Do you need a breast revision?

Thousands of women make the decision each year to have breast augmentation surgery with implants. While the overwhelming majority of women are pleased with their results, in some cases, complications occur, or the results are not satisfying. Some patients would like to change their size, while others might have an implant malposition or an asymmetry. The main reason, however, that patients have a revision, is because the original implants were too large for their frame. Women who have had breast implants that have been in place a decade or longer may consider a breast revision procedure to replace their current implants. We recommend all patients, who have breast implants 5 years or longer to undergo an MRI or ultrasound to see if they have any evidence of rupture. 

Breast rippling

Breast rippling and wrinkling can occur along the side of the breast, or underneath it. This occurs most often with saline implants and creates an unnatural breast look. This is most common in women who are extremely thin. Conversion to our newest 5th generation Sientra silicone implants can usually completely remove this problem. All patients with rippling that have implants above the muscle should have them converted to below the muscle if they wish to avoid rippling.

Reasons for revision surgery

Patients who wish to have their implants replaced will undergo a procedure where an exchange of one or both implants may occur. These revision surgeries vary considerably in their difficulty. It is very important to have an experienced surgeon. If a thickened scar tissue (capsule) does exist around the implant, it can be painful. It is removed by performing a capsulectomy. Some patients may require a breast lift during the revision surgery. In addition, an internal  support matrix device known as GalaFORM or Strattice may be placed when added support is needed. The goal of the revision process is to resolve or overcome issues in a way that satisfies the patient’s aesthetic goals. There are various circumstances as to why a woman may decide to undergo breast revision surgery. The most common reasons are:

Ruptured implant

If a saline implant ruptures, the implant device will deflate due to the leakage of saline. This will result in an obvious deflation of the breast(s). The replacement is done with a silicone implant to prevent this from happening again. Silicone implants will not deflate visibly, however a break in the shell may still occur. The only true way to detect a shell break is through an MRI or possibly an ultrasound, which is why routine check-ups are recommended throughout the years.

Double bubble

“Double bubble” is a rare complication with women who have breast implants. This occurs when the implant drops down below the natural breast crease,. When this occurs, an unnatural indention will result in a “double” breast appearance. This is usually caused by weakening of the lower crease of the breast where the implant sits during the original surgery. Care must be taken not to lower the crease too much without an internal support like GalaFORM.

Remove implants to return to a natural size

Some women may decide later in life they no longer wish to have breast implants in place. As the breast ages, the gland is replaced by fat and the breast mound can simply be too large for that patient. Breast implant removal is a procedure that removes the implants and often the skin around the breast is tightened/lifted to create a natural look.

Older implants

Implants that were placed years in the past will eventually need to be replaced. Generally, they last for 10 to 15 years, but many implants last longer. If you have concerns that your implants are too old, you may want to have them replaced. Newer implants last even longer.

Breast size

Some women will be unhappy with their breast size following breast augmentation surgery. They may desire a secondary surgery to replace the implant with one of a different size, texture or shape. Many women want to go from saline to silicone in order to have a more natural look and feel.

Implant bottoming out

This can occur post-surgery when an implant shifts or moves from its original location. This can also occur with aging, gravity, trauma to the chest area, or with excessive scarring.

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Poor planning

Some women are not good candidates for breast augmentation surgery alone. Instead, they need a combination of an implant and a breast lift. Women who have sagging breasts and undergo breast augmentation surgery alone will be NOT be happy with the results. Putting in a large implant to avoid a lift is always a bad idea. The breast will sag further due to the increased weight of the implant. In addition, implants that are too large and wider than the base diameter of the breast are at high risk of needing a revision.

Capsular contracture

Scar tissue that has formed around the implant may create a capsular contracture. When this occurs, excessive tightening of the capsule will result in a hard feel of the breast. Sometimes, to correct this, a capsulectomy is done to remove the scar tissue. This is the removal of scar tissue from around the implant. In general, silicone implants more than 20 years old have a higher incidence of capsular contracture (approximately 10-15% chances) than saline implants (10% chance). Newer 5th generation Sientra silicone implants have a contracture rate of just 5%.

What is the surgery?

Breast revision surgery is performed under general anesthesia as an outpatient procedure in an accredited surgical facility. The ease of recovery will depend on exactly what was needed in the revision process. Most women can resume their normal work activities after one week. Exercise will be a gradual process. It may take up to a full year for the scars to fully fade and for the newly revised breast or chest area to look and feel natural.

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Meet with us to discuss breast revision surgery.

The F.D.A. has recommended an MRI or ultrasound of the breasts at 5-6 years post-op and every 2-3 years after for best detection of rupture or the need for implant revision. Our practice will do our best to make the revision process as easy as possible for patients needing or wanting a breast implant exchange or removal surgery.

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