Will I need a revision surgery after breast reconstruction? [Kyle Baltrusch, MD, Portland]

Dr. Baltrusch (00:00):
My name is Kyle Baltrusch. I am a plastic surgeon at Portland Plastic Surgery Group in Portland, Oregon.

Eva Sheie (00:05):
Let's say you get all the way through this process. You've gone through tissue expanders and now you've gone through the second stage, you're fully reconstructed. How often do people require a revision after that? Does that come up often? Not often?

Dr. Baltrusch (00:24):
Not very often. It's also another reason why I like two stage reconstruction. So certainly revision rates are higher in a single stage. So some people do go direct to implant with mastectomies, but the revision rates are upwards of like 25 or 30%. And I think cosmetically my outcomes are better with a two stage. So usually at the second stage, I can fine tune if I need to do any capsular work or soft tissue work for better outcomes. So certainly I still see patients who want to have implant exchanges or they get contractures and we need to do capsulectomies and start fresh, but I would probably put that on the verge of maybe 5%.

Eva Sheie (01:00):
Are there types of patients who might have had a reconstruction years ago maybe before some of these newer techniques and technologies were available that could benefit from another round of reconstruction?

Dr. Baltrusch (01:14):
Certainly. So if patients have implants and they should be established with the plastic surgeon to, at some point, those implants are going to have to be exchanged. And the FDA recommends every 12 or so years. And so I mean, that's a great time to also undergo any additional revisions that need to be taken under so capsular work or soft tissue work. But I do see a lot of patients who had their reconstruction 15 or so years ago who are coming in to talk about revisions or even just having their implants exchanged.

Eva Sheie (01:44):
Can a reconstruction fall and require a breast lift later, just like any pair of breasts that fall over time?

Dr. Baltrusch (01:52):
Yeah, certainly. Part of the aging process is the ligaments of the body, they attenuate and stretch, and so there are certainly ligaments of the breast called Cooper's ligaments, and they also will stretch or attenuate with time. And so in 15 years at the time of an implant exchange, it's not too uncommon that we're doing some skin tightening or breast lifts concurrently.

Eva Sheie (02:12):
Links to our guest's website and contact info are in your show notes. Follow us on Instagram @wherebeforemeetsafter. Where Before Meets After is a production of The Axis, the podcast agency for aesthetics, theaxis.io.