Breast Implant Revision
Breast augmentation procedures are the commonest cosmetic procedures in Australia. Women can now enjoy their bodies that they always wanted
In recent years stricter regulations plus surgeon competition has helped people to negotiate better prices without compromising safety.
Unfortunately a few of them may have complications or are unhappy with their outcomes. They need implant revision. Implant revision is quite a demanding procedure and therefore its recommended to choose your surgeon carefully. One needs to have enough experience in these complex surgeries to achieve an acceptable outcome.
BREAST REVISION IN BRIEF
| Length of surgery | 1-3 hours depending on complexity. |
| Hospital | Day surgery under General anaesthesia |
| Recovery | back to office job in a week . regular activity 4 weeks and strenuous activity in 3 months |
| Final results | 3-6 months |
| Cost | The price depends on the complexity of the procedure |
Photo upload instructions
Please upload 3 photos for each set . Photos should show your body from neck to belly button.
SET 1 (standing position with arms by side) –
1. Front view 2. Oblique view and 3. Side view.
SET 2 ( Standing position with both hands held behind the head
1.Front , 2.Oblique and 3.Side
A face to face consultation is necessary to understand the procedure , measurements taken and for the final quote.
PROCEDURES
The anatomy of the breast tissue and the pectoralis major muscle is completely distorted by the initial implant. Thinned out tissues and the existing capsule makes it hard to determine the excat pocket size needed to accommodate your new implant. Hence a breast revision procedure needs an excellent surgical hand.
Dr. Mahadik will explain what to expect after a revision and help you select the new implant which could be sometimes a compromise and a balance to what can be achieved.
There are multiple procedures and their combinations depending on the complexity of the problem you come with.
There are multiple procedures and their combinations depending on the complexity of the problems.
Just to name a few :
- Pocket reducing and enlarging procedures
- Capsulectomy
- Muscle releasing procedures
- Permanent suture technique
- Reinforcement with ADM
- Capsular scoring
- Implant deflation ( previous saline implants )
Often it is a combination of 3 or more of them needed to achieve an acceptable result.
WHY DO PEOPLE NEED REVISIONS
Modern implants offer a lifetime warranty and also retain shape. The breast tissue on the top of the implant, unfortunately continues to age and change with pregnancy like any other part of the body.
Most women, hence would like to have a revision after enjoying their implants for 10 – 15 yrs. Others want revisions after unforeseen complications.
Broadly speaking , the common causes for breast implant revisions are
- Patients wish to upsize or downsize
- Implant problems
- Tissue and pocket problems
A) I WANT TO GO BIGGER
Majority would want to go one cup larger than what their previous implant. Its important to talk to us what aspect of those looks you are after , whether it is about
- more cleavage
- more side boobs or
- upper pole fullness
- This helps Dr Mahadik to choose what is best for you.
B) WANT TO GO SMALLER
Most challenging task is to shrink the large pockets symmetrically and to achieve medial fullness at the same time. Since the previously stretched skin collapses to surround a smaller implant , the excess has to be removed along with elevation of the nipple . This means you get a breast lift procedure that comes with a ‘ lollypop scar ‘.
Its advisable , not to go too small, because the outcome could end up being quite unnatural and something you didn’t expect.
C) IMPLANT RUPTURE
Capsular contracture remains the commonest cause of implant rupture when the outer shell breaks and the silicone or saline leaks into the breast tissue. Trauma or implant failure can also cause ruptures. Newer implants are cohesive which means the silicone doesn’t get displaced and doesn’t leak . leaked. Their rupture rate is also very low ( 0.5- 2 % )
Implant ruptures are difficult to detect. Most of them present with nothing more than a mild breast discomfort.
High level of suspicion, along with an MRI or ultrasound makes the diagnosis with minute details.
Once detected they should be removed with their capsule and replaced.
D) CAPSULAR CONTRACTURE
Every woman develops a thin breast capsule around their implant and this is a normal phenomenon. This capsule causes severe contracture probably in 5-7% of augmentation patients. The capsule thickens , shrinks and hardens to cause pain and rippling. It also distorts the breast to make it hard and uneven to feel. In advanced cases the implant fails and ruptures.
Smoking, pocket bleeding at surgery, infection increase the chances of capsular contracture.
Treatment – Revision surgery to removes the capsule ( capsulectomy ) and the implant needs to be changed. Alternatively a new subglandular pocket is created above the original submuscular pocket or vice versa for the new implant to sit.
Reinforcing the implant pocket with acellular dermal matrix might also be needed in select cases.
E) UNEVEN IMPLANTS
Implant migration – Occasionally patients find one implanted breast higher or pointing outward than the other. The implant tends to migrate higher into the pocket or sways on the side which looks suboptimal. Itsrecommended for this to settle down for 3 months before you go n for a revision We recommend you should wait for at least 3-4 months after the initial procedure before you go in for any revision. This will help your internal swelling to settle and a capsule to form.
Uneven Nipples – Subglandular implants can sag and bottom out bringing the nipple down with them . Submuscular implants can slide laterally if the pocket is inadequate in the inner cleavage area and nipple may point outwards.
Waiting for a few months to allow a capsule to form will help n any revision procedure planned later
F) RIPPLING DEFORMITIES
Rippling – is wrinkling of the breast skin over an implant that looks ugly and gives a ‘fake breast ‘ look. In subglandular implants under a thin skin the capsule scars up with the overlying skin and causes ripples. This is also a risk with multiple revisions when the overlying tissues become progressively thinner and they ripple.
Animation deformity – This is exclusive to submuscular implants . The breasts skin develops bands and ripples on activation of chest muscles giving rise to an ‘animation deformity ‘. It appears that implant moves with activities like lifting hands up or at gym. The breasts otherwise look absolutely normal at rest.
The bands result from both inadequate or over release of muscle in the midline. Treatment is revision by moving the implant in a new , above the muscle ( subglandular ) pocket. Reinforcing the muscle edge with artificial dermal matrix also helps.
G) IMPLANTS TOO CLOSE
Kissing implants or Symmastia is a deformity where implants are almost touching in the midline. There is no cleavage as the midline skin gets lifted up.
Too large an implant base or too wide a pocket size in this area gives this deformity.
Some patients have a deformity of depressed sternum called pectus excavatum. Symmastia is a very common in them unless extra care is taken while making the pockets.
Revision surgery with narrow implant bases or reducing the pocket with permanent sutures will help.
H) IMPLANTS TOO FAR ( no cleavage )
This is a difficult problem to fix. There are 2 main reasons that can cause this deformity .
1. Improper pocket size –
- medial muscle is inadequately divided or
- The lateral pocket is too roomy so they slide on the side
2. Small implant diameter –
- impalnts lesser than the breast footprint leave
- less cleavage and they appear spaced out
Dissecting the medial muscle off its attachment and placating the lateral pocket with permanent sutures is needed.
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