Breast revision surgery: tackling complications through innovative techniques

When undertaking any surgery, it’s natural for patients to worry about possible complications. However, when it comes to breast surgery, advancements in technology have allowed surgeons to tackle most issues through what is known as a “breast revision surgery”.

According to Doctor Domenico Pagliara, who has been heading the plastic surgery unit at the Mater Hospital in Olbia, Sardinia, for the past five years: «breast revision surgery is a general term we use to refer to a surgical procedure aimed at correcting or improving the results of a previous breast surgery, which may be an augmentation (breast enlargement), a reduction (breast reduction), or a breast lift (mastopexy)».

It should not be considered simply a “touch-up” or a minor correction, but rather a procedure that is often more complex, aiming to restore the shape, symmetry, and harmony of the breasts, in cases where the initial surgery or previous procedures have not fully met the patient’s expectations, or where immediate or long-term complications have occurred.

A complex course correction

As previously stated, the surgery can be quite difficult as it requires working on previously operated skin. «The greatest difficulty lies in the fact that the tissue is not virgin tissue – Doctor Pagliara explains – Revision breast surgery is intrinsically more complex because it involves working on tissues that have already been operated on, where the anatomical planes are altered by previous surgery, with scar-related changes and reduced vascularization, making the tissues often more fragile and thinner. This is where new technologies, such as assessing blood supply with indocyanine green or using thermography to estimate tissue perfusion, come into play, allowing us to perform a tailored and significantly safer surgery. The techniques we need to use often lie at the intersection of aesthetic and reconstructive surgery. It therefore represents a true “challenge procedure” that requires experience, great precision, and a personalised approach. It can rarely be considered a simple replacement of the implant». 

Therefore, a tailored approach must be applied to ensure the safety of the patient and achieve the desired results. The procedure becomes necessary when clinical complications arise, such as implant rupture or displacement, or a capsular contracture that may be associated with pain or significant asymmetries in shape or volume. However, there may also be other reasons for the revision, according to Doctor Pagliara: «Marked asymmetries and changes in the shape of the breast can compromise a patient’s quality of life, making surgical intervention necessary. In these cases, revision surgery is not merely an aesthetic need, but a true step toward restoring the patient’s physical and psychological well-being».

How innovative techniques are changing the field

Despite being a complicated procedure, advancements in technology have started to become extremely beneficial within the field. «Consider – the doctor points out – the ability to simulate the result using software and 3D tools, as well as all the innovations related to implants, such as implants with surfaces that provide greater stability, for instance, polyurethane-coated implants».

That’s not all, ultra-light implants, which are the same volume as regular ones but weigh 130% less, have proved particularly advantageous when choosing a larger-volume implant or for patients who are particularly athletic. Furthermore, Doctor Pagliara highlights the extreme usefulness of certain biocompatible meshes that can act as an internal bra, supporting the implants or the mammary gland, in such a way that, over time they create a collagen structure that can effectively provide an internal bra effect, resulting in a more stable outcome over time.

The future of breast revision surgery

These latest innovations are just a glimpse of what the future may have in store for the medical field. Doctor Pagliara concludes: «The future will certainly move increasingly in the direction of personalisation and biocompatibility. Researchers are developing smart materials that can better adapt to tissues, and even less invasive techniques to allow for faster recovery. This integration between plastic surgery and bioengineering could open up innovative scenarios, with biocompatible solutions capable of adapting to the patient’s tissues and following their changes over time».