Breast Implant Revision Salt Lake City & Layton, Utah
Complications following breast augmentation may require revision. Revision breast augmentation surgery can be more complicated than the original operation. It is essential to choose a surgeon with skill and experience in breast augmentation to help avoid these complications. Should one arise, the surgeon must have the skill and expertise required to perform breast implant revision surgery. Click here to view our Breast Implant Guide.
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 implant placement. If the pockets are improperly formed, there will be breast implant asymmetry. There are other issues during the maturation of the implant pocket that can result in implant pocket asymmetry, such as muscle effects.
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 the recovery is often much more comfortable than the original augmentation. Tough on the surgeon because symmetry is much harder to achieve than during the initial surgery.
If soft tissue is compromised and will not “hold” the implant into the desired position, additional support with synthetic or biological material can be added to support the implant. These materials aren’t without cost or complications, and Dr. Yates uses these only if other methods would not be expected to work.
Changing breast implant Size
Choosing an implant size is an essential component of the breast augmentation consultation. In Dr. Yates’s 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. A straightforward procedure 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. A simple, relatively inexpensive procedure with little downtime.
What is Capsular contracture?
Capsular contracture is the development of an inappropriate amount of inflammation and scar tissue around a breast implant. It can cause unsightly or uncomfortable firmness of the breast. There are several suspected causes of capsular contracture. Two of the most commonly suspected reasons for increased inflammation and scarring around an implant are bacteria or blood.
To decrease the risks of capsular contracture, 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 before 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. Acoustic sound wave therapy, such as the Zimmer in Dr. Yates’s office, can be beneficial as well when caught early. The later presentation generally requires the removal of the implant capsule (capsulectomy). The risks of recurrence can be reduced by changing to a pocket beneath the muscle if not already performed.
Removal of capsule affected by capsular contracture
What is Synmastia?
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. There is a higher risk when the implant is too large for the patients’ frame. Correction is complicated 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 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 undoubtedly 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 supported their safety. Proponents of breast implant illness 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 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 likely exists. 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 frequent, risks when making this decision. My advice to women who have implants and believe they may be causing illness is to see their Plastic Surgeon 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 removed from 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 BIO CELL 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 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.
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. Overfilling results in 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.
I just want my implants removed is that possible?
Absolutely. The cosmetic results of breast implant removal can range from fantastic to unacceptable. Factors including the size and location of breast implants, subsequent changes to the breasts after augmentation, and time the implants have been in place all affect the cosmetic outcome. There may be cosmetic options available such as breast lift and fat transfer to the breast for patients who need them.