Occasionally changes occur after breast implant surgery that require surgical revision. These changes can be due to a failed implant, natural changes to the breast tissue or from natural changes resulting from childbirth and breastfeeding.
More commonly, there are issues with the previous implant surgery either in technique, accumulation of scar tissue or improper choice of surgical techniques.
Other reasons for a Breast Revision include:
- Implant failure
- Patient dissatisfaction with implant size, style or type (saline vs silicone)
- Capsular contracture
- Implant malposition (bottoming out, symmastia, lateralization)
- Hyperanimation deformity (excessive breast movement upon pectoralis muscle movement)
- Recurrent laxity or sagginess that was not previously corrected with a breast lift at the time of augmentation
- Patients who don’t want implants any more
Women who have issues with their breast implants are good candidates if they have any of the above issues with their implants, are in good overall health, and do not smoke.
Breast revision surgery is usually performed on an outpatient basis under either sedation or general anesthesia. Planning the surgical approach is based on what needs to be revised so procedures can be performed either through previous scars or breast lift (mastopexy) scars.
Mastopexy or breast lift involves:
a) conserving the blood and nerve supply to the nipple-areolar complex and migrating it to a higher position
b) reshaping the remaining skin and breast tissue so that there is a secure “hand in glove” fit for the implant
c) preserving sensitivity to the nipple areolar complex for future breastfeeding needs.
Occasionally breast revision requires “restoring normal anatomical borders” of the breast and may include redefining the space in which the implant is placed, using either permanent internal sutures and/or ADMs (acellular cadaveric dermal matrices), which serve as “internal bras” to provide support against implants moving “down and out”. ADM capsulorrhaphy is a technically demanding procedure, which was originally pioneered in reconstruction but has become increasingly popular in cosmetic breast revision. It is a more extensive operation but enjoys a high degree of satisfaction because of the low rate of recurrent implant malposition, capsular contracture while not interfering with mammographic screening.
Following surgery, you will be sore and swollen for several days, but any swelling should diminish within ten days to two weeks, depending on the extent of the surgery. You should be able to resume your normal activities within a few weeks.
Dr. Chong is deeply committed to providing her patients with the optimal results and personalized care. She will be happy to consult with you personally to help you determine if a Breast Revision procedure is your best option.
Implant Exchange FAQS
Will it hurt as bad as the first time?
Everything depends on the surgical plan, however generally speaking the chest wall muscles (pectorals) don’t have to be re-elevated or stretched.
If it hasn’t been 10 years, should I still replace them?
If an implant hasn’t leaked, become problematic because of hardening, malposition, size, palpable wrinkles or folds, and both size & nipple position is satisfactory, then there is no need to replace your implants. Rupture of a saline implant is unequivocal as the device collapses; however the phenomenon of “silent rupture” of silicone gel implants requires a specialized x-Ray or MRI for confirmation. I believe that the notion of revising breast implants every 10 years is related to the fact that corporate (implant manufacturer) basic financial support for revisional surgery expires 10 years post-op. The inclusion criterion for financial assistance depends on the manufacturer, product type & year in which it was placed, so it’s critical to keep your warranty information safe.
What happens if your silicone implant is ruptured and the doctor doesn’t know before surgery?
We always order “back-up” implants so any unanticipated contingency can be covered. If the implant is intact, the patient doesn’t incur any financial liability.
Can you use the same incision?
Of course but choice of the incision depends on the surgical strategy & aesthetic goals.
Will I have drains?
If the extent of capsular contracture is significant enough to warrant surgical excision, drains are inserted until their daily output is minimal. Current theories of the formation of capsular contracture blame the accumulation of blood around the implant and/or a low-grade inflammatory response. Drains address these concerns.
What does it mean when my breasts are hard?
Breasts can be perceived as hard because 1. They haven’t dropped and fluffed yet; 2. They are overfilled saline implants, which always appear hard and project a lot; or 3. The breast has elicited a “foreign body” reaction or capsular contracture around the implant. All women with implants develop a capsule around their implants, but it’s the extent of firming and distortion, which eventuates in another surgery to remove the scar and replace the implant.
Will I get any financial assistance from the old implant company?
It depends on which warranty you received with your current implants. We can help you find out when you come in for your consultation.
Can implant exchange be done at any age?
All patients are screened to ensure that they are suitable surgical candidates. Some patients may need some of their health issues optimized before surgery, but we are content to report that we are taking care of healthy seniors, who also enjoy great outcomes. Everyone deserves to be the best they can, at every age.
How have silicone implants changed over the years?
From the manufacturing perspective: 1. Better engineering in terms of stronger external envelopes & more cohesive (sticky) gel; and 2. The More imaginative design of profiles, including the new-comer, “gummy bear” gel implants. For Plastic Surgeons: 1. Ability to render a more complete informed consent, using long-term data on rates of CC (capsular contracture), deflation & secondary procedures; 2. Cooperation with FDA in tracking these devices, thereby increasing the fund of knowledge; 3. Basic science research on associated topics like causes of CC; and 4. Availability of tissue engineering options for enhancing implant longevity and outcomes.
Do the rates of capsular contracture increase with an exchange?
If you have never had a capsular contracture (CC) before, chances are slim you will get a CC the next time. If you have had a CC before, the rate is 2x higher.
Implant Explantation FAQ
What will my breasts look like after? Will they be smaller than the size they were before the implants?
Breasts will appear smaller & slightly relaxed. The volume should be the same as you had, or slightly more than was present pre-op. Women are amazed how their breasts could grow, however the implant exerts a tissue expansion effect & a woman’s body is under continual development.
Will I need a lift?
Not necessarily. Factors such as nipple position, skin laxity, size of the implant & desired outcome should be considered. Many women choose to “stage” implant removal & breast lift. Once the breast skin is “off-loaded” from the weight of an implant, it may contract to a satisfactory form.
What is the downtime?
Patients are pleasantly surprised how little pain they experience. It is advisable to avoid heavy exercise involving the upper body for 2-4 weeks, in order to avoid a seroma, or a collection of fluid in the space previously occupied by the implant.
Where is the incision?
I recommend the IMF (fold where breasts meet abdomen) because it is well concealed, provides the surgeon with excellent access & is least associated with alterations in nipple sensation and lactation potential.
Can you go through the same incision?
Yes, however re-entry through the peri-areolar scar can occasionally result in a tethered or depressed scar, once the implant has been removed.
What are my options if I want smaller breasts?
Since 2012, I have taken care of 100 explant patients; approximately 2% have opted to re-implement but with smaller volume. Elective surgery is just that, a woman can always choose to “downsize”.
Do you always have a capsule?
All breast implants elicit a foreign body reaction or capsule, which is a fibro elastic layer of scar around the implant. Not all capsules need to be surgically removed, especially if they are not symptomatic, i.e. causing pain & deformation of the breast. Capsules are “graded” according to the Baker scale, 1-4; excision of the capsule is recommended for higher grades.
Do people ever decide to put implants back in?
Yes, although in my experience, the explantation patients are highly motivated and have researched extensively before consulting. The decision to choose or opt out should be freely made after approving the risk-benefit ratio & with a strong knowledge of your individual values, aesthetic ideals & priorities.
Will it improve my health?
Conditionally yes but explantation is fundamentally a question of a woman’s ability to tolerate risk. Women who never “made friends” with their implants because they were too big, were “not me”, made me feel self-conscious, etc. will be psychologically rewarded. Peri menopausal weight gain may cause breast development, which may make women feel matronly and impede exercise ability. Concerns about mammographic surveillance, as well as suitability for eligibility for surgical revisions are also “drivers” for women seeking to optimize their health. The link between silicone and the subsequent development of auto-immune disease has been definitively excluded. Regrettably, once established autoimmune disease doesn’t reverse with explantation.
If I don’t like my new implants, how soon after can I get them taken out?
We encourage patients not to “buy in haste, repent at leisure”. The decision to proceed with any surgery should be carefully weighed. Nobody wants “buyer’s remorse” so pre-op sizing is extremely helpful in understanding a patient’s aesthetic goals. If a patient from another practice desires explantation, we request they discuss their dissatisfaction with the implanting surgeon & wait a minimum 90 days, to fully evaluate their results.
Dr. Chong will be happy to help you achieve your goals and address your needs. Contact our office in Newport Beach to schedule your breast revision consultation at (949) 644-1400.