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Revisionary Breast Surgery

Dr. Pousti is double board certified in plastic and reconstructive surgery and is well known for his vast experience with revisionary breast surgery. Dr. Pousti is an expert in revisionary breast surgery and has patients fly from throughout the United States as well as worldwide to have him perform their revisionary surgery. Revisionary breast surgery may help alleviate previous complications such as:

  • AlloDerm
  • Asymmetry
  • Bottoming Out
  • Capsular Contracture
  • Capsulorrhaphy
  • Change in Size/Type of Implant
  • Deflation of Breast Implant
  • Double Bubble
  • Falling Outward
  • Riding High
  • Rippling Palpability
  • Symmastia ‘Bread-loafing’


AlloDerm is an acellular dermal matrix derived from donated human skin tissue. Since AlloDerm is  minimally processed and is not significantly changed in structure from the natural material, the FDA has classified it as banked human tissue.


AlloDerm is produced from donated human skin. It is handled in much the same way as other transplantable organs. The tissue is processed to remove cells that might cause your body to reject the foreign tissue or react negatively to it. What’s left is the collagen structure (fiber-like proteins) and other proteins naturally found in skin. This structure acts as a frame for your tissue to grow into and around.

Before Surgery

Breast Revision

After Surgery with AlloDerm

Breast Revision

AlloDerm is frequently used in conjunction with symmastia repair, capsular conjunction, pocket correction and many other revisionary breast surgeries.


Patients typically start with different sized breasts before surgery (most patients are not perfectly symmetrical). 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.

Before/After Correction of Breast Asymmetry

Breast Asymmetry

Board Certified Plastic Surgeon, Dr. Pousti takes his time in the operating room to make sure he achieves the patient’s goals.  Dr. Pousti uses temporary sizers in the operating room to help with the decision of whether or not to use to use different size implants to achieve better symmetry. If the patient currently has breast implants and is asymmetric, an internal suturing technique can be used to correct the pocket and provide for better  implant placement on the chest.

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 “raising” the inframammary fold using internal sutures. This is done after careful measurements are made from the areola to the “new” inframammary fold.

After Correction of Bottoming Out

Correction of bottoming out

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). The cause of capsular contracture is unknown, but it is the most common complication with breast augmentation surgery. There are different grades of capsular contracture ranging from mild to severe. The rate of capsular contracture has decreased from 20-30 years ago when all breast implants were placed above the muscle (sub-glandular). By placing the breast implants below the muscle (sub-muscular), the rate of capsular contracture has significantly decreased. Also, it is said that massaging of the implants helps decrease the chance of capsular contracture. When a patient is believed to be developing capsular contracture or hardening of the breasts, they may be placed on a medication called Accolate. This is an asthma medication that has shown to improve capsular contracture in patients at an early stage.

Before/After Removal of Scar TissueRevisionary Breast Surgery

Correction of capsular contracture can be handled surgically is necessary and in many severe cases surgery is necessary. The procedure can take from 2 to 3 hours, depending on the severity and complexity of the encapsulation. Correction involves removing the scar tissue that is encapsulating the implant and releasing the tension around the implant.


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.

Before/After Capsulorrhaphy


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.

Before/After Change of Size

implant exchange

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.

Before(Saline Implants)/After(Silicone Implants)

Silicone Gel 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.

Deflated Silicone Implant

deflated implant

Before/After Removal of Deflated Implant and Re-Augmentation

Breast Revision San Diego

Double Bubble

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.

Correction of this condition via breast revision surgery usually involves a lift or tightening with aggressive release of the tissues of the lower breast in order to allow the breast to take on the shape of the implant. Patients should also be educated toward tolerance of the imperfection, as this problem sometimes cannot be fully corrected.

Before/After Correction of Double Bubble

Double Bubble Breast Correction

Lateral Displacement

This is 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.

Before/After Pocket Correction

Breast Pocket Correction


Commonly referred to as bread-loafing or uni-boob, occurs when two implants touch one another in the center of the chest. If the breast implant pocket is over-dissected medially this cause the implants to migrate toward the middle of the chest causing symmastia.

Symmastia ‘Bread-Loafing’

Symmastia page-1

After Correction of Symmastia

What To Expect After Surgery

Pain is rarely strong, more commonly being a degree of discomfort. Swelling occurs but usually begins to subside by the third or fourth day. Some degree of swelling may persist for longer periods. A well-fitted bra is worn day and night for three weeks. While there is probably seldom interference with future breast feeding, women are cautioned that it may not be possible to breast feed in the future.

The bra that is worn after symmastia repair is referred to as the “thong bra”. It is used to stabilize the area after symmastia reconstruction.

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. In this case the pocket is lowered to allow the  implants to settle  into the pockets and have a nicer placement on the chest wall and more natural look.

Breast Revision Procedure


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. The rippling / palpability of the breast implant can be decreased by using silicone gel breast implants versus saline filled breast implants. Silicone gel breast implants are now FDA approved and give a softer, more natural feeling to the patient with little breast tissue.

Correction of Breast Implant Rippling

For correction of rippling and palpability of the breast implants, the procedure can take about 1-2 hours and resembles the original breast augmentation surgery. Since this occurs more on patients who have saline-filled implants, Dr. Pousti goes through the same incision line and removes the current implants and replaces them with silicone gel implants. Sometimes, alloderm is used to improve the coverage of the area that is palpable. Board Certified Plastic Surgeon, Dr. Pousti takes his time in the operating room to make sure that he does what he can to achieve the patient’s results.

AlloDerm San Diego

Revisionary Breast Procedure

Recommended Scar Treatment

Breast Augmentation San Diego

bioCorneum HC is the first and only FDA-Accepted silicone scar treatment with a steroid, and should be applied twice a day, in the morning and evening. Within minutes, the cream dries into a thin, waterproof, breatheable sheet that will lock in all of the necessary moisture, while keeping out the chemical, microbial and physical invasion of the scar. bioCorneum HC is available at Pousti Plastic Surgery as a perfect scar treatment solution to your plastic surgery procedure!

Resumption Of Physical Activities

Driving may be resumed in 1-2 weeks.
Non-contact sports in 3 weeks.
Contact sports in 6 weeks.