Breast Implant Revision Surgery
What is Appropriate for You?
Michael C. Edwards, MD, FACS
Saline implants can leak or ?rupture? leading to a distressing situation for the patient. Although it is helpful to evaluate and treat these patients as soon as possible a carefully planned approach can be taken to alleviate anxieties. Most implants placed in the US now come with an implant warranty where the implant manufacturer will replace the implant. The same is true of silicone implants except you would not know if your silicone implant had a structural defect, aka crack unless you had surgery or an MRI to tell you that there was a chance that the implant was defective. Treatment may be as simple as removing the deflated implant and replacing with the same size or you may have decided that you would like to change your implant size. As stated before, each case is different and the starting point is different. If you have a capsular contracture or thin tissues covering your implants, there may be good options to improve on your breast aesthetics (see the complicated cases at the end of this article). If it has been awhile since your primary surgery, your breasts may have changed from changes in your weight or with pregnancy. If this is the case you may need to entertain having a breast lift in addition to tighten your breast tissue and move your nipple to a position more at the apex of your breast.
This patient underwent breast augmentation approximately 8 years previously and noted a decrease in the size and fullness of her left implant. She chose to have a larger implant placed accompanied by a breast lift.
A desire to be larger
The goal with your primary breast implant surgery is to choose an implant that both fits your body frame and tissue characteristics. Your breasts will change with time and life circumstances though. If you choose to have a breast implant revision to change to larger implants, it is very helpful to have the information about your current implants so that an intelligent decision can be made about the change you would like to make. This surgery as well can be relatively simple or require more tissue release to make room for the new bigger implants.
This patient desired a larger breast size and was very happy with her results after switching to silicone implants from her older saline implants.
A desire to be smaller
Just as with changing to a larger size, some patients choose to decrease their implant size after their initial surgery. This could have been due to them not being involved in the planning or from a surgeon feeling they know what is best for the patient. The choice of a breast implant should be based questioning the patient?s desired outcome, on a careful analysis of the dimensions of the breast and tissue characteristics, and a good dose of common sense. That having been said, if you choose to decrease the size of your implant, it may not be as simple as placing a new implant. The capsule that surrounds the implant may need to be tightened with internal suturing (capsulorrhaphy) and the skin may need to be tightened or lifted.
This petite woman did not get the results she wanted with her first surgery. Her initial surgeon felt that placing larger implants would negate the need for a breast lift which is what she had with her revision surgery and decrease in implant size. She is now more proportionate and her areolas are smaller which is what she wanted as well with her first surgery.