Breast Implant Revision
A good Breast Augmentation surgery will result in increased breast size that will hopefully make patients happier and more confident. However, not all the results are positive. Breast Revision surgery is performed when the results of a previous Mammoplasty were less than ideal due to skin elasticity, internal structure, or a less trained surgeon, or when implants need to be replaced. Breast Implant Revision surgery is a procedure used for revising or correcting a prior reconstructive or cosmetic breast surgery. This includes changing the size or type of the breast implants and fixing and correcting any complications or unsatisfactory results from prior surgery.
Why is breast implant revision needed?
There are several medical and cosmetic reasons why Breast Implant Revision is needed. In some cases, breast implant revision may be required due to complications following breast implant surgery, breast enlargement surgery, breast augmentation, or other aesthetic plastic surgery. The following are some of the reasons patients may opt for this procedure.
Implant size issues
Sometimes after the breast augmentation surgery, women realize that their breasts are too big and want them to be smaller. When exchanging larger implants for smaller ones, the surgeon's concern is ptosis, sagging breasts, and redundant breast tissue and skin.
Therefore, the procedure to downsize the implant is accompanied by a breast lift procedure to ensure there is no sagging skin or excess breast tissue. For patients that want to upsize their implants, the surgeon will focus on creating a bigger pocket where the surgeon will place breast implants. If the implant location was subglandular, the surgeon will change this to submuscular and create a new implant pocket for the bigger implant while removing the former implant.
Leaking/ruptured implants / Implant rupture
Both saline implants and silicone breast implants can get leaks and ruptures. For saline leaks, patients may slowly notice a decrease in breast volume or asymmetry during or after the healing process, especially if only one side of the round implants is leaking. Silicone ruptures are more difficult to spot and patients may need an ultrasound or mammogram to see the leak.
When breast implants leak, surgeons will need to remove them and replace them with new implants to help the patient achieve their desired outcome again.
A capsular contracture is the response of the immune system to foreign objects in the body and the formation of an abnormal “capsule” of scar tissue around the implant. A capsular contracture is a tight and thickened scar tissue that the body creates in order to protect the important organs from the foreign object inserted during the surgery. The tight scar tissue makes the breast appear unnatural as the movement of the implant is restricted. It can also lead to feelings of discomfort.
To address this, surgeons remove the hardened scar tissue around the implant and replace the implant in a new position relative to the patient's chest muscle.
Breast Implants are positioned too high
Sometimes, the breast implants are placed too high in the chest wall or in a different position during breast enlargement surgery. The surgeon hence, has to perform a second surgery to move the implant in the right position to create balance in the chest, remove its capsule and create a new pocket lower than the previous one. The surgeon will then insert the new implant in the correct position.
Lateral displacement of the Breast Implant
This occurs when Breast Implants are placed too far apart during a previous surgery. Because of their distance, the breast shape doesn't create the desired cleavage. To address this, the surgeon will use stitches to minimize the side of the previous pocket, insert the new implants, and put them towards the body's midline, or simply provide the patient with bigger implant size.
Bottoming out of Breast Implants
The bottoming out of breast implants may be due to the skin's loss of elasticity, weak internal muscles, or a less-trained plastic surgeon made the breast implant look low and the nipple too high. This is addressed by the surgeon replacing the implant and then making the pocket higher. The surgeon will then place the implant in the elevated pocket and suture the lower pocket.
Rippling on the skin
Rippling usually occurs in thin patients. This is when ripples from the breast implants are seen on the skin’s surface. To hide these, the surgeon will either utilize fat grafting to increase the volume of soft tissue under the skin or use Acellular Dermal Matrix (ADM) as a scaffold to create a more natural-looking breast. Both surgical procedures help provide camouflage for ripples.
Uniboob or Symmastia correction
Symmastia can happen in breast surgery patients. This is when the implants are placed too close to one another, appearing to form a uniboob. In rare cases, the skin and muscle between the breasts and over the sternum may detach and the two pockets for the breast implants come together into one pocket. A Uniboob look may also be the effect of implants that are too large inserted in a thin woman who has a small chest circumference.
Whichever the reason, symmastia can be addressed by extending laterally and outwards from the midline breastbone. This will create more space between the implants. This involves creating an incision below the implants and expanding the pockets laterally. The chest midline is then fixed with sutures.
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
In very rare cases, a treatable type of lymphoma may develop around breast implants. This may occur in patients with implants that have textured surfaces. BIA-ALCL is a type of cancer of the immune system and not breast cancer.
Symptoms for this may include pain, breast enlargement, asymmetry, a lump developing in the breast or armpit, rashes, fluid retention, or breast hardening. Symptoms can occur anywhere from 1 year to 8-10 years. Patients should see their doctor right away to be evaluated.
If this happens, the surgeon will need to remove the implant and the scar tissue around the breast implant including any lumps. Affected patients, may also have to undergo additional treatments.
Candidates for Breast Implant Revision Surgery
Criteria to consider for Breast Revision Surgery candidates are:
- Patients should consult with their surgeon to discuss issues and desired results. Together, the plastic surgeon and patient will evaluate the problem and decide on how to solve it. Breast implant revision can be a difficult procedure as many factors are involved, so surgeons will have to explain to each patient the best path forward depending on their needs, implant issues, and desired outcomes. Surgeons will also explain potential incision locations, shapes and sizes of implants, and their positioning prior to performing the boob job.
- Patients will undergo a physical examination including blood tests, chest x-rays, and any other tests their surgeon requires.
- Patients must stop smoking and drinking at least 2 weeks before the breast augmentation plastic surgery / augmentation mammoplasty.
- All blood-thinning medications like Aspirin, Ibuprofen, hormones, and herbal supplements must be stopped 2 weeks before the cosmetic plastic surgery.
Breast Implant Revision Surgery Procedure
Breast Implant Revision surgery is more complicated than the original breast enhancement surgery. Some of the challenges for surgeons include the presence of scar tissue, anatomical changes caused by previous implants, and the stretching of muscles. These factors make it harder to predict the surgical outcome.
The surgery steps are relatively straightforward:
- The surgery is performed under general anesthesia.
- The surgeon will address breast revision issues either replacing old implants, repositioning implants, releasing scar tissue, breast lift, or resizing and reshaping.
- The Surgeon will then close the incision and bandage the wound with surgical tape and adhesive.
- The operation can run from 1 to 4 hours depending on the reason for the revision and any potential complications.
Post-Procedure care for Breast Implant Revision Surgery
Post-operative care tips for the Breast Implant Revision surgery are similar to the previous Breast Augmentation post-op care tips. Things to remember include:
- Keep the wound clean and dry for 2-3 days after the surgery.
- Use a cold compress to help control bruising and swelling
- Sleep with the torso elevated slightly to help with bruising and swelling.
- Take pain medication as needed.
- Stitches will be removed 7 days after the surgery.
- Keep every follow-up appointment with the surgeon.
- Patients should wear a compression bra for added support and positioning to help prevent fluid accumulation and control the swelling.
- Patients should not lift anything over 2-3 kilograms within the first six weeks after the surgery.
- Patients must avoid all strenuous activities for a minimum of 2 weeks after the surgery.
Breast Implant Revision Recovery
The recovery time for Breast Implant Revision surgery is similar to that of Breast Augmentation. There is usually minimal discomfort that can be managed with pain medication.
In most Breast Implant Revision cases, patients can return to work within a few days with some discomfort. However, the actual length of recovery will depend on the type of surgery performed.
- Breast implant replacement has approximately the same recovery time as Breast Augmentation. It will require more time if the new implant is bigger. Discomfort symptoms may include pain, stiffness, bruising, or swelling. It could take several weeks or months for new implants to fully settle and for patients to see the final results.
- Breast implant replacement with lifting will have a longer recovery time. Patients may experience swelling, pain, or seroma around the nipple area. Patients should wear a compression bra to provide support and improve swelling and positioning.
During Breast Implant Revision surgery recovery, patients must avoid heavy lifting and all strenuous exercise for a minimum of six weeks.