Breast Implant Revision Salt Lake City & Layton, Utah
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 the 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.
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 the 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 affect 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 the 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 the re-creation 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.
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”. For a demonstration of the strength of silicone breast implants watch these videos of my staff trying to destroy them.
Breast implant Illness
“I believe my silicone breast implants are causing me to be sick and I want them removed”. This has been a concern of some patients for many years but in light of social media, there has been renewed vigor of these concerns recently. Defenders of silicone implants will say that the data and science are conclusive. Silicone implants were taken off the market for over a decade while rigorous testing and studies were performed supporting their safety. Proponents of the breast implant illness theory claim that these studies were poorly designed and inconclusive. Here is my (Dr. Yates) editorial and current belief on the issue… I don’t know. Sorry for the obscurity but as a surgeon who has been placing, replacing and removing silicone implants for years I cannot say that I have EVER definitively seen a patient with BII. I have had several patients that I have removed implants for presumed BII and some of them report improved symptoms. But few of these symptoms are objective and measurable.
I believe Breast Implant Illness very well may exist. Our bodies and our immune systems are so different it would be unwise to deny that a rare population of people may react differently to any foreign body, including breast implants. My advice is that a patient considering breast augmentation should consider breast implant illness as well as a number of many other, more common, risks when making this decision. My advice to women who have implants and believes they may be causing illness is to see their Plastic Surgeon to discuss these issues as well as their general medical doctor to rule out other conditions. Implant removal +/- capsule removal may be indicated. For more information regarding breast implant illness, click the link.
BIA-ALCL and Textured implants
There is a relatively new disease process associated with breast implants called BIA-ALCL (Breast Implant-Associated – Anaplastic Large Cell Lymphoma). It is a cancer of the lymphatic system that has been associated specifically with textured breast implants. There is a much higher risk of ALCL with a specific type of breast implant texture called Macrotexture, made by Allergan. As of July 2019, these textured Allergan implants have been taken off the market. Although the FDA is not recommending implant removal or exchange unless symptoms develop many patients who have these implants are having them removed and exchanged with smooth implants out of caution. As of Jully 2019, Allergan created the BIOCELL Replacement Warranty in which they will provide smooth-walled implants free of charge to replace textured Allergan implants.
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.
Before & After
59 year old female presented with a previous breast augmentation 20+ years ago. She felt that the breasts were too large and droopy and was unhappy with her abdomen. Photos are before and 3 months after breast revision including removal of old implants, adjustment of implant pockets, replacement with slightly smaller implants, lower breast reduction and breast lift. She also had full abdominoplasty with upper hip liposuction the following day. Procedures were separated for safety and were done without general anesthesia. View More.
Call us at (801) 525-8741 to learn more about breast implants in Layton, UT or schedule a consultation by contacting us here.