After Photos (1 Day After Surgery)


The capsulorrhaphy procedure, also known as pocket correction or use of internal sutures/bra, involves closing a portion of the breast pocket to correct displacement of the implant. This can also be necessary when breast implants fall toward the axilla (armpits) and therefore the pockets need to be internally sutured to keep the breast implant in the correct position on the chest wall.

Change in Size/Type of Implant

Some patients choose to change their breast size after undergoing breast augmentation surgery. The most common “complaint” that patients have after breast augmentation surgery is that they “wish that they had gone bigger”. After a year or so, they may decide to remove their current implants and replace them with larger breast implants. Other patients may have gone larger when they were younger and are now ready to have a more natural look so they remove their larger implants and replace them with smaller implants. Patients frequently decided to change the type of their implant as well. The most common change is going from saline to silicone. These patient choose to go from saline to silicone because they have rippling, want more of a natural feel, or just as a personal choice. We also have patients that switch from silicone to saline, most of these patients are interested in XL implants, which involves overfilling saline implants.

Deflation of Breast Implant

Breast implants are not known as lifetime devices. They may deflate or rupture for reasons such as trauma to the breast, injury from surgical instruments, normal wear and tear on the implant, and mechanical damage prior to or during surgery. If a deflation or rupture occurs, the treatment option would be to return to the operating room, remove the ruptured implant, and replace it with a new breast implant. If the ruptured implant is a silicone gel implant, then care needs to be taken to clean out the ruptured silicone gel from the pocket area before replacing the breast implant with a new silicone gel breast implant.

Double Bubble

This is a cosmetically undesirable circumstance for patients with breast implants, which occurs when the breast fails to take on the shape of the implant, resulting in the appearance of a visible line showing a separation between the bottom edge of the implant and the bottom edge of the natural breast. This tends to happen more often in the case of a very tight or constricted pre-op breast or when there is significant droop present. Patients should also be educated toward tolerance of the imperfection, as this problem sometimes cannot be fully corrected. This can be corrected with a revision breast augmentation that may involve reconstruction of the inframammary fold or release of the parenchymal breast tissue underneath the breast.

Superior Displacement (Riding High)

This is when breast implants are too high on the chest wall and there is too much fullness superiorly. This displacement may cause the nipple-areola complex to appear low or pointing downward. This typically occurs with sub-muscular placement of the implants. The high-riding of the breast implant typically resolves with the usage of a breast stabilizer, especially the the breast implant is placed using the dual-plane technique. Unfortunately, with the sub muscular placement of the breast implant, the resolution of superior displacement of the breast implant is unpredictable. This can be resolved with revision breast augmentation, capsulectomy and conversion to a dual-plane technique.


When a patient doesn’t have much breast tissue or body fat, they may experience palpability of the breast implants and possibly rippling of the breast implants. Although the breast implants are placed under the muscle (sub-muscular), the outer edge and cleavage areas are not covered by the muscle and these are the most common places where rippling is experienced. Rippling are more common with saline breast implants and can be corrected by placing the breast implants underneath the pectoralis major muscle and replacing them with silicone gel implants.

Symmastia ‘Bread-loafing’

Symmastia- commonly referred to as bread-loafing or uni-boob, occurs when two implants touch one another in the center of the chest. This typically occurs if the breast implant pocket is over-dissected medially which cause the implants to migrate toward the middle of the chest causing symmastia. There are several techniques that Dr. De La Cruz employ to correct symmastia, which includes a capsulorhhaphy, alloderm placement and other techniques.

Emmanuel De La Cruz M.D. PLLC

Houston Plastic & Reconstructive Surgeon | Cosmetic Surgeon

Call NOW at 832-520-1844

Clinic Locations: The Galleria in Houston, TX & The Woodlands, TX


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