Reasons for Breast Implant Revision Surgery
There are various reasons why a woman might decide to undergo breast implant revision surgery, as changes to the breasts are natural over time, and those with implants are no exception. Life events such as aging, weight fluctuations, and hormonal changes continue to affect the breast tissue and implants, sometimes requiring adjustments to enhance breast appearance, improve comfort, and resolve issues that may have arisen from previous breast augmentation surgeries. Here are some common reasons why women choose to undergo breast implant revision:
01.
Size Change
Many patients opt for breast implant revision surgery to change the size of their implants, either increasing or decreasing the volume. Over time, preferences can shift, or changes in body composition, lifestyle, or fashion trends may lead to dissatisfaction with the original size. Some individuals might seek a smaller implant to alleviate discomfort or to achieve a more natural appearance, while others may desire larger implants to enhance cleavage.
02.
Breast Implant Rupture
Implant rupture occurs when the outer shell of a breast implant breaks, causing the implant’s contents to leak. With saline implants, the rupture is usually noticeable because the breast quickly deflates as the saline is absorbed by the body. Silicone implant ruptures are less obvious, often termed “silent ruptures,” because the silicone gel may remain within the scar tissue capsule around the implant, without causing immediate changes. However, both types of ruptures require revision surgery to replace the damaged implant and restore the breast’s shape and volume.
03.
Capsular Contracture
Capsular contracture is the most common complication following breast augmentation surgery, occurring when the scar tissue (capsule) that naturally forms around the implant tightens excessively. This tightening can cause the breast to become hard, painful, or misshapen. Revision surgery for capsular contracture typically involves removing or releasing the hardened scar tissue and replacing the implant to restore a softer, more natural breast shape and feel.
Unfortunately, there is no way to predict who will experience capsular contracture or when it might occur. While it used to be more frequent, the incidence has significantly decreased in recent years, with current rates around 5% within 10 years post-surgery. It’s important to note that smokers and vapers face twice the risk of developing capsular contracture compared to non-smokers. Additionally, individuals who have had capsular contracture are at a higher risk of experiencing it again in the future.
04.
Breast Implant Malposition
Breast implant malposition refers to implants that have shifted out of its proper position within the breast pocket. This can result in an abnormal appearance, with the implant sitting too high, too low or too far to the side. Causes of malposition include issues with the surgical technique, implant surface texture, natural body changes over time, or the weight of the implant causing it to migrate. Revision surgery is performed to reposition the implant and, in some cases, adjust the breast pocket or use surgical mesh to hold the implant in place. This helps restore symmetry and the desired aesthetic result.
05.
Symmastia
Symmastia, occurs when breast implants are placed too close together cause the skin between the breasts to stretch or detach from the chest wall, leading to the appearance of merged breasts. This condition eliminates the natural cleavage between the breasts and can be aesthetically displeasing. Symmastia is often caused by over-dissection of the breast pocket during surgery or the use of implants that are too large for the patient’s chest. Revision surgery involves reconstructing the breast pockets and repositioning the implants to create a more natural separation and restore proper cleavage.
06.
Wide Cleavage
Wide cleavage is a condition where the implants are positioned too far apart, resulting in a noticeable gap between the breasts. This may occur due to the patient’s natural anatomy, improper implant placement, or an implant that is too small for the chest wall. Wide cleavage can be aesthetically displeasing for those seeking a fuller, more centred breast appearance. Revision surgery for wide cleavage involves repositioning the implants closer together or addition of fat grafting to the cleavage area to achieve a more proportionate and balanced breast appearance, with improved cleavage definition.
07.
Double Bubble Deformity
Double bubble deformity happens when the breast implant shifts below the natural crease (inframammary fold) of the breast, creating a visible indentation or second fold, hence the term “double bubble.” This can occur due to improper implant placement, anatomical factors, or improper use of implants in tuberous breast anomaly. The condition can distort the breast’s appearance, making the lower part look unnatural. Revision surgery corrects this deformity by adjusting the implant position, reconstructing the breast fold, or fat grafting to camouflage the second fold.
08.
Waterfall Effect
The waterfall effect happens when the natural breast tissue sags or droops over the implant, creating a discrepancy between the position of the breast tissue and the implant. This occurs when the implant remains in place, but the breast tissue loses elasticity and starts to sag, typically due to aging, weight fluctuations, or pregnancy. The result is a “waterfall” appearance, with the breast tissue hanging lower than the implant. Revision surgery for the waterfall effect often involves a breast lift (mastopexy) to reposition the breast tissue, restore a firmer breast shape, and align the tissue with the implant.
09.
Animation Deformity
Animation deformity occurs when breast implants, particularly those placed under the chest muscle (submuscular), move or distort when the pectoral muscles are flexed. This can lead to visible shifting of the implant, especially during physical activities like exercising or lifting. While it does not pose a health risk, animation deformity can be aesthetically unappealing and uncomfortable. Revision surgery to correct this involves repositioning the implant over the muscle (subglandular) or using specific techniques to minimize the movement of the implant when the muscles are contracted.
Breast Implant Removal
Breast implant removal, also known as explant surgery, is a procedure in which breast implants are surgically taken out, often due to complications, personal preference, or health concerns. Women may choose to remove their implants for various reasons, including changes in aesthetic preferences, discomfort from aging implants, or the development of complications like capsular contracture, implant rupture, or breast implant illness (BII). The decision can be a personal one, influenced by physical, emotional, or medical factors.
The procedure itself typically involves removing the implants along with the surrounding scar tissue (capsulectomy), especially if there has been hardening or other complications. Depending on the patient’s goals, additional procedures, such as a breast lift (mastopexy) or fat grafting, may be performed to restore the breast’s shape and volume after implant removal.
How the Procedure is Performed
Breast implant revision surgery is always performed under general anaesthesia in a fully accredited hospital with the assistance of a qualified anaesthetist. Depending on the complexity of the procedure it may take 1 to 3 hours, and generally you are discharged the same day.
Dr Scott J Turner, Specialist Plastic Surgeon provides a comprehensive range of breast implant revision procedures, including implant removal, implant replacement, mastopexy and fat grafting techniques
01.
Implant Exchange
Implant exchange involves the removal of existing breast implants and the insertion of new ones, which may differ in size, shape, or material. The new implants can be placed in the same breast pocket or, if necessary, in a newly created one to achieve better symmetry, shape, or positioning. This technique is often chosen when patients want to update their look or address issues such as implant aging, rupture, or dissatisfaction with the original results.
02.
Capsulectomy
A capsulectomy is performed to remove the scar tissue (capsule) that naturally forms around the breast implant. In cases where the capsule has hardened excessively (capsular contracture), the entire capsule may need to be removed along with the implant. During the same surgery, a new implant may be placed to restore the breast’s shape and softness This procedure is essential for patients experiencing discomfort or aesthetic issues due to the thickening or tightening of the capsule.
03.
Pocket Revision – Internal Bra Technique
Pocket revision involves modifying the breast pocket to either tighten or loosen the capsule. This technique is commonly used to correct issues like wide cleavage, symmastia, or bottoming out. Dr. Turner may also use a mesh or sutures to create an “internal bra,” providing extra support to hold the implants in place, particularly for patients with weak or thin tissue or who have experienced implant shifting. The breast implant pocket may be changed from a subglandular (above the muscle) position to a submuscular (below the muscle) position or vice versa. This change can provide better tissue coverage, reduce complications, and improve the aesthetic result.
04.
Breast Lift (Mastopexy)
A breast lift, or mastopexy, is performed to address sagging or drooping breasts, often combined with implant revision. Excess skin is removed, and the breast tissue is lifted and reshaped to create a firmer, more youthful contour. The nipple and areola may also be repositioned higher on the breast to enhance symmetry and appearance. This technique is particularly useful for restoring firmness and correcting sagging after years of implant wear.
05.
Fat Grafting
Fat grafting is a technique where fat is harvested from areas such as the abdomen, thighs, or flanks using liposuction. The fat is then processed and injected into the breast to add volume, smooth rippling, or improve tissue coverage over the implant. This technique allows for a more natural enhancement and can be used in conjunction with other revision procedures to enhance overall results.
06.
Implant Removal - Explant
The implants are removed, and depending on the patient’s goals, the surgeon may also remove the capsule (capsulectomy) and perform a breast lift or fat grafting to restore a natural breast appearance after explant surgery.
07.
Scar Revision
The surgeon removes or repositions old scars, using advanced techniques to minimize their appearance. Scar revision is often done in conjunction with other revision techniques.
