breast implant revision
dallas, Texas

A breast implant revision surgery is for women who have already had breast implants and are unhappy or dissatisfied with their breasts. If you are one of these women, we are here to help you understand what breast implant revision surgery is, why it is performed, whether you are a suitable candidate and what you can expect from the surgery.

You may be considering a breast implant revision for aesthetic reasons, for issues with the implants themselves, or to fix a problem caused by previous surgery. Whatever your reason, the skilled surgeons at RS Plastic Surgery in Dallas under the leadership of Dr. Robert Schwartz will offer you more than 20 years of experience in the industry.

What is breast implant revision?

Breast implant revision surgery is an operation to change the results of a prior breast surgery and is done for several reasons. You might want to correct something in the appearance of your breast implants that you are not happy with. Revision surgery could be performed to repair a mechanical issue with the implant itself – this is most commonly a leaking implant. Breast implant revision could also be necessary if there is an issue with the pocket in which your implant is sitting.

Revision surgery might happen more than once and the term ‘breast implant revision’ applies to any surgery that takes place after your initial breast augmentation.

Am I a good candidate for breast implant revision?

Any woman who is dissatisfied with her breasts following breast augmentation or previous revisions is a good candidate for breast implant revision.

This dissatisfaction can be in the appearance of your breasts, in that you may want smaller or larger implants. If you are unhappy with the position of your implants, you may opt for revision surgery. This could include implants that are too high, too low, too close together, or too far apart.

If you are experiencing mechanical issues with your implants or surgery site – leaking implants or a build-up of scar tissue – then you are a candidate for breast implant revision surgery. Also, you must be willing to undergo general anaesthesia. Most problems that require breast implant revision can only be corrected through surgery.

You should also be healthy enough to be able to undergo surgery, though it is very rare that a candidate for a breast implant revision is not in good enough health.

Common Reasons For Breast Implant Revision

Almost all issues related to breast implants can be fixed or made significantly better. However, in most cases, you will require surgery to remedy them – sometimes multiple surgeries. You may even be experiencing more than one issue. When we meet with you to discuss your case, we will first diagnose what the exact cause of the problem is. Sometimes this is obvious. Sometimes it isn’t. But it’s critical to understand the problem in order to design the best solution. Here are some common reasons for breast implant revisions and how they can be addressed.

Implants that are too big or too small

If after your breast augmentation your breasts are not the size you wanted, your current implants can be removed and replaced with more appropriately sized implants.

Sometimes, it may feel as though your implants are the incorrect size, when in fact they are actually the wrong shape. We use predominantly Allergan implants which are manufactured in five different profiles or shapes for each size. So, an incorrectly shaped breast implant might appear too big or too small when in fact it is the wrong profile for your body. Using the correct shape will make your breasts prettier.

Implants that are too high

If your implants look too high or they are unnaturally bulging at the top, the pocket in which your implants are sitting might be incorrectly placed. This will be fixed by adequately releasing a small section of your pectoral muscle from your sternum and ribs to create a better-positioned pocket under your chest muscle. Your implant will then drop into the correct position.

An implant that is too big could also appear as sitting too high on your chest. This is corrected by replacing your implants with a more proportional and flattering size.

A build-up of scar tissue around your implant, known as capsular contracture, can tighten around the implant and squeeze it upwards, making your implants appear too high. During your consultation, your surgeon will be able to identify whether this is the possible cause. To correct this, the scar tissue is removed and, sometimes, the implants are replaced.

Implants that are too low, bottoming out

A ‘bottoming out’ breast will look excessively full and elongated below the nipple while almost empty near the top. This is caused by the skin at the bottom of the implant stretching. The best way to correct this is through the removal of some of the stretched-out skin. This repositions your implant higher and balances the shape of your breast. This procedure does leave a scar in the crease under your breast and not all women find that to be an acceptable trade-off for the improved breast shape. This is something we would review with you to ensure that the treatment is right for you.

If your implant is too small or is the incorrect shape your breasts could appear too low. This means the top of your breast might look unnaturally low or too empty. A more suitably sized or shaped implant will fix this.

The fold under your breast can shift. This varies from woman to woman but it can cause your implant to drop and if this is the case, we will perform a procedure called a capsulorrhaphy in which we will suture the skin back into place. Closing off the pocket below the fold will reposition your implant higher and restore the fullness of your breasts.

Implants that are too close together

If you feel as though your cleavage looks unnaturally scrunched up, your implants may be too close together. This can occur when the implant pocket extends too far toward the center of your chest. Sometimes, this can lead to the two pockets connecting which is called synmanstia. To repair this, we suture some of the inner border of the pocket closed moving your implants a little further apart.

Implants that are too far apart

If the space between your breasts is too large, your nipples seem to be pointing inwards, or you feel as though you have too much ‘side-boob,’ your implants might have been placed too far apart. Once we’ve identified the cause, we will either suture the outer edge of your breast implant pocket to shift the implants inward or we will need to release the tissue at the center of your chest from your breastbone to allow your implants to settle more symmetrically across your chest.

In some cases, we might find that your implants are not big enough and are simply sagging towards the outer edge of your chest. Or, you might have too high a profile implant, creating a gap. A broader or larger implant that fills the space better will close the gap.

If when you lie on your back, you feel as though your breasts are disappearing into your armpit, this could mean that the skin on the outer edge of your breasts has stretched. Similar to bottoming out, this will be fixed by removing some of the skin. As with bottoming out, this skin removal does leave a scar that you need to consider if you’re thinking about this procedure.

Rippling or visible implants

If you are seeing the edges of your implants, or your implants appear to be rippling under your skin, you may need breast implant revision. There are a number of possible causes of rippling implants.

It can be caused by the type of implant used. For example, saline implants more commonly do not blend in with the breast tissue and can also cause more visible rippling at the edge.

Overly large implants can appear more visible as they might bulge outwards at sharper angles. The pressure from very large implants can thin the breast tissue over time making the implant edges more obvious.

If your implants were placed over your pectoral muscle, and not under, this might also make your implants too visible.

Depending on the cause, there are a number of solutions to visible implants. These can include switching out saline for gel, switching out soft gel for a firmer gel, replacing implants with smaller sized ones, or repositioning your implants under your pectoralis muscle.

The most difficult situation is one in which overly large implants have been in for too long, causing the natural breast tissue to thin out too much. While a common fix for this is to place a mesh between the implant and your breast tissue, we believe this can often lead to even more visibility as the mesh itself and the way it moves can be more obvious than the implant. Often we find it more effective to temporarily remove your implants. This will allow your natural breast tissue to thicken out and heal. After this healing phase, we augment your breasts with more proportional implants. Think of this as hitting the “Reset Button” on very problematic implants.

Breasts that feel hard

Soft, natural feeling breasts are the goal, so if your breasts are too hard you might want revision surgery. Most commonly, this is caused by an imbalance between the implant size and pocket size. This can be fixed by correcting the balance either by expanding the pocket or using smaller implants.

Scar tissue, or capsular contracture, can over time cause your implants to start to feel hard as the build-up squeezes on the implant. This is corrected by removing most or all of the problematic scar tissue and quite likely changing out the implant as well.

Creases on the lower part of your breast or ‘double bubble’

Soft, natural feeling breasts are the goal, so if your breasts are too hard you might want revision surgery. Most commonly, this is caused by an imbalance between the implant size and pocket size. This can be fixed by correcting the balance either by expanding the pocket or using smaller implants.

Scar tissue, or capsular contracture, can over time cause your implants to start to feel hard as the build-up squeezes on the implant. This is corrected by removing most or all of the problematic scar tissue and quite likely changing out the implant as well.

Ruptured or leaking implant

Your implants are not designed to last forever. They are designed to be soft enough to move in a natural way, so over time, this can cause some wear and tear to the implant. This typically will happen ten to twenty years after your initial augmentation, although it can be sooner.

Once it has been discovered, your surgeon will remove the ruptured implant, clean out your pocket and insert new implants.

Asymmetry

Asymmetry of your breasts can be caused by a number of issues, including a combination of more than one. It can also be contributed to by pre-existing asymmetry of your natural breasts that wasn’t corrected during your breast augmentation surgery.

We will be able to identify the issues causing your asymmetry during our consultation with you. We will then be able to formulate a plan to address the root causes. This could include changing the size or shape of your implants to two different ones, changing the consistency of gel in your implants, modifying each pocket separately to increase symmetry, performing a breast lift on one or both sides, and so on. Fixing asymmetry usually requires multiple approaches.

Excessively visible scars

This is a very rare reason for breast implant revision. However, there are occasions in which surgery may help reduce the appearance of scarring. In some cases, thick scars can be reduced by surgical removing the scar tissue.

Implants that are moving too much

This phenomenon is known as excess animation and can be caused by the contraction of your chest muscle or pectoral muscle. This does not affect everyone; some women don’t notice it at all. The solution will depend on the location of the implant under the muscle and can include releasing the muscle a little more.

Textured implants and the risk of cancer

In the last few years, it has been discovered that certain textured implants may increase the risk of developing ALCL, which is a rare lymphoma of the breast. Though this is incredibly rare, one manufacturer of textured implants has recalled their textured versions and offered replacements with a smooth-surfaced implant.

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Signs and Symptoms of Breast Implant Rupture

One of the most common reasons for breast implant revisions is a ruptured implant. If you have had a breast augmentation, you should know what to look for.

A saline implant rupturing will be a lot more obvious as the breast very quickly deflates, usually within 24 to 48 hours of the rupture.

With gel implants, it can be more difficult to tell. Modern silicone gel is thick and cohesive, so it sticks to itself and doesn’t often move around, even after a rupture. While it is good that it doesn’t go anywhere, this does make it harder to diagnose a ruptured implant.

You might have already identified that something has changed, even if it is subtle, during your self-examinations. But as this can be unreliable, and to be sure nothing is missed, the FDA recommends you have periodic ultrasounds or MRI scans of your breasts with your first scan at five years and thereafter every three years. This way, a rupture will be spotted and can be addressed.

If your implant has leaked, we will remove it. Saline gets absorbed by the body and will be gone by the time of surgery. If your implants were silicone gel, your breast pocket will be cleaned out and washed.

We will also address any potential issues in the pockets themselves including removing any possible capsular contracture or scar tissue and adjusting the pockets if needed. Your new implants will then be put in, optimizing size and shape to yield the prettiest breasts.

Benefits of Breast Implant Revision

Ultimately, breast implant revision surgery will mean you are happier with your implants, they are no longer causing discomfort and are more attractive.

If you have experienced dissatisfaction with the results of your breast augmentation, either soon after the surgery or over time as your body changes and your implants settle or shift, revision surgery will help correct that and restore confidence in your decision to have had the breast augmentation.

In order to fix some common mechanical issues related to breast implants, breast revision surgery will be the best option.

In some cases, breast implant revision will relieve pain and discomfort caused by capsular contracture, the forming of excess scar tissue.

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How Breast Implant Revision is Performed by RS Plastic Surgery?

Depending on the reason for your breast implant revision, we will use a number of techniques and methods during your surgery. Most revisions are performed under general anaesthesia.

In some cases, your surgery will be as simple as replacing the implant and closing the incision. In other cases, we may need to perform a capsulectomy during which the scar tissue in your breast will be removed. This can be done partially or fully, relative to how severe the contracture is. A capsulectomy will likely be performed to correct asymmetry, your implants appearing too high or low, or feeling too hard.

Another common technique used in breast implant revisions is a capsulorrhaphy, during which your breast pocket is sutured back into place. This can be done to correct bottoming out, a double bubble, asymmetry, or a number of other issues.

Recovery After Breast Implant Revision

Although your breast implant revision could be quite an elaborate surgery, these operations usually don’t hurt very much. This is because, generally, the pocket your surgeon is working on is already there as it was created during your original breast augmentation. Typically, patients report that after a breast implant revision they feel as though they’ve worked out to an extent that they weren’t in shape for. So, you may feel stiff, sore, and tight but not in severe pain.

Most patients will be able to resume normal household activities a day or two after their surgery. If you have an office job, spending most of your days at a computer, you will probably be able to get back to work about four days after your surgery. Returning to work for women with more physical jobs will vary according to the type of work they do.

More extensive activity, such as lifting anything over ten pounds or moving your arms either back behind you or up over your head, will take about three weeks before this is possible.

If you underwent a capsulorrhaphy, where your breast implant pocket was sutured back into place, your recovery has to be monitored a bit closer than others. This is because the sutures used will be strong, but the tissue sewn together can be weak and flimsy. So, any strenuous activity such as lifting heavy objects, moving your arms too much, or bouncing around too much, could cause the tissue to tear. A capsulorrhaphy will be discussed in your pre-operative consultation so that you are aware that your recovery could take up to six weeks.

In terms of the look and feel of your new implants, this will vary according to what was done in your surgery. In the majority of cases, swelling is minimal, and most women will be bathing-suit ready in two to three weeks after their surgery. We work off the basis that in most cosmetic surgery, your end result will be about 70 to 75% visible by the end of the first month and 90% by the end of two months.

FAQ For Breast Implant Revision

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What is breast implant revision?

What is breast implant revision? Breast implant revision is a general term for a variety of procedures used to correct problems or issues that may develop in women with breast implants.

What types of problems are corrected by breast implant revision?

The most common breast implant revisions are:

  • Replacement of ruptured implants
  • Adjustment of poorly positioned implants
  • Treatment of capsular contractures
  • Correction of double-bubble deformities
  • Repair of synmastia
  • Implant size changes
  • Changes from saline to silicone gel implants or vice-versa
  • Changes from subglandular to submuscular positioning or vice versa

This list does not include all possible revisions or combinations of corrections.

Will insurance pay for breast implant revision?

Health insurance will sometimes cover breast implant revisions. Most of these procedures are considered cosmetic and are not covered.

Where will my breast implant revision be performed?

We perform most breast implant revisions on an outpatient basis at a JCAHO-certified ambulatory surgery center.

What type of anesthesia will be used for my breast implant revision?

Most breast implant revisions are performed under general anesthesia (i.e. you will be asleep). We use only board-certified physician anesthesiologists.

Where are the scars from breast implant revision?

If your implants were originally placed through an incision adjacent to your nipple (periareolar) or underneath your breast (inframammary), most revisions can be performed through the previous incision. Options for revision through an underarm or umbilical scar are limited and a new incision may be required.

When can I return to work after breast implant revision?

When can I return to work after breast implant revision? Most patients with desk jobs can return to work in 4-7 days. Patients with more physically demanding jobs will require a longer recuperation.

How painful is breast implant revision?

Most breast implants revisions are less painful than the initial implant placement.

How soon can I exercise after breast implant revision?

Exercise can be restarted 3-4 weeks after most breast implant revisions. Longer waits may be necessary after some implant repositioning operations. Performing physically strenuous activities earlier than this can impair healing or disrupt the repairs.

When can I drive after breast implant revision?

Most patients can resume driving seven days after breast implant revision.

What are the signs of a ruptured silicone implant?

Signs of a ruptured silicone gel implant may include:

  1. New pain or discomfort in the breast
  2. A change in the appearance of the breast
  3. Hardening of the breast
  4. A change in the way the breast feels

You should also consider the possibility of rupture after a strong blow to the chest (fall, car accident, etc.)

In most cases, breasts with ruptured implants look and feel the same as they did before the rupture; the history and physical exam are not reliable for detecting rupture.

The best test for rupture is a breast MRI. MRI's will detect 80-95% of ruptures.

Are there special precautions for breast implant patients when scuba diving?

Yes, but they are minor. Silicone gel implants are heavier than water and will subtly alter your buoyancy and trim in the water. This may require gear or technique adjustments. This does not apply to saline implants which are buoyancy-neutral. Divers are also advised to avoid buoyancy compensators with constrictive chest straps, which can put undue pressure on the implants.

Pressure changes themselves are unlikely to damage the implants. In a study performed by the Divers Alert Network (www.diversalertnetwork.org), implants experienced a very small increase in gas bubble size and overall volume. The effect was more prominent in silicone gel implants because nitrogen is more soluble in silicone. Regardless, the volume change was not sufficient to damage the implants and the gas bubbles disappeared with time.

What can be done for implants that fall to the side when I lie down?

The first thing to determine in these situations is why this is happening. In most cases, it is because the implant pocket is extending too far to the side. This can happen over time due to pectoralis muscle pressure on the implants. The treatment for this is a capsulorrhaphy - a procedure where the outer part of the pocket is tightened with sutures.

Sometimes, the pocket is not too wide and the implants lie to the side because the the breast skin has stretched. This can sometimes be improved with a breast lift but there is a significant chance of at least partial recurrence.

In all these situations, we should keep in mind that natural breasts fall to the side when a woman lies down so not all of these laterally displaced implants need treatment.

Is it normal to have a sore throat after surgery?

Sore throat can happen after surgery. It is usually caused by the endotracheal tube the anesthesiologist uses to help you breath. It is somewhat more common in women than in men. The soreness is usually mild and goes away within a few days. A severe sore throat or one that lasts for more than a few days should be reported to Dr. Schwartz.

Can I donate blood before surgery?

Donating blood causes a temporary anemia. This usually corrects within 1-2 weeks. Nonetheless, we recommend that patients do not donate blood for at least one month before cosmetic surgery.

Some patients have expressed interest in donating blood for their own use, if needed. Since most cosmetic procedures are designed to produce minimal to moderate blood loss, transfusion is almost never needed. While you are, of course, free to self-donate blood, this would almost always be unnecessary.

Should breast implant patients take antibiotics for teeth cleaning?

I do recommend that my breast implant patients take a dose of antibiotics before dental work.

The problem is that dental work introduces bacteria into the blood stream. If that bacteria gets to the breast implants, it can cause an infection or a capsular contracture. Either of these may require surgery to fix.

Now it's unlikely that a dental cleaning will lead to any problems with your implants but since the consequences can pretty significant, it's worth taking the antibiotics as a precaution. Ask your dentist to prescribe whatever antibiotics he or she uses for patients with heart valves or other implants.

One additional note: You should avoid any dental work for the first 2 months after your breast implant surgery.

Dr. Robert Schwartz, M.D.

Dr. Robert Schwartz is the founder and director of Robert Schwartz Plastic Surgery in Dallas, TX. He is certified by the American board of Plastic Surgery and member of the American Society of Plastic Surgeons. He graduated from the David Geffen School of Medicine at UCLA in Los Angeles, CA and has been in practice for over 20 years. Dr. Schwartz is gifted with a keen eye and the unique skill to visualize you at your best, and he will execute that vision throughout every phase of your treatment to consistmently deliver stunning results. This is what makes him a world-class plastic surgeon.

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