Purpose: the purpose of this study is to standardize the secondary breast augmentation procedures for aesthetic reasons (prosthetic malposition, skin rippling, unaesthetic result) for which the use of silicone anatomical implants allowed a satisfactory correction.

Material and method: Twenty eight women underwent reoperative breast surgery between 2001 (date of the authorization of use of silicone implants in France) and 2003, for correction of unaesthetic breast augmentation. All the cases of capsular contracture or implant rupture were discarted. The new implants replacing the explanted saline or silicone round or anatomic implants were 410 style anatomical implants (Inamed, USA). Implant replacement was always bilateral, and usually associated with a modification of the implant pocket (capsulectomy, dissection adapted to the repositioning, capsulorraphy, inframammary fold suspension…) The evaluation of the results is based on a standardized photographic analysis with a 6 months minimal follow-up after the recovery.

Results: The various complaints of the patients and their causes are analyzed. They include unnatural shape with upper pole bulge, insufficiently corrected ptosis, implant malposition and visible rippling. In all the cases, partial capsular excision and suture adapted to the new implant position and use of anatomical implant made it possible to improve the aesthetic result notably. Skin rippling was treated by the use of implants with cohesive gel, except when the Pectoralis Major muscle was largely divided. Anatomical implants drawbacks are mainly the larger choice of those implants over round implants.

Conclusion: the use of silicone anatomical implants with an adapted repair of the pocket made it possible to treat in a satisfactory way the near total of the aesthetic insufficiencies after a first breast augmentation