Lewis Plastic Surgery: Gordon Lewis, MD
2331-A Robious Station Circle
Midlothian, VA 23113
(804) 267-6009
Monday–Friday: 8:30 a.m.–4:45 p.m.

woman holding breast

Breast Revision

Breast augmentation is very popular and the majority of women who get breast implants are highly satisfied. In some cases, though, patients seek breast implant revision surgery at our Richmond, VA, practice. Revision breast surgery is typically more complicated than primary breast augmentation and requires the skills of an experienced plastic surgeon such as Dr. Gordon Lewis.

Recovery: 1 to 2 weeks
Pricing: Varies
  • Recovery: 1 to 2 weeks
  • Pricing: Varies

What Are The Most Common Reasons For Breast Implant Revision?

Over 300,000 women annually are getting surgery to enlarge their breasts in the Unites States. This is often thought of as a simple and straightforward procedure with no potential pitfalls. Achieving a great result requires meticulous attention to detail and proper surgical technique. Avoiding these principals can lead to less than desirable outcomes. There is no simple breast augmentation, and we pride ourselves on our attention to detail and surgical care. There is no question that careful attention to detail and meticulous surgical technique will keep the need for revision to a minimum.

Unfortunately, we do see many women who are dissatisfied with the appearance of their breasts after prior surgery from other surgeons. There are a variety of reasons for this and each patient needs to be evaluated individually.

In some cases, despite a well-executed procedure, implant revision may be necessary. The need for revision can be grouped into three categories.

  • Implant related issues: Wrong size (too big or too small) or rupture
  • Implant positional issues: Too high, too low, Synmastia (too close together) or too far apart
  • Issues with the soft tissue: Capsular contracture, Rippling, Palpability of the implants, Ptosis (droop) of the breast over top of the implants, Thinning of the tissue, Enlarged areola, Tuberous breast deformity

Procedure

Wrong size

Despite proper planning prior to a breast augmentation a small percentage of women will want a different size to their breasts at some point after a breast augmentation.  This can be a change to a smaller or a larger implant.  This may be immediately after surgery, or maybe at a later time.

Rupture

An implant may rupture simply as a result of the amount of time it has been in your body.  While technology has improved greatly, breast implants still cannot come with a lifetime promise.  Current evidence suggests that Mentor silicone breast implants have a 1.1% chance of rupture after six years.  There are other studies supporting a somewhat higher rate of rupture for silicone breast implants. Saline breast implants do have a higher rate of rupture.  At 7 years, studies have shown a 7% cance of rupture of saline breast implants.  When a rupture is detected, replacing the implants is usually a very easy, small procedure that is more cost effective than the original surgery and has an easier recovery.

  • Saline implant ruptures are generally very easy  to determine as the breast deflates and the breasts become uneven in appearance.     If treated quickly, replacing the implants is a very simple and easy process.  If there is a delay, the pocket (that the implant sits in) will shrink, and a slightly larger surgery may be necessary to recreate the appropriate space
  • With silicone the rupture can be harder to detect.  Whereas saline gets absorbed into the body, the silicone will not be absorbed. There is subsequently no change in volume of the breast.  Often this is first seen on a mammogram.  Because of this, the FDA recommends MRIs to evaluate for rupture after the placement of silicone breast implants.   Once rupture is detected, we do recommend removal of the ruptured implants.  Usually new implants are placed at the time of the removal
  • A rupture may also occur due to an external factor such as a blow to the chest, but more commonly, there is no identifiable cause of the rupture

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Issues With Tissue

Whenever a foreign body is placed within our tissues, our bodies react to that.  This occurs with breast implants but also with orthopedic implants as well. Normally that capsule is a very soft, pliable, nearly see through film that surrounds any implants.  In some cases, the capsule can become thickened and contract.   If this occurs around a plate on a broken bone, the plate is stronger than the capsule and patients never know there is an issue.  However, if this is around a soft breast implant, the breast can become less soft, even hard and painful in some circumstances.  This often leads to further surgery for this problem.

Studies suggest that there is about a 5% chance of getting a capsular contracture that leads to another operation after breast augmentation; we do all we can to keep this number as low as possible in all cases involving breast implants.

Rippling

In a small percentage of women who have breast implants, they may be able to see rippling in the underlying implants through their skin.   This is rare in all patients, but is more common in thin skinned women, (particularly those who have saline breast implants) or thin women who have very large impants.   There is usually an option to fix this issue, but it usually involves changing the implants.  Usually a change from saline to silicone will resolve the problem.  In women who have silicone implants, decreasing the size can help, or changing to a “gummy bear” cohesive gel implant can also help.

Palpability of the implants

In  most cases after breast augmentation, the implants can not be felt by someone not trained to feel them.   However, in some circumstances, the implant can be felt.  If this is an issue, it is usually on the lower outer portion of the breast. This can usually be fixed, but may require a change in implants. The options depend on the type of implants that are present, and the soft tissue overlying the implant

Ptosis

A (droop) of the breast on top of an implant.  (also called Snoopy deformity due to the profile) Over time, breast tissue will lose some of its elasticity, and most women as they get older, or after pregnancy, will develop some sagginess in their breasts.  This can occur even if there is a properly place implant underneath a breast. Although breast implants can give a degree of lift to the shape of the breast, the breast tissue can droop over time.  This can result in a breast that is sitting below a properly placed implants.   This can be fixed by preforming a lift (mastopexy) of the breast tissue over top of the implants.   Depending on the duration of time since the placement of your implants, we may recommend changing your implants to new implants at the same time.

Thinning of the tissue

Over time breast tissue in all women can thin.  This can be more apparent in women with breast implants. There usually are options to help with this, but it will depend on your specific anatomy and goals.

Asymmetry

No women’s breasts are perfectly symmetric.  This can be due to inherent size differences in the two breasts, or could be due to more subtle asymmetry in the underlying chest wall.  This all needs to be taken into consideration prior to a primary breast augmentation.  We take great care in analyzing each patient’s breasts for asymmetry and therefore it is rare to have any significant asymmetry after breast augmentation. When asymmetry does exist after a breast augmentation, we strive to determine the cause. The asymmetry usually can be decreased once the cause is identified.

Areolar enlargement

After a breast augmentation, the skin does need to stretch to accommodate the breast implant.  This always involves a small amount of increased diameter to the nipple areolar diameter.  In patients who are starting with a larger baseline areolar diameter, there is a risk that this may be more than what is desired.   This can be preventively treated at the time of the original surgery if desired, or if a decision to decrease the diameter is made later, this can be done then.

Tuberous breast deformity

This is not a problem related to another surgery, but a developmental problem in the breast.  This deformity can be mild to severe.  This involves a constriction of the base of the breast and often a herniation of the breast tissue to just underneath the nipple. The treatment can be relatively straightforward for mild cases to very complex for severe cases.

Capsular contracture

Bacterial contamination

There are several studies showing a strong link between bacterial contamination at the time of the original operation and capsular contracture.  Dr. Lewis uses a “no-touch” technique to introduce to implants to the pocket.  He also washes the implants and pockets with a triple anti-biotic solution.  This will nearly eliminate the possibility of bacterial contamination.   Saline breast implants are placed through small incisions and should not need to touch the skin.  Silicone breast implants are prefilled and skin contact had been unavoidable until recently.  We use the Keller Funnel (link) to place all silicone breast implants.  This allows the implants to be placed through a smaller incision and eliminates the contact to the surrounding skin.

Incision placement

Increasingly we are realizing that bacterial contamination has a large role in capsular contracture.   Implants placed either through the axilla or through peri-areolar incisions have been shown to have a higher rate of capsular contracture than those placed through inframammary incisions.  It is thought that the skin in the armpit is more contaminated, and that the breast ducts near the peri-areolar incision contribute to contamination as well.   For this reason, we prefer the use of the inframammary incision for primary and most revision breast augmentations.

Placement of the implants above the muscle

There are a number of studies supporting higher rates of capsular contracture when the implant is placed above the muscle.  When the implant is underneath the muscle, it is mostly covered by the muscle.  This brings more motion to the area and also better blood supply.  This position has a lower rate of capsular contracture.

Hematoma

If there is a hematoma (blood collection) around the implant after surgery, it should be surgically removed.  It will resolve if left in place, but will increase the chance of capsular contracture.

Tobacco use

Smokers have a 3-fold increased rate of developing capsular contracture after breast augmentation.  At 14 months one study found 1.9% of non-smokers had capsular contracture, where 5.5% of smokers had developed capsular contracture.

Grades of capsules around breast implants

Baker’s classification

Grade 1– soft pliable capsule, no change in shape to the breast.  This is the normal capsule after a breast augmentation.  This is what we want.  This is a capsule, but is not  capsular contracture.

Grade 2– breast shape is normal, but the implant feels more firm.  This usually does not require operative intervention, but needs to be followed to make sure it does not worsen.

Grade 3-breast is more firm, and there is a change in the shape of the breast.  The breast shape can not be fixed without removing the capsule.  We thoroughly wash the pock with antibiotic and replace the implant as well.

Grade 4– the breast is hard, and can be painful as well.   This also requires removal of the capsule, washing the pocket with antibiotic, and replacement with a new implant.

Options to fix capsular contracture?

Grade 1  capsules are normal and never require surgery. This is not contracture, but your bodies reaction to the implant.

Grade 2 capsules rarely require surgery, but may be treated with antibiotics and/  or a leukotriene inhibitior such as Singulair.

Grade 3 and 4 capsular contractures require surgery to fix.  This can vary by person, but usually requires the removal of the implants, removal of the entire capsule, washout of the pocket with antibiotics, and replacement of the implants with new implants.  If the original implants were above the muscle, they will likely be placed below the muscle at that time. Following surgery, you may be placed on antibiotics for a few weeks as well as a leukotriene inhibitor such as Singulair.

A Reputation Built on Results

You deserve the highest caliber of service, care, and results, and at Lewis Plastic Surgery, we're committed to providing all that and more. But don't take our word for it—see for yourself what our actual patients have to say about their experiences with us.

Read More Patient Reviews
Google
5.0/5
Oct 15, 2020
Google Lewis Plastic Surgery
Dr Lewis and his staff is amazing . His Cordinater Erin is absolutely amazing . Few months prior I went somewhere else and did receive the quality of care I did here. They truly go above and beyond. Dr Lewis Keep it 100 straight forward with you no sugar coating but still compassionate with his approach. Erin make you feel like you are best friend very easy to talk to and warminf . And from the moment I spoke to the receptionist Irene who set the tone because she is the first person of contact before anything . You can feel her how genuine she is . I never once felt rushed and they walk me through the entire process The entire staff is like the chick fil a of plastic surgeons I’ve been crying because I’m so happy with them and more then happy with my finish look. I would tell anyone to skip the other places and go straight to these guys. Something i wanted for the past 15 years I’m so excited and very please . I can’t thank Dr Lewis and his team enough
Google
5.0/5
Oct 1, 2020
Google Lewis Plastic Surgery
Great doctor and surgeon. Highly recommend
Google
5.0/5
Jun 10, 2020
Google Lewis Plastic Surgery
Dr. Lewis and his staff are FANTASTIC! I recently had a breast implant removal procedure. He answered all of my questions with so much patience and thoroughness, even when asking more than once (with my millions of questions and concerns.) The day of surgery, he made me feel so comfortable. I was a bit nervous and frantic (I hate anesthesia) but his staff was super comforting and made sure that I was calm. So far I love my results! His assistant Lee was also super helpful answering my questions and concerns and made my appointments easy and stress free! I would recommend Dr Lewis to anyone 100%!!!
Google
5.0/5
Mar 13, 2020
Google Lewis Plastic Surgery
I had a breast reduction about a year ago from doctor Lewis. This entire staff is very kind and helpful during the process. They made sure I was comfortable before, during and after the procedure. Erin, his nurse specifically dedicated to breast reduction patients, is an absolute delight and is very responsive with any questions or concerns I had. Doctor Lewis isn’t a man of many words but his work speaks for itself. My scars have healed beautifully and are virtually unnoticeable. I have not suffered back pain or discomfort since surgery. I would absolutely recommend Dr. Lewis and his staff to anyone looking for good people and good results!
Google
5.0/5
Jul 30, 2019
Google Lewis Plastic Surgery
5 ⭐️'s are honestly Not Enough when it comes to Dr. Lewis and his staff!! As referral coordinator for a large family practice group, this review is from one familiar with most local specialists ...and also an extremely Pleased, Grateful patient. When Dr. Lewis opened his office some years ago not far from ours he came by to introduce himself, and has become a patient "favorite" since we first started referring to him. During these years I've never once heard a single negative about him or his staff (very .rare. in my particular job!)... so, when my opthalmologist determined my droopy, sad eyelids were contributing to vision issues and blepharoplasty recommended, the surgeon I wanted was an Easy choice-- Or, so I thought. When I called to schedule a consult I was genuinely heartbroken to hear Dr. Lewis was non-par with my Medicare insurance. After much procrastinating finally decided on an ocular plastic surgeon-- went for the initial evaluation and even set up a surgery date. The following day I needed to schedule an appointment for one of our patients with Dr. Lewis -- long story short and as Fate would have it discovered Dr. Lewis had Just started taking Medicare the week before. To my extreme delight, before hanging up Lee scheduled me for an eval and the rest is history. Had my surgery 4 months ago -- the procedure and recovery was a breeze. I'm thrilled to See so much better, not to mention look Better and Awake, like I have Eyes again. Lewis Plastic Surgery is Sincerely the B e s t, and I couldn't recommend Any cosmetic office more Highly!!
Google
5.0/5
May 23, 2019
Google Lewis Plastic Surgery
Dr.Lewis, Lee & the rest of his staff are fantastic!! I went in for a breast lift and to replace my old implants. Dr. Lewis was very informative as to how the procedure was going to be, recovery and what to do after surgery. I’m beyond ecstatic with my results! I totally recommend Lewis Plastic Surgery.
Google
5.0/5
May 9, 2019
Google Lewis Plastic Surgery
I got my BBL with Dr.Lewis and I am 100% satisfied. From the very first day I walked into his office, his receptionist and staff were extremely welcoming and kind. Lee made my experience very comfortable and I always felt heard and very well taken care of. Dr. Lewis is very knowledable and takes his time to answer questions and make his patients feel that they are getting the care that is necessary. I never once felt that I was wasting my money and the staff gave me very reasonable before and after expectations.
Google
5.0/5
Apr 3, 2019
Google Lewis Plastic Surgery
Dr. Lewis is amazing. He talks to me like I'm person, not a case file. Shared a few laughs too. I wasn't exactly sure how much i want to reduce the size of my breast. He gave me a homework assignment, 'Find my ideal breasts size on someone with similar body build as mine'. I showed him the pictures, we talked about realistic results. I could not be more happier with the results. No more neck, or back pain. Also the ladies that run the office are all wonderful. Thanks for easing my anxiety. I would recommend them to anyone looking to have some work done.
Google
5.0/5
Feb 28, 2019
Google Lewis Plastic Surgery
After tons of research and 2 other consults, I made a consultation appointment. I was brought back by Lee who immediately made me feel more comfortable than I had felt in the other consultations. Lee has stayed in touch with me and now I consider her a friend. I am still saving up for a tummy tuck and will hopefully have it by the end of the year.
Google
5.0/5
Feb 13, 2019
Google Lewis Plastic Surgery
When I researched for a plastic surgeons on line to perform an abdmominoplasy on me, I found that Dr. Lewis was reported to be the best in the Virginia. So, I had the procedure done by him and the reviews were true. Him and his staff (especially Lee) were awesome. I feel like a new woman, I no longer turn off the lights with my husband anymore. I feel so sexy. Thank you Dr Lewis. You really are the best.
Google
5.0/5
Oct 7, 2018
Google Lewis Plastic Surgery
Dr. Lewis and Lee are the reasons why I chose this practice. I felt right at ease from the beginning. It's not a "stuffy" atmosphere. Dr. Lewis earned my respect when he told me I didn't need work done in an area I was considering. This proved to me that he had my best interests at heart and wasn't all about making money. On the day of surgery, Lee came personally pre-op to keep me calm and Dr. Lewis was great about making me feel comfortable.
Google
5.0/5
Sep 25, 2018
Google Lewis Plastic Surgery
Can't say enough about Dr Lewis and his staff... They make you feel comfortable , they are not pushy but provide you any and all information you need you make good decisions and have a great recovery. I would recommend Dr Lewis to anyone!! If you are thinking of getting plastic surgery, see Dr Lewis and his staff. I'm sure I will be making a second trip😊
Google
5.0/5
Sep 24, 2018
Google Lewis Plastic Surgery
Dr. Lewis did a wonderful job--I am so happy with my results! Him and his staff were so professional and friendly, it totally put me at ease.
Google
5.0/5
Sep 24, 2018
Google Lewis Plastic Surgery
After a very long 30 years of being over weight I finally decided to have Bariatric surgery to help me with my weight loss I went from 240 lbs to 165 lbs and kept it off for 2 years. I tired to do something with the extra skin around my waist, hips, thighs, and sagging breast with no success. I finally decided to look for outside help … One afternoon I was making some calls to the Local Plastic Surgeons, When low and behold I call the office of Dr. Gordon Lewis office ,and Lee answers the phone and had all of the answers to any questions I ask. I just had to meet them the only thing was he was on vacation, I had to wait an addition week , but it was all worth it, I went in the office feeling so comfortable and excited. I met Tande within about a 2 minutes of waiting I was talking with Lee and I got just what I expected a Phenomenal person who truly understands where you are coming from, not knowing that this group was going to mean so much more to me than a Dr.s office it is a Family !!! Dr. Lewis truly cares about you, Erin is also in the office and she is fantastic ..They all have the best interest in your happiness and safety. they are the best I just can't say enough ..Thank you to the whole Practice. OK,OK, get to point Lisa, I had 3 surgeries Abdominoplasty (tummy tuck), Thighplasty, and a Breast Lift !!! and it has been a AMAZING Journey !!!! Thank you so Much to the whole Practice.
Google
5.0/5
Jul 24, 2018
Google Lewis Plastic Surgery
Couldn't have asked for a better experience. His assistant Lee made me immediately comfortable and relaxed at every appointment. Pricing was competitive and follow up was great. I love my results!!
Google
5.0/5
May 1, 2018
Google Lewis Plastic Surgery
Best dermaplane in my life!! Beautiful office and great location. The staff was helpful and friendly.Yvette educated me about my skin throughout the service, which was awesome! I was so relaxed the entire time. One of the most pampering experiences I’ve ever had. Thank you!!
Facebook
5.0/5
Apr 9, 2018
Facebook Lewis Plastic Surgery
Very hospitable and professional staff. I felt very at ease the moment I arrived and they checked up on me at home. I love the results of my procedure. I would definitely recommend! ��
Google
5.0/5
Oct 10, 2017
Google Lewis Plastic Surgery
I had one baby and then twins, and my abdomen was a wreck. So after 5 years of twin-skin I decided to proceed with a tummy tuck and repair of my diastasis recti. I had 3 consultations and decided on Dr. Lewis. So glad I did. He was so kind and listened to all of my concerns. He also recommended I not do an additional procedure I had thought about. And I appreciated that, glad I held back. He never seemed to be in a hurry to move on to the next patient, which is a nice feeling when you have 500 questions about your upcoming surgery. Lee was also awesome to work with and easy to get in touch with. I could sit and just chat with her all day! My surgery went smoothly and as expected. His demeanor was so calm and gentle right before I went into the OR that I wasn't nervous at all. All of my follow up visits have been great, all the staff is wonderful and always cheerful! I never had to wait longer than just a few minutes before he popped in. He is very committed in his follow up care with me still and I am 12 months and 2 weeks post-op. We are working on fine-tuning areas of my tummy tuck scar, my skin is being difficult. My belly button looks awesome and I spent this summer in a bikini----WHAAAT!!?? Very happy with my surgeon and my choice. Thank you Dr. Lewis!
Google
5.0/5
Aug 19, 2017
Google Lewis Plastic Surgery
Awesome staff- beautiful location- love Dr. Lewis!
Google
5.0/5
Mar 6, 2017
Google Lewis Plastic Surgery
All my life I struggle with my weight and body image. It wasn't until 2015 that I made the commitment to eat better and hire a personal trainer in order to reach that goal. I was able to go from 135lbs to 119lbs. Yet my body still not looked the way I wanted to no matter how much I worked out. My trainer told me that my abs where strong but I had excess skin around them and that exercise could not make it better. It was then that I decided to get an Abdominoplasty (tummy tuck). I visited a total of four surgeons, I saw hundreds of photos. Many did not looked convincing at all. After all the research and face to face meetings I decided to visit Dr. Lewis On January 2016. He was the one with the best reviews and recommendations but I needed to see if this was true. The first thing I need to say is that his Staff is AMAZING! Everyone Erin and Lee were always courteous, nice, humble, and caring. I didn't feel like just a costumer at all, they really showed interest during all my visits. They made me feel comfortable and safe. When I finally met Dr. Lewis he was just like everyone in the Staff. He took his time, explain the procedure,provided options for procedures, and answer all my questions and even my boyfriend's concerns 9who was more nervous than me). On the following appointments we explained in detail what I needed to do to get back to my workout routine and again: taking his time and always treating me as a valued patient. Words cannot express how thankful I am about the results of my surgery. I used to hate looking at the mirror since I was 11 years old. Finally, 23 years later I can look, smile and for the first time wear a 2 piece bathing suit. My body image issues are no longer there, I am happier and more confident. I wouldn't be able to reach this life dream if it wasn't for Dr. Lewis and his Staff. Thank you Dr.Lewis, Lee and Erin from the bottom of my heart, God Bless and continue with the outstanding work. With lots of love and appreciation: Karina
Google
5.0/5
Feb 7, 2017
Google Lewis Plastic Surgery
Having plastic surgery is a huge decision. However, once I met Dr. Lewis the decision was easy. From the first appointment for a consultation to all my follow-ups, Dr. Lewis has been nothing but dedicated to my safety and satisfaction. I had two procedures at the same time which turned out to be the best things I have ever done for myself. My recovery was quick and the results are spectacular. I could not be more pleased and will be back for more very soon.
Google
5.0/5
Feb 3, 2017
Google Lewis Plastic Surgery
Having plastic surgery with Dr. Lewis was absolutely the BEST decision I have ever made for myself! I feel more confidant than I ever have in my life, not to mention working with Dr. Lewis, Lee and his entire staff was an amazing experience. They will forever be my friends and I highly recommend Dr. Lewis and his staff to everyone who is considering a positive life changing experience!!
Google
5.0/5
Feb 2, 2017
Google Lewis Plastic Surgery
Had surgery 6 month ago and have been thrilled with results! Dr Lewis and staff are fantastic!
Google
5.0/5
Feb 2, 2017
Google Lewis Plastic Surgery
Highly recommend. Never have to wait at an appointment. Everyone is wonderful to work with and they make it a breeze.
Google
5.0/5
Dec 29, 2016
Google Lewis Plastic Surgery
Dr. LEWIS AND HIS STAFF ARE AHHHHHMMMAAAZZZING!!!!!!!
Facebook
5.0/5
Mar 29, 2016
Facebook Lewis Plastic Surgery
I've seen Dr. Lewis twice and I've loved both results! Wonderful staff and he makes you super comfortable!!
Google
5.0/5
Mar 23, 2016
Google Lewis Plastic Surgery
I loved working with Dr. Lewis and his staff! They were awesome and patient with me. I had several things done with Dr. Lewis including Tummy Tuck, Lipo, Rhinoplasty, and Breast Augmentation. I am so HAPPY with the results!! He's AMAZING!! Always courteous and available for me. Couldn't be happier with my results and his work 🙂
Google
5.0/5
Nov 6, 2015
Google Lewis Plastic Surgery
Dr. Lewis has guided me through three cosmetic surgery procedures over the last three years (face, abdomen and breast). Each was a step to address body changes, after bariatric surgery; and each surgery had the result I hoped for. The patient experience could not have been better; from initial consultation, to being well prepared for what to expect, and finally excellent recovery care. His staff is fabulous as well. Erin, Iveth, Kelsey and Jessie always show kindness and respect, and are skilled and efficient in their roles too. I highly recommend this MD for his skill, his compassion, and the team he has assembled to create Lewis Plastic Surgery. I am a repeat customer by design! Final note: Since having the facial surgery I have found that the investment in ongoing skin care by Iveth is well worth the investment. It far exceeds the quality of a local spa and the products are remarkable.
Google
5.0/5
Nov 17, 2014
Google Lewis Plastic Surgery
My bilateral brachioplasty (upper arm lift) was performed flawlessly by Dr. Gordon Lewis. I am not exaggerating when I say that I only had very minor discomfort in both arms during the recovery period and absolutely no pain !! Over-the-counter medication was all I needed. I was skeptical when Dr. Lewis told me that I would not have an agonizing recovery. I assumed when he removed the loose skin from both upper arms that I would surely have pain. The slight scarring on the inside of both arms continues to fade and I couldn't be more complimentary of Dr. Lewis' expertise as a surgeon. The "chicken wing" look I used to have has been replaced with youthful looking arms and I'm wearing sleeveless tops once again. I am ecstatic with the results.
Google
5.0/5
Jan 22, 2014
Google Lewis Plastic Surgery
A kind and caring team! Thank you so much for a great experience, your team has been absolutely super. I would be more than happy to recommend you to and friends or family who needed you.

Issues With Position

Poor position of the implant

When implants are placed underneath the breast, there are several goals.   The implant is ideally centered underneath the nipple areolar complex.  The breast should have a smooth contour from the side.  The breast tissue should be on the front of the implant.  There should be a normal size and position of the cleavage, and the breasts should be reasonable symmetric.   If the implants are not correctly placed at the original operation, or if a patients soft tissue does not react as expected, the implants can stay in positions the do not create a harmonious appearance to the breast.

Implants too high

When the implants are placed at the time of surgery, in most  women, the tissue at the bottom of the breast needs to stretch to accommodate the implant.  The implants usually sit a bit high after surgery.   The implants the “drop” over the next few months.  In some circumstances, the implant does not drop.  This may require a small revision to release this tissue.

Implants too low

If the pocket underneath the breast is made too large at the time of surgery, or if large implants are placed and over time the soft tissue can  not support them, and revision surgery may be needed to raise the implants on the chest and to recreate the inframammary fold.  Often this can be done with an internal bra that will increase the strength of the tissue and prevent recurrence of the problem.

Synmastia  (implants too close together)

This results from the creation of a pocket for an implant that gets too far to the middle of the chest.  If all the medial fibers of the muscle and fascia are released, the implants can migrate centrally and sometimes can touch each other.  This can create the appearance of a “uni-boob”.   This can be a much more difficult problem to repair.  This always requires surgery to repair and sometimes requires decreasing the size or temporarily removing the breast implants.

Implants too far apart

If the pocket created for the implants is too wide, the implants may sit farther out than wanted.  This can be repaired by internally closing down the extra space bringing the implants closer together.

Procedure

What is a breast implant?

Breast augmentation surgery involves the placement of custom-fitted saline breast implants or pre-filled silicone implants. This procedure allows women of all ages to select the bust line they have always desired or restore the youthful contour of the breasts they once had. In addition to enhancing the size and shape of the breasts, this procedure improves firmness. More on Breast Implants / Augmentation.

Do many of Dr. Lewis’s patients need revision?

Dr. Lewis has been very successful in guiding patient to implants that are the correct size and shape for each persons body.   He is also meticulous in his surgical care.  This has helped to keep the need for revision in his patients to a minimum.

Most of the revisions he has performed are in women who have originally had breast augmentation surgery through another surgeon.  He has been very successful in helping these women resolve their issues.

The care needed for revision breast surgery can be very easy such as in cases of a recent saline breast implant rupture, however it can also be very challenging such as in cases of significant asymmetry, synmastia, or substantial implant malposition.  We carefully individualize the plan for each person coming in for an evaluation and direct the plan based on the best options to fix the problem.

Your options include:

Implant exchange

Placing new implants in the same pocket

Capsulotomy

Making openings in the capsula to allow the breast to stretch around the implant.  This is very useful in minor cases of implant malposition.

Capsulectomy

Removing the entire capsule-  This is most commonly performed in cases of significant capsular contracture.  This usually also involves removal of the breast implant and replacement with another implant.

Capsulorraphy

This involves removal of a portion of the capsule and suturing it to tighten the pocket.   This is most commonly used as part of an operation to raise an implant to is too low, or too wide on the chest.

Areolar reduction

In some cases after breast augmentation, the areola can stretch to a larger diameter.  This is usually a very mosest amount, but in rare cases it can be more than desired.  The areolar diameter can be reduced with a very small surgical procedure and has minimal complications.

Repair of a tuberous breast

This can be a very complex process depending on the degree of tightening and herniation of breast tissue from the tuberous breast deformity.  The repair can be as simple as opening the under surface of the breast, or can be a process that involves two to three steps to create a natural appearance.

Recovery

Will anesthesia or pain relief be used during and after surgery?

You will be made comfortable throughout the whole procedure. Most women have a general anesthesia for this surgery. However, if a patient has a medical condition or concern that would preclude general anesthesia, monitored sedation can be used. After surgery, you will be given instructions on pain relief medication, if required.

What happens immediately after surgery?

Once the incisions are closed with sutures, surgical garments are wrapped around the chest to protect the treatment area. Our breast revision patients initially recover in the recovery room, observed by our licensed nurses. After a short period when you are awake and comfortable, you will be able to go home to rest.

How long will complete recovery take?

We suggest taking a week off of work, but some patients will return to work faster assuming that they do not have to perform any heavy lifting. Full recovery takes two to four weeks.

Your first post-operative visit will be scheduled about two to four days after the procedure and you are then seen a few more times during the recovery period. In the first few days patients often experience mild discomfort, bruising and swelling, all of which are considered normal and treated with prescription medicine. Patients are also asked to wear a special supportive garment for five to seven days after which they may resume wearing normal bras. Detailed instructions on how to care for the incisions, when to resume exercise and other pertinent facts are provided prior to surgery.

Your relationship with us will not end after the surgery. We will see you frequently after the surgery for the next weeks and months and will want to see you back one year after surgery as well. We will continue to advise you on activity, exercise, breast self-examination and the future need for mammography, as you require.

Risks

What are the risks of breast reduction surgery?

Check Accreditation

With any surgical procedure there are risks that you must be aware of. To minimize the risks, ensure your surgery is conducted in a safe and secure environment using the latest surgical techniques by checking the certifications and accreditation of your surgeon. Accreditation boards and bodies are there to protect you. Dr. Gordon Lewis has 9 years surgical experience and is affiliated to several important professional organizations.

  • He is board certified by the American Society of Plastic Surgeons www.plasticsurgery.org
  • Affiliated to the Richmond Academy of Medicine www.ramdocs.org and the Medical Society of Virginia www.msv.org
  • He is also an associate member of the American Society for Aesthetic Plastic Surgery www.surgery.org and the American College of Surgeons www.facs.org
  • A candidate member of the American Society for Surgery of the Hand www.assh.org

Possible Complications

Although infrequent, breast implant surgery risks may include (but are not limited to);

  • Numbness of the breast
  • Swelling
  • Bleeding
  • Leakage or Rupture
  • Poor aesthetic scar healing
  • Formation of scar tissue around the implant
  • Changes in nipple / breast sensation

Post-operative complications are rare but may occur in some patients. If you experience any alarming symptoms, please contact us right away.

Consultation

During a comprehensive one-on-one consultation at Lewis Plastic Surgery, we will assess the existing implant, determine any immediate dangers and discover your goals moving forwards:

  • Assess reasons for implant revision
  • Look at the options for new implants including the difference between saline and silicone breast implants
  • Look at breast implant sizes and shapes
  • Breast implant placement: behind, in front of or partially behind the pectoral muscle
  • Incision types: under the breast, around the nipple or in the axilla (arm pit)
  • Surgical facility and anesthesia
  • Breast revision cost and financing options

Location

Dr. Lewis performs surgical procedures at an accredited outpatient surgical center or a local hospital. He is affiliated with several local medical centers where his patients undergo surgery. He primarily operates at these locations:

Johnston-Willis Hospital
Stony Point Surgery Center

Initial consultations, follow up appointments and all non-surgical treatments and minor surgical procedures are performed at Lewis Plastic Surgery in Midlothian, VA.

Cost

Revision breast surgery is very difficult to price without a consultation because the needs are so individualized.  If you email us with general concerns, we will attempt to give you a price estimate, but unfortunately, this may not be accurate.  The only way for us to give you a accurate estimate of costs, is to have an in person consultation.   At that time, you will be given a quote which includes all the costs of the surgery. This will include:
CosmetAssure

  • Dr. Lewis’s Fee
  • Operating room fee
  • Anesthesia fee
  • Cost of implants
  • Cost for CosmetAssure®

Booking

Every patient is required to attend an initial consultation before a procedure can be booked. Once you decide to proceed with surgery, we will assist you in finalizing a date and getting everything ready for surgery. We try to be as flexible as possible and will make arrangements to see you at Lewis Plastic Surgery on the grounds of Johnston-Willis Hospital within a few days after you contact us.

Depending on your requirements, we can normally perform your procedure within 2 weeks. You can book a consultation online or by calling (804) 267-6009.


Gordon Lewis, M.D.

Dr. Lewis, a native of Richmond, prioritizes building honest, trusting relationships and providing personalized care for his patients.

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