Revisional Breast Reconstruction
(Tertiary Breast Reconstruction)

Some women find that for one reason or another they are unhappy with the results of their previous breast reconstruction, often some years after the event or when their original surgeon retires. In this instance Professor Malata will carefully assess your problems and advise you as to whether the result can be improved using modern plastic surgical techniques. Often these are patients previously treated elsewhere or by non-plastic surgeons. Although options may be limited please be assured that Professor Malata will provide you with an objective and clear opinion on how to improve the reconstruction, if this is feasible. He will fully discuss the options available to you, their advantages and disadvantages and make a recommendation.

Often this involves implant exchange with the total removal of the surrounding contracted capsule (total capsulectomy), introducing new soft tissues, fat injections or occasionally total conversion to a method using only your tissues (total autologous conversion). Sometimes a reconstruction which used your own tissues only may need to be augmented with implants. Frequently with the effects of gravity on the opposite breast in addition to weight gain of middle age the contralateral breast may need to be lifted, reduced or both to match the implant based reconstruction.

Although Professor Malata is widely experienced in this field and receives many such tertiary referrals, revisional breast reconstruction is complex surgery and has the principal limitation of not starting on a clean sheet/ canvas or virgin field. A principal cause of suboptimal results is previous radiotherapy. The surgeon also has to contend with the scarring from previous surgery – the higher the number of previous operations the more the underlying scarring and the less improvement that can be achieved.

All operations carry risks as well as benefits. As in any plastic surgery, there are benefits, risks and the final results are not guaranteed. The chance of complications following revisional breast reconstruction depends on the type of operation and other factors such as your general health and previous radiotherapy. Professor Malata will explain how the risks apply to you. Detailed postoperative instructions will be discussed during consultation and a procedure-specific handout given to you by Professor Malata.

To view the before and after photos of surgery in some of Professor Malata’s publications on tertiary or salvage breast reconstruction please click below:

An algorithmic approach to abdominal flap breast reconstruction in patients with pre-existing scars results from a single surgeon’s experience

Indications for extra full projection anatomical cohesive silicone gel implants in cosmetic and reconstructive breast surgery

Anterolateral thigh free flap for complex composite central chest wall defect reconstruction with extrathoracic microvascular anastomoses

Implant augmentation of perforator flap-reconstructed breasts PDF

Limitations of tertiary or revisional breast reconstruction

• Scarring from previous surgeries
• Unfavourable effects of radiotherapy on the tissues and blood vessels
• Missing records for surgery done a long time ago or abroad
• Reluctance of the patient to abandon previous reconstruction