What is breast implant revision surgery?
Breast implant revision surgery includes a number of procedures:
- breast implant removal and replacement - with or without a breast lift (mastopexy)
- breast implant removal without replacement
- breast implant removal without replacement and a breast lift (mastopexy)
This 56 year old patient had previously undergone two breast augmentation procedures with other surgeons, the first using round 450cc implants in the 1980’s and revision surgery more recently, using anatomical 290cc implants. She missed having a fuller bust line and wished to restore the volume she once had in her breasts, while also removing loose skin that had developed through the ageing process. During the patient’s pre operative consultations, Dr Sharp discussed her ideal implant size relative to her chest width and overall aesthetic goals. The pros, cons and risks of a one-stage revision and mastopexy procedure were weighed up against the lower risk profile of a two-stage procedure, whereby the implants are removed and mastopexy performed initially, and then months later the augmentation is performed. The patient and Dr Sharp decided upon a one-stage procedure; her implant pocket was revised and the mastopexy lifted the breast into a higher position on her chest. Finally, cohesive gel round high profile 450 cc implants were placed. Dr Sharp utilised implant ‘sizers’ to ensure the chosen implant would improve the profile and contour of the breast. These photos show the patient’s recovery and lollypop mastopexy scarring at 12 weeks post surgery.
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This patient underwent breast implant revision surgery (removal and replacement) in 2017 with Dr Sharp. For her original augmentation with another surgeon in 2010, the patient had 330 high profile round ‘Brazilian’ polyurethane implants placed above the muscle (sub glandular placement). She saw Dr Sharp because she was happy with the appearance of her breasts, but had been experiencing discomfort, and had a grade 4 capsular contracture. During the patient’s pre operative consultations, Dr Sharp discussed the process of capsule removal, implant size and profile choices and revising her implant pocket, changing it from above the muscle, to a dual plane. During the operation Dr Sharp utilised implant ‘sizers’ to ascertain the best size and profile to achieve a similar look and size to the patient’s previous augmentation, while improving the profile and contour of the breast. Cohesive gel 455 cc round, ultra high profile implants were used.
What does a breast implant capsule look like?
Dr Sharp shows a breast implant contained within a capsule. Dr Sharp frequently removes and replaces breast implants for women who wish to upgrade their prosthesis or obtain a change in breast shape or size. In most cases, Dr Sharp removes the capsule along with the implant (called a ‘capsulectomy’). Capsules form around implants naturally, and usually don’t pose any problems, but in a small percentage of patients they can lead to discomfort and changes to breast appearance.
above: before and five months after breast implant removal and lift surgery with Dr Sharp
I want to replace my breast implants
Whether an implant rupture or capsular contracture requires you to have your current implants removed and replaced - or you simply wish to change the size or shape of your breast implants - this procedure involves the removal of your current implants, with or without the surrounding capsule, and replacement with new implants. In most cases an MBS item number applies to this procedure and you may receive a rebate from Medicare and/or your private health fund for some of your surgery costs. Some implant manufacturers have a replacement warranty for capsular contracture or rupture, and may provide new implants at no cost. If you are downsizing your implants, your surgeon can advise whether or not you may benefit from having a mastopexy to remove excess skin and lift your breasts.
I want to remove my breast implants
Breast implant removal without replacement is sometimes sought by women who no longer wish to have implants, due to recurring complications, back problems or health issues. In most cases there will be resulting excess skin or possibly asymmetry due to pre existing breast anomalies, ageing and the stretching effect of the implants. You may wish to have the resultant excess skin removed and the breast lifted after the implants are removed, in a procedure called a mastopexy - at the time of removal, or sometime in the future. The surgery can be performed with or without removal of the capsule that forms around the implant, and the risks and benefits of this will be discussed during your pre operative consultations. Sometimes, full capsular removal is not possible due to the capsule’s close proximity to the skin or chest wall.
FREQUENTLY ASKED QUESTIONS ABOUT BREAST IMPLANT REVISION SURGERY
I WANT MY BREAST IMPLANTS REMOVED + REPLACED…
Will my breasts look the same after my revision surgery?
In most cases, your breasts will look different after your revision surgery. If you are replacing your implants, they make look higher initially, and you may notice that your inframmary fold (the fold under your breast) is a different height.
If you have changed implant shape, profile or size, this will also leave you with a different shape and profile.
It’s important to let your surgeon know what you do or don’t like about your current breast appearance so they can factor this into their surgical approach, and discuss your expected result. [Right: implant removal, replacement and lift (mastopexy) surgery as a combined procedure].
What’s involved in having smaller breast implants placed?
Your procedure will depend on the size of your original implants, how much your skin has stretched, nipple position once the implants are removed, the internal chest anatomy that has supported the implants and your inframammary fold. It will also depend upon your desired result and the size of implant you are reducing to. In most cases where a patient is reducing from a large implant down to a small to medium size, there will be excess skin and laxity that requires a breast lift (or mastopexy) if you wish for a ‘perkier’ appearance or clevage. This is a more complex procedure that involves more scars and carries risks of additional complications - especially when an implant is placed simultaneous to the lift being performed. Your surgeon will discuss the risks and benefits of this procedure with you. Sometimes, this transition is done in a single procedure, or staged over two operations, depending on the patient. Most removal and replacement procedures attract a rebate from Medicare (and if you have appropriate insurance, your private health fund) to cover a portion of the costs. If your inframammary fold requires additional support, your surgeon may recommend the placement of a dermal matrix that acts as an internal ‘sling’ at the base of your breast, to provide additional support for your new implant.
I’d like larger implants placed - what’s involved?
The first thing Dr Sharp will do is examine your current size and shape, and take measurements of your chest. The gold standard in breast augmentation is to create a proportionate look, and there is a standardised ideal ‘range’ for each patient’s breast width, that sets out best practice implant sizing. You will have at least two consultations with Dr Sharp to discuss the procedure and decide upon your ideal sized implants. The surgery itself takes about 90 minutes and involves the removal of the existing implants, any adjustments that need to be made to your implant pocket and inframammary fold and placement of new implants. The procedure may attract a rebate from Medicare (and if you have appropriate insurance, your private health fund) to cover a portion of the costs. Placing implants that significantly exceed the recommended range for your anatomical measurement can not only unnaturally distort your body shape - it can also increase your chances of complications (see complications discussed below) and require costly reconstruction down the track. It can also hinder everyday activities and create an unbalanced proportions. These lifestyle and clinical factors are all taken into consideration when choosing the optimal size increase for you.
What is the recovery from breast implant removal and replacement like?
In most cases it is similar to the recovery from the primary breast augmentation. Some patients report that the recovery is easier because they knew what to expect after experiencing their first surgery - while others who require extensive capsular removal or mastopexy surgery - report a slower recovery and more swelling. Most patients have 1 to 2 weeks off work, depending on the duties they perform and whether they can have assistance with transport to and from work (no driving during this period). The first 6 weeks will be limited to only light activities, lifting nothing more than 1-2kg; being careful not to raise your arms above your head and generally taking care with your upper body movements. You will need to wear a special support bra (which we provide) for at least the first 6 weeks. Swelling can take 3 months to settle, implants can take 12-24 months to settle into position as the internal scars change and supporting structures adjust and soften - and scars take up to 2 years to ‘mature’ into their final form.
I have a double bubble breast implant deformity - can this be corrected?
Yes. A ‘double bubble’ or ‘bottomed out’ implants occurs when implants are placed behind the chest muscle and the natural breast tissue sags (breast ptosis) below the implant. This sagging can become worse after pregnancy or with age. Sometimes, it occurs when a patient accidentally over-exterts the chest muscles after surgery, which is why it’s very important to be patient and take care when lifting or pulling heavy objects at any stage after augmentation surgery, as your chest muscle anatomy is impacted by surgery and the fact you have implants changing your natural dynamics. Another double bubble scenario occurs when your preoperative natural fold (inframammary crease) is too high. As a result, there is a visible groove between your nipple and the new lower crease. This basically separates a bulge above from a bulge below. Placing breast implants behind the muscle, does not mean a woman will develop double bubble and it is not always the results of surgical error.
My breast implants have bottomed out - can you correct this?
Yes. ‘Bottoming out’ occurs when a breast implant slips below the inframammary crease (the fold under your breasts). The fold becomes lower, and less defined, and the nipple and areola may tilt upward as the breast implant heads south. The scar from your original breast augmentation may travel up the lower breast. Bottoming out can occur if your implant is too big and heavy for the amount of skin and underlying breast tissue – or if your implant was placed above your muscle. There are several options based on how extensive the bottoming out has been. Your surgeon can sew the capsule under the breast in order to push the implant higher in the pocket and center the nipple and areola on the breast mound. This can be done using sutures or via a flap of tissue from the inside of the implant pocket, however if oversized implants are the cause of your bottoming out, you may continue to have recurrent complications and a smaller implant should be placed. Often, a tissue substitute (called a dermal matrix) is used like a sling at the bottom of the breast, to hold the breast up and support the implant. In some cases, a breast lift (mastopexy) could also be required.
I WANT TO HAVE EXPLANT SURGERY..
Will my breasts look the same as they did before I had breast implants?
No, they will look different. After explant surgery, breasts rarely return back to what they looked like before you had breast implants. You will need to consider the fact that your skin has been stretched by the size and weight of your implants, and also with time and ageing, your natural breast tissue and skin condition will be different now. Sometimes, women are disappointed with the appearance of their breasts after having explant surgery due to excess skin and stretching of the breast, and opt to have further surgery to lift their breasts, or have fat transferred to their breasts to restore volume. Dr Sharp will discuss these options with you at your pre operative consultations, and the decision to proceed with further surgery to correct any asymmetry or breast changes can be delayed until months or years after your removal surgery, so there is no rush to make a final decision about this at the time of your implant removal.
Do I need to have a breast lift (mastopexy) after explant surgery?
Dr Sharp offers mastopexy surgery for excess skin or sagging breasts (ptosis) after breast implant removal; in our clinic’s experience, most patients choose to do this for cosmetic reasons, however it is not medically required in most cases - and is entirely your own decision. We respect that the scars, additional surgical costs and the more extensive surgery involved with this may not be for everyone; we will always respect your choice as to whether or not you wish to have a mastopexy after your breast implants are removed, and Dr Sharp will discuss the benefits and risks of the mastopexy procedure with you at your pre operative consultations.
My breast implants are ruptured; do I need emergency surgery?
In most cases, no. If you have modern form stable cohesive gel implants, the silicone itself will stay contained and won’t be ‘leaking’ like the syrupy horror stories seen in the early days of breast implants. Sometimes ruptured implants will cause discomfort and swelling, and so for this reason Dr Sharp always tries to see any patients with rupture concerns as soon as possible, so a plan of action can be put in place. Sometimes it is very evident when an implant ruptures, but other times it can take months or years to be detected - and even then, ultrasounds can indicate a possible rupture, and when the implant is removed, no rupture can be found. Finding out that your implant might be ruptured can be a scary experience and its understandable to feel anxious, but usually the surgery to correct his is straightforward and involves removing the implant, cleaning the breast pocket and replacing it with a new implant. Most breast implant manufacturers in Australia offer a replacement warranty for implants if they rupture, so in many cases your implant will be provided by the manufacturer at no cost, and there will also be a rebate from Medicare (and if you are insured, your health fund) to cover some of the costs of the procedure itself.
How can I avoid breast augmentation complications that require revision surgery?
This is one of the greatest concerns we hear from women when having their initial implant surgery - and if you are asking yourself the same question, it’s a good sign that you are consciously weighing up the risks and benefits of surgery from an informed perspective! All surgery carries risks, and while it’s easy to get caught up in the excitement of planning a breast augmentation, it’s also vital to understand that complications occur sometimes, and if you intend on having breast implants for the next 40 years of your life, they may need to be revised once, or more, during this time. There will be surgical costs, and recovery time, involved with this.
The most common breast augmentation complications are capsular contracture and rupture; it’s not possible to 100% prevent these, however some steps can be taken to reduce these risks, such as choosing certain implants and ensuring the sterility of the environment in which they are placed - that’s why Dr Sharp only performs this surgery in accredited hospitals under general anaesthetic, and opts for high quality form stable cohesive gel implants. While the implants available in Australia undergo stringent testing before being made available here - and are very durable - sometimes ruptures inexplicably occur, even if the patient hasn’t had a trauma or accident in the chest area, which would easily explain the rupture. As Dr Sharp uses technically-advanced implants, if you do have a rupture, the silicone stays contained and does not ‘leak’ into the chest as was seen in the early days of breast implant surgery.
Other complications, such as seroma, haematoma and infection, are uncommon but can be addressed promptly and effectively if you notify your surgeon as soon as you have any concerns.
Breastfeeding and pregnancy will always change your breasts, and are another reason patients seek out revision surgery, so if this is a concern for you if might be worthwhile considering delaying your augmentation until after you have finished having your family.
Other complications - such as a ‘double bubble’ or ‘bottoming out’ discussed above - can be minimised by choosing an implant that is appropriate for your body, taking great care during your post operative recovery period and choosing a qualified plastic surgeon. We are frequently contacted by people who have had very large implants placed elsewhere, only to find their bodies can’t support the size, and they cannot afford the expense of corrective surgery privately, especially if they’ve had cut-price surgery overseas. Overly large implants can cause many problems and this is one of the reasons why Dr Sharp aims for a more proportionate, natural looking result.
Taking care with your recovery and observing your post operative instructions is also integral to preventing complications. After the initial recovery period, your implants will eventually feel very much a part of your body, and you will carry out your every day activities not really thinking too much about them! While this is very normal, it’s important to remember that you’ve had surgery in this area and your body is supporting a foreign object - so you will always have to consider your breast implants during heavy exercise or when performing rigorous activities that involve your chest muscles.
And finally, it’s important to monitor your breasts - and if you notice any changes, irregularities, swelling or discomfort to see your GP. In most cases, if you have breast implants and your GP has any concerns, they will refer you to have an ultrasound - and if any problems with your implants are found, its important to make a prompt appointment with your plastic surgeon.
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