Breast Implant Revision
Breast implant revision, also referred to as breast augmentation revision, is a surgical procedure involving the removal and/or replacement of breast implants to correct complications that have occurred after breast augmentation or implant-based breast reconstruction surgery. Breast implant revision can also be performed to correct an unsatisfactory result from either of the aforementioned surgeries.
Removal of Implants
For some patients, unrelated health problems can arise that require the removal of implants. An example is the diagnosis of breast cancer – although breast cancer is not linked to breast implants, treatment of the disease may be more effective after breast implant removal.
Implants may also require removal due to implant complications, such as rupture, severe capsular contracture (hardening of the implants) or shifting of the implant. Sometimes, discomfort associated with breast implants (mostly due to hardening or size) is also an indication for removal with or without replacement.
Lifestyle changes are another motivating factor behind breast implant revision, replacement, or removal. A woman may simply decide she no longer desires implants, or that the specific size she opted for no longer meets her cosmetic goals. Whatever the reason, any patient dissatisfied with her breast implants is a potential candidate for implant revision.
Is it right for you?
Some women experience unwanted complications after breast augmentation or implant reconstruction, such as asymmetry, breast pain, implant deflation, and other side effects. Some women want their implant removed for breast screening purposes, as presence of implants can decrease the effectiveness of mammograms. Others have implant rupture and calcified silicone leak which can obscure breast cancer on mammography. These ladies often require not just removal of the implants but also excision of calcified lumps of leaked silicone (also known as ‘silicomas’).
Patients who are simply dissatisfied with the results of their breast augmentation may be candidates for a revision. The cause of dissatisfaction will need to be established (size, shape or position). Expectation will also need to be re-established and confirmed – whether it is realistic and whether removal and replacement will achieve this. Speaking frankly with Dr Vrtik during your consultation is essential for her to fully determine if a breast implant revision is practical and applicable in your circumstance.
Options in Implant Revision Surgery
Implant Revision is performed under General Anaesthesia. Regardless of previous incisions used for implant insertion, implants are often removed via an inframammary incision to allow visibility and access. The incision is made in the inconspicuous crease at the base of the breast to minimize visible scarring. The choice of incision varies based on the type of implant, degree of revision required, your particular anatomy, and patient-surgeon preference.
If your implants are being removed due to capsular contracture, concurrent removal of the capsule (capsulectomy) with the implant is essential to prevent recurrence.
If your implants are being removed due to rupture and silicone leak, often breast tissue affected by the silicone or calcified silicone deposits may require removal to allow adequate breast screening on mammogram.
If no replacement or other concurrent surgery is being done, drains are inserted to closed the redundant space left by absence of the implants. The incision is then sutured closed. Often the stretched breast tissue will become floppy and droopy once the implants are removed.
Removal & Replacement
Implants can be replaced after removal. The implant size and shape, as well as the pocket in which the implants are re-inserted are determined by the reason for removal in the first place. If replacement is for rupture, often similar implants are replaced in the same pocket. However, if implants have been removed due to capsular contracture, the implants are often replaced in a different pocket (usually under the muscle) to prevent recurrence of the contracture.
Sometimes, if implants are removed and replaced due to wrong positioning, the implants do not have to be changed, and can just be washed and re-inserted once the correct position and pocket has been created. If implants are being removed to maximise mammography screening, replacement with new implants are not recommended as the presence of implants can decrease efficacy of mammography.
Removal & Breast Lift
When implants have been removed, the breast tissue and skin are often stretched and can appear very droopy. Most of the breast tissue will hang low with the nipple sitting at the bottom half of the breast and pointing downwards. A concurrent breast lift at the time of implant removal can significantly improve the shape and cosmetic outcome. Often, with shortening and tailoring of the stretched breast skin, the breast tissue can be centralise and tightened to re-create the volume of a normal-looking breast mound. This procedure will also not affect any future breast imaging. The trade-off of a breast lift is the extensive incision (and thus scarring) involved as part of the breast lift. To find out more about Breast Lift, please click here.
Specific Risks of Implant Revision
The decision to have implant revision surgery is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable.
Dr Vrtik and our staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks or potential complications.
The risks include:
- Unfavourable scarring
- Bleeding (hematoma)
- Poor healing of incisions
- Changes in nipple or breast sensation, may be temporary or permanent
- Capsular contracture, which is the formation of firm scar tissue around the implant
- Implant leakage or rupture
- Wrinkling of the skin over the implant
- Anaesthesia risks
- Seromas (Fluid accumulation under skin or around implant)
- Blood clots
- Pain, which may persist
- Deep vein thrombosis, cardiac and pulmonary complications
Breast implants do not impair breast health. Careful review of scientific research conducted by independent groups such as the Institute of Medicine has found no proven link between breast implants and autoimmune or other systemic diseases. Pregnancy, weight loss and menopause may influence the appearance of the breasts over time.
Most of the risks are very uncommon, and some people (with particular health problems or specific breast features), may be at higher risk for specific complications. Dr Vrtik will discuss this with you during your consultation if any of these risks are specifically pertinent to you.
Although this surgery can be an effective procedure where the benefits significantly outweigh the risks, like everything in the practice of medicine and surgery, it is not an exact science. The degree of surgical success can be altered by how each individual’s body responds to surgery and healing. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure; revision surgery may be necessary.
Be sure to ask questions: It’s very important to ask questions about your procedure. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings and any specific concerns with Dr Vrtik or any of our staff members.
After the operation, your breast is covered in gauze and elastic foamy bandage to give your breasts support. You will have thin tubes (drains) from each breast. Hospital stay can range from 1-5 days dependent on drain output. Once the drains are removed, you will be able to go home. A special garment may need to be worn for 2-4 weeks depending on the type of surgery. If implants were replaced, no underwire bra should be worn for a minimum of 3 months.
Although the breast skin and tissue are already accustomed to the presence of implants, recovering from implant revision is very similar to the recovery experienced after the initial implant surgery. Symptoms such as swelling, soreness, and stiffness are to be expected for the first week or two.
Exercise and normal activity can resume at Dr Vrtik’s directions, and is dependent on the extent of your surgery. Over time, post-surgical swelling will decrease and incision lines will fade. The breasts will settle into its final shape at around 3-4 months.
For more information please browse our Postoperative Instructions page under Patient Resources.
Results and Expectations
The results of your breast reduction surgery are immediately visible. The first thing you will notice is the relief on your neck and shoulders as the weight of your breast have been instantly reduced. Over time, post-surgical swelling will resolve and incision lines will fade. Satisfaction with your new image should continue to grow as you recover.
The results of breast reduction surgery will be long-lasting. Your new breast size should help relieve you from the pain and physical limitations experienced prior to breast reduction. A breast reduction also provides a concurrent lift of your overall breast tissue, shape and nipple position. This will permanently alleviate the need for you to wear bras with underwire support as well as giving you more youthful, perky breasts with naturally enhanced cleavage! Your better proportioned figure will likely boost your self-image and improve your self-confidence.
The long-term outcome of breast reduction can be difficult to predict, as over time, your breasts can change due to aging, weight fluctuations, hormonal factors and gravity. More importantly, the elasticity and stretch of your skin plays a major role in the severity of these changes. Sometimes, a repeat breast lift (without reduction) or breast shape adjustment may be required.
Costs associated with Implant Revision Surgery
Implant revision surgery may be covered by private health insurance when it is performed to treat implant complications such as migration, rupture, or capsular contracture. However, some policies may not cover plastic surgery of the breast in general nor complication associated with previous cosmetic surgery. Each insurance policy varies greatly. Carefully review your policy to determine coverage prior to surgery. If your insurer covers for implant complications, it will often cover for removal +/- replacement. However, mastopexy (concurrent breast lift) is always considered cosmetic and not rebatable.
Some implants may be under a life-time warranty. If you still have the records of your old implants, it may be worth contacting the implant company and ask about any possible reimbursement in regards to removal and replacement of the implants concerned.
Vocabulary to know
- Areola: Pigmented skin surrounding the nipple.
- Augmentation mammaplasty: Breast enlargement by surgery.
- Breast Augmentation: Also known as augmentation mammaplasty; breast enlargement by surgery.
- Breast Implants: Medical devices placed in your body to enhance an existing breast size or to reconstruct your breast. Breast implants can be filled with either salt water (saline) or silicone (elastic gel).
- Capsular contracture: A complication of breast implant surgery which occurs when scar tissue that normally forms around the implant tightens and squeezes the implant and becomes firm.
- General anaesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.
- Haematoma: Blood pooling beneath the skin.
- Inframammary incision: An incision made in the fold under the breast.
- Mammogram: An x-ray image of the breast.
- Mastectomy: The removal of breast tissue, typically to rid the body of cancer.
- MRI: Magnetic Resonance Imaging; a painless test to view tissue similar to an x-ray.
- Saline implants: Breast implants filled with salt water.
- Silicone implants: Breast implants filled with an elastic gel.
- Submammary or subglandular placement: Breast implants placed directly behind the breast tissue, over the pectoral muscle.
- Submuscular or subpectoral placement: Breast implants placed under the pectoral muscle, which is located between the breast tissue and chest wall.
- Sutures: Stitches used by surgeons to hold skin and tissue together.
- Ultrasound: A diagnostic procedure that projects high frequency sound waves into the body and records the echoes as pictures.
(Some Information & Illustrations are courtesy of the American Society of Plastic Surgeons).