CONSULTANT PLASTIC SURGEON
BREAST IMPLANT REVISION
What is breast implant revision surgery?
Breast implant revision surgery is intended for patients who have had a breast augmentation in the past and are now unhappy with their implants or concerned about the condition of their implants. This procedure can address those concerns by replacing the existing implants with new implants. Often the goal is also to change or improve the appearance of the breasts while updating the implant material, which could include a concurrent breast lift or reduction, reshaping the breast implant pocket to reposition the implant on the chest, or either increasing or decreasing the size, shape or style of the breast implant.
You may have breast implant revision surgery if you have a desire to change the size of the breasts, have pain from capsular contracture, have a concern about rupture or migration of the implant, need to change the implants from saline to silicone or different style of the implant or need to change the implants from submuscular position (under the muscle) to subglandular position (over the muscle).
Over time, breast implants can change shape or size, and the overlying breast tissue can also change, creating an appearance or feel to the breast that is less desirable than the original result. Also, many breast implants have a lifetime warranty on the actual implant device, but after ten years the costs associated with having surgery to replace the implants are no longer covered. Because of this, many women will elect to replace or update their breast implants at around the 10-year time frame.
Breast implant revision surgery is not a standard or routine procedure and needs to be tailored specifically to the patient's goals and desires. Therefore, this surgery should be performed by a board-certified plastic surgeon who is well-trained and experienced in all types of breast surgery and who will listen to the patient's goals and desires and will develop a surgical plan specifically to address all of the issues at the time of surgery.
“Breast implant revision surgery is a highly individualized procedure. You should do it for yourself, not to fulfil someone else's desires or to try to fit any sort of ideal image, especially those coming from social media. Choosing a procedure based on “what’s new” is never a medically sound decision. Hearing about a procedure on television, through an advertisement or online does not necessarily mean it is the best procedure for you”.
Who is a good candidate for breast implant revision surgery?
In general, you may be a good candidate for breast implant revision surgery if you are unhappy with the size, shape, or appearance of your breast implants, concerned about the integrity or condition of your implants, are physically healthy and at a stable weight, nonsmoker or have stopped smoking recently and if you have realistic expectations.
What should I expect during a consultation for breast implant revision surgery?
During your initial consultation, you will have the opportunity to discuss your cosmetic goals and surgery and clarify what approach is best for you. Alternative and additional treatments may be considered, once Dr Ricardo understands your goals and medical condition. It is important to be completely honest during the consultation. During your consultation, be prepared to discuss your surgical goals, medical conditions, drug allergies and medical treatments, current medications, vitamins, herbal supplements, alcohol, tobacco and drug use, and previous surgeries.
Dr Ricardo will also evaluate your general health status and any pre-existing health conditions or risk factors, examine your existing breast implants, take photographs, discuss your options and recommend a course of treatment, discuss likely outcomes of breast implant revision surgery and any risks or potential complications and share before-and-after photos of cases similar to yours.
The success and safety of your breast implant revision surgery depend very much on your complete candidness during your consultation. It's very important to understand all aspects of your procedure. It's natural to feel some anxiety, whether it's excitement about your anticipated new look or a bit of preoperative stress. Don't be shy about discussing these feelings with Dr Ricardo.
How should I prepare for breast implant revision surgery?
In preparing for breast implant revision surgery, you may be asked to get lab testing or a medical evaluation, get breast or implant imaging, such as a mammogram, ultrasound or MRI, take certain medications or adjust your current medications, stop smoking in advance of surgery and avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding.
Your breast implant revision surgery will be performed in an accredited hospital and is usually performed on an outpatient basis unless you and Dr Ricardo have made other plans for your immediate postoperative recovery. You must arrange for a friend or family member to drive you to and from surgery and to stay with you the first night following surgery.
Dr Ricardo and the entire staff will provide thorough preoperative instructions and answer any questions you may have. The goal is to help you achieve the most beautiful and natural-looking results, as well as to make your surgical experience as easy, comfortable and safe as possible.
What are the steps of a breast implant revision procedure?
Step 1 – Anaesthesia
Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anaesthesia. Dr Ricardo will recommend the best choice for you.
Step 2 – The surgical procedure
The exact procedure Dr Ricardo will use for breast implant revision surgery varies depending on the reason for your revision:
Change in breast size: If you decide to change your implant size, Dr Ricardo will frequently use your original incision for implant removal and replacement. If you want a larger implant, you will need a surgical enlargement of the "pocket," or space in the breast, surrounding your implant to accommodate a larger implant; if you want smaller implants, a surgical reduction of the size of the pocket with sutures to properly fit smaller sized implants. A breast lift may be done at the same time.
Capsular contracture (hardening of the capsule and implant): Dr Ricardo will probably use the same incision used to insert the original implants to remove the hardened capsule and then insert a new implant.
Implant rippling: When the edges of saline implants are visible and palpable (able to be felt), Dr Ricardo may use the same incision used to originally insert them to remove or reposition the implants. Silicone implants will be used and placing the new implants into a different breast pocket that either has thicker muscle coverage or uses other tissues to cover the implant edge as your fat tissue. Dr Ricardo maybe uses a procedure called hybrid (or composite) breast implant revision surgery which refers to a breast implant revision using both implants and your fat. The main advantage of adding fat to a breast implant in a breast implant revision is that the fat can be placed strategically in the cleavage and around the implant to “soften the edges” and give a far more natural look, preventing rippling.
Implant malposition: Sometimes implant pockets are created too far apart or too close together, resulting in poorly positioned breasts. To correct this, using the prior incision, Dr Ricardo will manipulate the scar tissue from the capsule surrounding the implant and reconstruct the pocket in the appropriate position using suturing techniques.
Implant removal: If your implants are large and your skin has stretched, Dr Ricardo may recommend a breast lift in addition to implant removal, but implant removal alone may suffice. The original incision created to insert the implant will almost always be the same one used to remove it. The lining around the implant, or "capsule," is often surgically removed at the same time to facilitate rapid healing.
Elevation of nipple and areola position: If it is necessary to elevate the position of your nipples and areolas (pigmented skin surrounding the nipples), you will need additional incisions. Incisions around the upper portion of the areola will be adequate in cases where not much elevation is needed. When more lifting and tightening is necessary, an incision around the areola, including a vertical scar extending down from the areola to the crease under the breast, may be necessary. For cases where significant excess skin needs to be removed (such as in women who have had massive weight loss), a third incision may be necessary that will extend horizontally beneath the breast, following the natural curve of the breast crease. If your nipples need lifting, the nipples and areolas remain attached to underlying mounds of tissue and this usually allows for the preservation of sensation and the ability to breastfeed.
"Internal Bra Technique": What patients need to know?
The inner bra concept has been around since the early eighties. It refers to a myriad of different surgical techniques. “Internal bra” is an umbrella term including techniques intended to strengthen the lower pole of the breast. The idea of this technique is twofold. Firstly, to reinforce the inframammary fold. And secondly, to strengthen the lower portion of the breast. In tandem, this provides a more supportive foundation for a breast implant. The most common technique used for the internal bra is additional suturing. Sutures create a more secure and stable breast fold and a stronger lower pole of the breast.
A rarer option used in more severe cases is the use of a surgical mesh that can be placed around the entire breast or around the lower pole of the breast to maintain shape and position. Recently, after good experience with human and animal dermal grafts in reconstructive breast surgery after cancer, plastic surgeons started using acellular grafts in the form of a support bra for cosmetic breast surgery. Known by the acronym ADM, Acellular Dermal Matrix eventually gets integrated into the body and may be completely replaced by the patient’s collagen resulting in a thick and stronger layer of tissue.
Placing foreign materials in your body may increase the chance of infection, scarring, and deformity and, although the "Internal Bra Lift technique" with a surgical mesh looks like a miracle procedure and maybe an appealing concept to the patient who wants breasts to stay perky, there is no evidence that this procedure works and what is its complication rate. It might be indicated for extreme cases of cosmetic breast deformities or patients with breast reconstructions despite its use remains controversial.
Step 3 – Closing the incisions
Sutures, skin adhesives (glues), or tapes close the skin incisions.
Step 4 – See the results
The results of breast implant revision surgery are immediately visible. Satisfaction with your new image should continue to grow as you recover.
What should I expect during my breast implant revision recovery?
Following your breast implant revision surgery, gauze dressings or bandages may be applied to your incisions. Depending on the details of your surgery, you may or may not be placed in a support bra or other type of garment.
You will be given specific instructions on how to care for the surgical site, medications to apply or take orally to aid healing and reduce the potential for infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with Dr Ricardo. Remember to always follow his instructions to ensure the success of your surgery.
Because it is possible to bleed into the pockets around the breast implants for the first days, take it easy until you have permission to increase your activity level. Acute pain typically subsides after one to five days, but you may experience soreness and swelling for two weeks.
The surgical incisions must not be subjected to excessive force, swelling, abrasion, or motion during the time of healing. Sutures will be removed when it is appropriate. You should be ready to return to work and normal activity after 5-7 days. However, you must realize that the amount of time it takes for recovery varies based on what your surgery entails.
What results should I expect after my breast implant revision surgery?
The final results of your breast implant revision surgery will be initially obscured by swelling. It will take at least six weeks for the swelling to resolve and the breasts to feel softer and more natural. In some cases, it can take 6-12 months for the breasts to feel "normal." Healing time is different for everyone and sometimes it can take longer for the breasts to soften, for normal sensation to return, for scars to fade and for the patient to get used to the feel of having an implant.
Unless you gain or lose a significant amount of weight or become pregnant, your new breast shape should remain fairly stable. However, gravity and the effects of ageing eventually alter breast size. The weight of the implant used will also affect how your breasts appear as time goes on. Breast implant revision surgery results are long-lasting and satisfaction with your new image should continue to grow as you recover from surgery.