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.

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.

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.
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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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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.

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.

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.

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.