Breast Implant Revision

Revision surgery is nearly as popular as primary breast augmentation. As discussed in the breast augmentation section, maintenance-involving breast implant revision surgery after breast enhancement is very common. When a woman chooses to improve the appearance of her breasts with breast implants, she is also assuming a lifelong endeavor to sustain the quality of her enhanced breast profile.

If you take 100 women with breast augmentation and follow them for thirty or forty years, you will find that the majority of these women will have had one or more additional surgeries on their breasts. Therefore, it is highly likely that augmentation mammoplasty patients will need a breast implant revision surgery during their lifetime. Dr. Miguel Delgado performs Breast Revision surgeries at the Marin Cosmetic Surgery Center.

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WHO IS A CANDIDATE?

Women who have had previous augmentation surgery and have issues with their breasts are candidates for secondary breast implant surgery, assuming they are healthy enough to undergo the proposed procedure.

There are many reasons or conditions to have redo implant surgery. The most common ones are the following:

• Breast capsular contraction: when the breast implant is inserted into the body, the body’s response is to recognize the breast implant as foreign material. In response, it forms a scar capsule that encases the implant and walls off the breast implant from the body. An inflammatory process occurs which causes the scar tissue to thicken and constrict around the implant making it unnaturally hard. Though theories exist, it is not known exactly what triggers this response, or why it happens to some people and not to others. The current theory is that a low grade infection causes inflammation around the breast implant and starts the formation of scar tissue.
• Deflation or rupture of the breast implant.
• Laxity of the skin and the resulting changes in breast shape, as part of the normal aging process.
• Stretching of the skin and changes in breast shape caused by pregnancy and breastfeeding.
• Infection or bleeding in the early postoperative period, while uncommon, may occur in 1%-2% of patients nationwide.

In general, there is no reason to change implants unless there is a significant issue. Revision breast implant surgery, which is surgery that is done to correct a problem, often takes more skill, precision and artistic ability than the primary breast augmentation surgery.

The various options for revision may be:

• Removal of the scar capsule and replacement of the implants, with the same size, larger or smaller breast implants.
• Breast lift, with or without changing out the breast implants.
• Remove the breast implants altogether. (Patients rarely choose this option.)

Each case requires careful study of a patient’s needs and a personalized treatment plan in order to achieve the best outcome.

One advantage to secondary surgery is you can switch from saline implants to silicone, or vice versa. You can also change your implant size to larger or smaller ones.

Dr. Delgado has extensive experience and expertise with this type of surgery.  Dr. Delgado will guide you through the various decisions that will customize your new look.

BREAST IMPLANT OPTIONS

There is no ‘perfect’ breast implant. All implants have their advantages and disadvantages. There are essentially two breast implants used today: saline-filled and silicone filled implants. Both types of breast implants have an outer shell or envelope, made of silicone. The contents of the shell are either saline (saltwater) or silicone gel. For saline breast implants, the silicone shell is filled with saline at the time of surgery. Saline-breast implants have been used for decades. They are safe and effective.

Dr Delgado and his staff were amazing. I had a Breast Implant Revision and was a little nervous about having surgery. Dr. Delgado and his staff were friendly, incredibly caring and took the time to make me feel comfortable along the way from my first visit to my post surgery appointments. I am so happy with my results! I would highly recommend Dr Delgado.

The advantages of saline implants are:

• If a leak does occur, the saltwater is safely absorbed
• Saline implants are filled after insertion, therefore, more adjustments can be made for volume discrepancies
• In general, smaller incisions can be used
• Saline implants are less expensive

The disadvantages of saline implants:

• Slightly firmer than silicone breast implants
• Mild rippling or scalloping (of the bottom edge of the breast implant)
• Not ideal for implantation over the muscle in thin women, due to the increased likelihood that a rippled edge will be noticeable

Silicone-breast implants have been approved for general use since November of 2006. The FDA (Food and Drug Administration) requires that women less than 22 years old should have normal saline-breast implants.  In addition, the FDA suggests an MRI at three years and then every two years thereafter to check for leakage. Though this is suggested, it is not required.  Dr. Delgado feels that a follow up exam is warranted at three years and not an automatic MRI test.

Silicone-breast implants have evolved and improved over the years. They now have a thicker outer shell and contain a more cohesive gel. This means that the silicone has a more solid consistency and is less liquid. For example, if the breast implant is cut with a pair of scissors and squeezed, the silicone material will go out and then retract back into the silicone shell.

The advantages of silicone implants are:

• A softer, more natural feel (the greatest advantage)
• No wrinkled or scalloped edges and therefore, can be installed on top of the muscle, if desired

The disadvantages of silicone implants are:

• A leak or rupture may occur unknowingly
• Silicone implants are prefilled and, therefore, the size cannot be adjusted
• An MRI may be required in the future
• Silicone implants are more expensive
• The new product on the market is the “Gummy Bear Implants”. The Food and Drug Administration (FDA) has approved the three United States companies, Mentor, Allergan and Sientra to distribute these breast implants.
• The goal of these implants is to replicate a real implant in making them form stable, heavier at the bottom and shaped like a tear drop. The implant is firmer and this is what holds the shape. If the breast implant is cut in half it will hold the exact shape without spilling out of the implant shell. This is why this type of breast implant is commonly called “gummy bear implants”.
• As with all breast implants they have advantages and disadvantages. The obvious advantage is that it mimics the shape of the natural breast giving more volume at the bottom of the breast. Because of the composition of this implant it has firmer silicone that results in less wrinkling. Some women want to have a firmer breast. These are textured implants to hold the orientation.
• The disadvantage is the potential for implant rotation which will cause the breast shape to distort. The incision needs to be larger to accommodate a firmer breast implant. Some women do not like the firmer consistency.
• The bottom line is the form stable breast implants gives plastic surgeons and their patients another option when considering breast augmentation.

As a general statement, women who have saline-breast implants and change to silicone-breast implants do prefer the silicone more for the natural feel. The breast implant companies now offer a variety of shapes and sizes to customize the fit to your body.

Based on your anatomical dimensions and your personal goals for your appearance, Dr. Delgado will expertly advise you on options for implant size, style and shape.

Before Breast Implant Revision Surgery

A personal consultation is the first step for every patient considering surgery.

Dr. Delgado will ask you to discuss your concerns about your appearance. He will go over your breast implant history in great detail to understand the previous surgeries. During this meeting, he will discuss your current conditions and what goals you wish to achieve. A physical examination will be done and your medical history reviewed to determine if surgery is the best option for you. If you are a good candidate, Dr. Delgado will explain:

• The best surgical options for your goals.
• If a breast lift is advisable with the implant.
• Locations of the incisions.
• The pros and cons of saline versus silicone implants.
• How to correct the double bubble or breast capsular contracture, etc.

Dr. Delgado will want operative reports if possible and the breast implant cards you were given and the time of your breast surgery. Blood tests done within six months of your surgery date are required to assure Dr. Delgado and the anesthesiologist that surgery is a safe option for you. These include a CBC (Complete Blood Count) and possibly other tests, depending on your medical history. If you are 40 years old or older, a current mammogram is required and if you are 50 years old or older, an EKG (Electrocardiogram) is required.

You will be given a preoperative instruction booklet that will explain your medications and any preparations that you need to make at home. This booklet supplies you with a list of aspirin and aspirin-containing compounds, including anti-inflammatory products, all of which must be stopped two weeks before and two weeks after surgery. This precaution is taken to avoid excessive bleeding during surgery. Tylenol may be safely taken during this time.  However, do not exceed 1 gram over 4 hours or 4 grams per day from all sources since this can cause liver damage.  You will also be given a list of vitamins and homeopathic medications that you can opt to take prior to and after surgery to minimize bruising.

After Surgery

The first few hours after surgery will be spent in the recovery room at Marin Cosmetic Surgery Center. When you are fully alert, you will be able to go home with the assistance of a friend or family member. For the next week, it is important to sleep with your head and back elevated to reduce swelling in the area. Two days after surgery, you may take off the dressing and take a shower. If drains are placed, a shower should not be taken until 24 hours after the drains are removed. Drains are usually removed after three days. Revision implant breast surgery is usually more uncomfortable than primary breast augmentation, especially if the breast capsule is removed or the muscle is manipulated. Pain medications are taken for a few days to make it comfortable. Sometimes patients will opt to have an Exparel long acting pain injection which can last up to four days.

The recovery period is generally seven to ten days. Once the bruising and tenderness are gone, the patient can return to her normal activities. Most patients can drive a car and return to work or social activities after a week. Strenuous exercise should be avoided for four to six weeks following surgery, as it can cause uncomfortable swelling to occur.

Risks And Complications

The risks and complications of revision surgery are the same as breast augmentation; except if a breast lift is done, more scar management is required. Each year, thousands of women have secondary breast implant surgery. It does not guarantee that you will never need another revision procedure in the future. As with all surgery, the risks of bleeding, infection and the risk of anesthesia exist. Additional complications specific to breast augmentation revision include deflation or rupture of the implant. In addition, capsular contraction can still occur and there may be slightly a higher chance of it reoccurring in those patients who have had previous breast capsular contracture. Breast redo surgery can be extremely complicated. The surgery is usually dealing with a very complicated issue and compromises must be considered. Dr. Delgado will go to great lengths to explain the possibilities and perform at the highest level.

Surgery Results

Revision breast surgery is a maintenance procedure. This is not a complication, but a natural progression of changes. When the surgery is performed, the goal is to create more youthful appearing breasts. There is a variety of solutions for each woman’s situation. Dr. Delgado will carefully explain the details involved, as well as the best options for you to reclaim your more youthful breast profile.

Frequently Asked Questions

What is a breast revision?

It is surgery, which is needed for a woman who is having issues with her present breast implants. This can be due to breast implant scar contraction, hardening, rupture or deflation of the implant, breast change from pregnancy, a desire to change the implants from a normal-saline breast implant to a silicone breast implant or silicone to saline. The goal is to improve the breast better than it was before.

What surgery is needed for a breast redo?

Depending on what the complication is, if it is scar tissue around the implant known as capsular contraction, the scar tissue will be removed surgically and the implant must be replaced. If the implants have ruptured or deflated then the implants must be exchanged. If the breast tissue becomes loose from pregnancy, the patient may need a breast lift or a larger size implant. These are some of the more common scenarios.

Can the implants just be removed?

You can always remove the implants. However, your breasts may look aesthetically unacceptable and deflated. A breast lift may rebuild the breasts to a very nice shape and volume, but only if there is enough breast tissue.

If I have a problem after breast implant surgery, do I need to have a revision?

Dr. Delgado explains that if breast augmentation surgery is performed a revision will be required in nearly 100% of patients over a lifetime. Many patients live with breast issues and have breast revisions when they can afford the surgery or when the issue becomes too uncomfortable or aesthetically unpleasing.

The exception is a rupture of a silicone implant and deflation of a saline breast implant. The silicone breast implants releases silicone slowly. Even though the present day silicone breast implants have “conforming gel”, which is more like the consistency of firm Jell-O, it should be removed as soon as possible to prevent the spread outside the breast capsule and into the breast and surrounding tissue.

Is there a manufacture warranty for failed implants?

Yes. Mentor Implants which are the type that Dr. Delgado uses, has lifetime replacement for failed implants and a ten-year warranty for compensation toward replacement surgery, also the patient can purchase an extended warranty for $100, which increases the amount of compensation towards surgery. Allergan also produces a great breast implant product with a wide variety of sizes and shapes as well as Mentor, with their own warranty.

Should I go back to my original surgeon?

Possibly, the surgeons experience required for revision implant breast surgery is critically important. Be aware that revision surgery is much more complex and necessitates more skill than the original surgery. If your surgeon is a board-certified plastic surgeon certified by the American Board of Plastic Surgery, this is a good start. If your surgeon is confident in the correction required and you are comfortable and confident in his or her skills, then “go for it”. Having done hundreds of primary and revision surgeries, Dr. Delgado states that about 40% of breast surgeries he has performed are revision surgeries. He is very confident in his artistic eye and surgical skills.

Is it possible that a second breast implant revision surgery may be needed?

Yes, very possible. If a woman has breast augmentation surgery in her early 20’s and lives to be 80 or 90 years old, if you do the math, you can see it is very possible.

What is the cost of breast revision surgery?

Depending on what surgical technique is needed will determine the cost.

If the correction is capsular contracture caused by scarring, the cost is about $8000-$10,000 to remove the scar tissue and replace the breast implants. Some women may need a breast lift in addition, and then the cost may be as much as $10000-$12000; but if it is for removal only, then approximately $2500.

If the breast implant is ruptured or deflated within the warranty period, the implants are at no cost and $1200-$2500 will be awarded to offset the expense of revisional surgery. Your out-of-pocket expense will be reduced significantly.

How painful is breast revision surgery?

Breast redo surgery is more complex than the initial surgery, therefore, it may be more uncomfortable, especially if scar tissue needs to be removed and/or a breast lift is required.

How long will I need to take off work and exercise?

If your work does not require and heavy lifting it is possible to return to work by the end of the second week. Usually one can drive after a week if no longer taking pain medication. The patient needs to wait to resume exercise for about five to six weeks.