Complications following breast augmentation may require revision. Revision breast augmentation surgery can be more difficult than the original operation. It is important to choose a surgeon with skill and experience in breast augmentation to help avoid these complications. Should one arise, it is especially important that the surgeon has the skill and experience required to perform breast implant revision surgery.
Breast implant malposition or asymmetry
This is one of the most common problems requiring breast implant revision surgery. During breast augmentation, implant pockets are created and assessed for size and symmetry before implants are placed. If the pockets are improperly created, there will be breast implant asymmetry. There are other issues during maturation of the implant pocket that can result in implant pocket asymmetry.
Treatment requires modification of the implant pocket on one or both sides. This procedure is usually easy on the patient but tough on the surgeon. Easy on the patient because there is very little pain afterward and often can be done with light sedation. Tough on the surgeon because symmetry is much harder to achieve than during the original surgery.
If soft tissue is compromised and will not “hold” the implant into the desired position a new technology, acellular dermal matrix (ADM), can be used to support the implant.
This patient presented to Dr. Yates with subglandular silicone implants that were too narrow and misplaced. She also had severe capsular contracture. Revision required 1) removal of the old implant and hard capsule, 2) changing to a submuscular implant pocket and 3) choosing an implant that better matched her frame. The current implant is 250 cc silicone.
Exchange of breast implants for larger or smaller size
Choosing an implant size is an important component of the breast augmentation consultation. In Dr. Yates office the most valuable tools are “trying on” implants and 3D imaging. Occasionally, a patient will desire exchange of implants for a larger or smaller size. This is a very easy procedure and can be done with mild sedation with a very easy recovery.
Changing from saline breast implants to silicone breast implants
Silicone breast implants are softer and a little less likely to have rippling. Occasionally, patients with saline breast implants would prefer silicone breast implants. This can be a simple, relatively inexpensive, procedure with little downtime.
Capsular contracture is the development of an inappropriate amount of inflammation and scar tissue around a breast implant. This can cause unsightly or uncomfortable firmness of the breast. There are a number of suspected causes of capsular contracture. Two of the most commonly suspected causes for increased inflammation and scarring around an implant are bacteria or blood.
To help decrease the risks of capsular contracture great care and attention should be given to sterility during breast augmentation. Antibiotics are given before and after surgery and the implants are “bathed” in antibiotics prior to implantation. Steps to decrease risks of bleeding at the time of surgery and afterward are also taken.
The type of incision, implant texture and location of the implant pocket also effect capsular contracture risk.
- Inframammary incision has the lowest risk as it avoids hidden bacteria in milk ducts
- textured implants have a lower capsular contracture rate than smooth implants
- submuscular pocket has a lower capsular contracture rate than subglandular
Treatment of capsular contracture depends on the severity and how early it is diagnosed. If caught early oral medications, including Vitamin E and Accolate, can be helpful. Later presentation generally requires removal of the implant capsule (capsulectomy). The risks of recurrence can be reduced by changing to textured implants or changing to a pocket beneath the muscle if not already performed.
Synmastia is a loss of cleavage between the implants. This results from a pocket created too far medially with over-aggressive release of the implants medially. This is a higher risk when the implant chosen is too large for the patients frame. Correction is very difficult involving recreation of the medial pocket allowing the implants to separate, possibly supporting the tissue with acellular dermal matrix.
Saline implant deflation
Saline breast implant deflation requires removal of the deflated implant and replacement with a new implant. Generally a very easy, straightforward procedure.
This patient had breast augmentation performed elsewhere several years ago complicated by deflation of the right.
Silicone implant rupture
Silicone implant rupture generally requires removal of the silicone breast implant and all breast implant material. With newer generation cohesive silicone breast implants the silicone is certainly less “messy”
Rippling or wrinkling of breast implants
Rippling occurs when the breast implant has a fold or ripple that is either seen or felt in the breast. In actuality, all breast implants ripple to some degree but most patients cannot feel or see this rippling as it is well hidden by the breast and tissue covering the implant. Different implants ripple at different rates based on the amount and type of “fill” of the implant. Silicone implants tend to ripple less than saline as the fill material is less liquid than saline. Textured implants tend to ripple more than smooth. The more cohesive (solid) the silicone in an implant is the less it will ripple. The most cohesive implant currently available are the anatomical or teardrop shaped silicone implants, also known as “gummy bear implants” which may ripple at the lowest rate of all implants. The tradeoff is that these implants are slightly firmer.
For saline implants overfilling is a valuable tool to minimize rippling. This is commonly misunderstood to imply filling the implant more than it should be. The implant manufacturers have a fill range for saline implants and overfilling is simply filling on the larger side of this range. This does cause a little more firmness and roundness of the implant but is generally an acceptable trade-off.