19380 Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction)

Name of the Procedure:

Revision of Reconstructed Breast
Common names: Breast reconstruction revision, Breast revision surgery
Medical terms: Autologous flap revision, Capsular contracture revision

Summary

Breast revision surgery involves correcting or improving the results of a previous breast reconstruction. This can include significant removal of tissue, adjusting and re-insetting tissue flaps in cases involving the patient's own tissue, or significant changes to the capsule and soft tissue in implant-based reconstruction.

Purpose

The procedure aims to address complications or unsatisfactory results from a previous breast reconstruction. The goals include improving breast symmetry, correcting shape or position, and resolving issues such as capsular contracture or excess scar tissue.

Indications

• Deformity or asymmetry after initial breast reconstruction
• Capsular contracture (tightening around an implant)
• Implant rupture or other complications
• Poor aesthetic outcome
• Patient discomfort or pain related to the prior surgery

Preparation

• Fasting for at least 8 hours prior to surgery
• Adjustments or discontinuation of certain medications (e.g., blood thinners)
• Preoperative imaging or diagnostic tests, such as MRI or ultrasound
• Discussion with the surgical team about health history and expectations

Procedure Description

1. Anesthesia: Administered general anesthesia.
2. Incision: Making incisions along the existing scars or new strategic places.
3. Adjustment:
   • Flap-based Reconstruction: Removing or reshaping tissue, re-insetting flaps.
   • Implant-based Reconstruction: Removing scar tissue and implant, replacing or adjusting it.
4. Suturing: Closing the incisions with dissolvable or removable stitches.
5. Dressing/Bandaging: Applying surgical dressings and possibly drainage tubes.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity.

Setting

The procedure is performed in a hospital or surgical center.

Personnel

• Plastic surgeons
• Surgical nurses
• Anesthesiologists
• Supportive surgical staff

Risks and Complications

• Infection
• Bleeding or hematoma formation
• Scarring or poor wound healing
• Asymmetry or aesthetic dissatisfaction
• Anesthesia-related risks
• Complications related to implants (in implant-based cases)

Benefits

• Improved breast shape, size, and symmetry
• Relief from discomfort or pain caused by previous reconstruction
• Enhanced self-esteem and body image
• Benefits typically realized within a few weeks to months post-surgery.

Recovery

• Initial recovery period of one to two weeks
• Instructions for wound care, activity restrictions, and use of support garments
• Follow-up appointments for suture removal and monitoring
• Possible limitations on physical activities for 4 to 6 weeks

Alternatives

• Non-surgical options: External prostheses or fillers
• Revisions with different techniques, such as fat grafting
• Pros: Non-invasive options have minimal recovery time
• Cons: May not provide as durable or natural results as surgery

Patient Experience

• During the procedure: Under general anesthesia, so no awareness or pain
• Post-procedure: Expect swelling, soreness, and limited mobility initially
• Pain management: Prescribed pain medication and instructions for managing discomfort
• Full recovery typically occurs over a few weeks to months.

--- This markdown description succinctly covers the essential aspects of the breast reconstruction revision procedure, making it accessible and informative for patients.