Breast Implant Revision


Breast implants, like car tires, do not last forever. And, like car tires, sometimes they can fall out of balance, lose their alignment, or even go flat. For that reason, breast implant revision is something that every breast implant patient will likely need over time. Breast implant revision procedures come in two major categories: those you have to do and those you want to do. Complications such as deflation, rupture, and capsular contracture fall into the “have to” category while conditions such as the desire for a size change or a different implant are more elective in nature.

Breast Implant Exchange

If your saline breast implant has deflated or if you have a ruptured silicone implant, that implant should be replaced at your earliest convenience. Breast implant exchange can be a very straightforward procedure where new implants are placed right back where the old implants were. In these breast implant exchange procedures, patients can choose new sizing and they can choose completely different implants than what were used originally. In these implant failures, “the sooner the better” is generally very applicable. Especially with saline implants, addressing the problem early generally translates into a better recovery and easier procedure.

Many patients these days are simply exchanging older silicone implants for the newer “gummy bear” silicone devices. And many are electing to replace saline implants with these new silicone implants as well. The elective implant exchanges can have very quick recovery times with minimal disability.

Capsulectomy, Capsulotomy, and Capsulorrhaphy

Breast implants live in a space that is lined by scar tissue. This scar tissue is referred to as a capsule. There are times when the capsule becomes a problem for the implant and for the patient. Capsular contracture, for example, is the most common implant-related complication of breast implant surgery. This condition is characterized by a hardening of the breasts as the scar capsule thickens and tightens. This condition is generally treated by capsulectomy—removal of the capsule—and implant exchange. Even if this condition occurs early, we generally recommend that a new implant be placed to decrease the risk that the capsular contracture recurs.

There are other situations where the breast implant either does not fall into the desired location or it falls too far out to the side or even “bottoms out.” These positional implant problems are generally treated by adjusting the capsule. The capsule can be incised to allow more movement of the implant (capsulotomy) or it can be tightened to allow less movement of the implant (capsullorhaphy).

These breast implant revision procedures can be more complicated than the original implant procedure and may include the use of drain tubes and multiple incisional sites.

Complicated Breast Implant Revisions

Complex problems often require complex solutions. Breast implant problems related to previous infections, recurrent capsular contractures, or a history of multiple surgeries can create a condition that requires more of a reconstructive effort. These revisions may require temporary implant removal with replacement and reconstruction at a later time. Newer products such as internal mesh and artificial dermal matrices can be helpful adjuncts to those patients who require these complex revisions.

Breast Implant Removal

And, finally, some patients simply want their implants removed entirely. Although the breast will never return to its pre-augmentation size or shape, implant removal can relieve symptoms or heaviness or the feeling of being “too big”. Although much less common than exchanging to a small size, implant removal is an alternative for patients who are just “done” with breast implants. And, if the desire for new implants returns at a future time, implants can be replaced!

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