It is possible to have a second breast lift, which surgeons refer to as revision mastopexy. This subsequent procedure is typically more involved and complex than the original surgery. The first procedure changes the internal architecture of the breast, introducing new challenges for any later operation.
Primary Causes for Seeking a Second Breast Lift
The results of an initial lift are not permanent. The most common reason for seeking a second procedure is the recurrence of breast descent, known as recurrent ptosis, which happens naturally over time. Gravity and the ongoing loss of skin elasticity due to the aging process gradually cause the breast to sag again, lessening the effect of the previous surgery.
Significant changes in body weight after the initial operation can also compromise the results. Both substantial weight gain and subsequent loss can stretch the breast skin envelope and alter the volume and shape of the breast mound. Pregnancy and breastfeeding following a mastopexy procedure are major factors that can cause a return of ptosis and volume changes.
When a breast augmentation was performed concurrently with the first lift, implant-related changes can necessitate revision. Issues such as capsular contracture, where scar tissue tightens around the implant, or implant malposition can distort the breast shape. Dissatisfaction with the original result, perhaps due to residual asymmetry or insufficient lift, is another common motivator for patients to seek a second procedure.
Technical Challenges of Revision Mastopexy
Operating on breast tissue that has already undergone surgery presents technical challenges. The most significant challenge is navigating the internal scar tissue, or fibrosis, left from the first mastopexy. This dense, hardened tissue can restrict the movement and reshaping of the breast mound, making it more difficult to achieve the desired contour and projection.
A second surgery involves working with a limited amount of skin, as excess skin was removed during the initial lift. This limits the surgeon’s ability to pull the skin taut for a new lift without creating excessive tension on the incision lines.
Furthermore, the previous surgery may have altered the local blood supply to the nipple-areola complex, increasing the risk of vascular compromise during the revision. The surgeon must carefully consider the technique used in the first surgery to ensure the new incisions do not jeopardize the remaining circulation.
Achieving perfect symmetry is particularly challenging in revision cases because the breasts may have healed and scarred differently from the first procedure. The procedure requires a more intricate and customized approach compared to a primary mastopexy to account for the altered tissue planes and existing scars.
Planning and Expectations for Repeat Surgery
The planning phase for a revision mastopexy involves a waiting period to ensure the breast has fully healed from the first procedure. Surgeons typically recommend waiting at least 12 months after the initial surgery to allow for complete tissue softening and scar maturation. This allows the surgeon to accurately assess the final outcome of the first operation and plan the revision.
Patients should be aware that revision surgery carries a heightened risk profile compared to a primary lift. Risks can include higher rates of delayed wound healing, wound separation, or further visible scarring. The probability of recurrent ptosis following the second procedure is also present, as the natural forces of aging and gravity continue to act on the tissues.
The results of a second breast lift may be more limited than the first. Correcting all imperfections and achieving perfect symmetry can be difficult when working with previously altered tissue. The surgeon’s primary focus will be on improving the contour and position while minimizing complications, acknowledging that the final outcome may not be the ideal.