The first texts that talk about cosmetic surgery date back to 800-600 BC; the Indian surgeon Sushruta described his personal rhinoplasty technique which used the “Indian flap”. However, it was in the second half of the twentieth century that cosmetic surgery took on a ubiquitous value in all social classes, becoming a means not only to allow aesthetic improvement but also to allow the patient social assimilation.
Today, there are more and more patients who visit their cosmetic surgeon after having already undergone one or more procedures in the same body area and who wish to further improve or correct or maintain the result and therefore require secondary or even tertiary surgery.
We can distinguish two categories of secondary surgery:
- maintenance: when after years of treatment, the result of the procedure needs a natural
- revision: when even after just a few months after treatment, the patient has not achieved the desired result
The most frequent procedure that requires maintenance is mammoplasty followed by blepharoplasty and the facelift.
The surgery that most frequently undergoes revision is once again mammoplasty
Breast surgery is linked to this problem because of the cohabitation with a foreign body that is the prosthesis and because of the technique evolution in the last 20 years. Since the end of the 90s, in almost all cases, the dual-plane partial submuscular procedure was the most used one (better coverage of the prosthesis, better aesthetic result), whereas in the 80s and early 90s, the technique used was the sub-glandular one (in a plane that is above the pectoralis major muscle).
Today, patients who want to replace old prosthetic breast implants because the diagnostic-instrumental assessments have highlighted a rupture, or because they are no longer fully satisfied with the result, must undergo a more complex operation that involves a change of placement (from the supramuscular to the submuscular plane).
In general, operating on previously untreated tissue is simpler for the surgeon since we are not faced with those annoying scar adhesions that disguise the anatomical planes and leave room for a possible uncontrolled evolution in healing.
Secondary surgery certainly has a higher risk of possible complications and for this reason a more in-depth approach is taken.