Breast Implant Removal and Replacement

Today’s generation of breast implants are much improved over previous devices, and most should last a long time.  However, we cannot expect them to be lifetime devices.  At some point, implants may require replacement; this is normal and should be considered with every breast augmentation surgery.  This doesn’t mean that you have to have breast surgery on a regular basis.  By and large, if everything looks and feels good and there is no evidence of rupture, you can keep your implants for many many years.  

Most of the time, removal and replacement of breast implants is desired for cosmetic reasons, rather than implant ruptures or other complications.  In either event, if you aren’t happy with the outcome of a previous breast augmentation or you are experiencing problems with your current set of implants, there are several options available to you.  Dr. George Landis has extensive experience performing breast augmentation revision procedures, and he can devise the best treatment plan to deliver exceptional results safely.

Is Breast Implant Removal and Replacement Right for Me?

There are several reasons for breast implant removal; it is a personal decision that each woman makes according to her own body goals.  As time passes, you may wish to have your breast implants removed. 

Some common reasons for considering breast implant removal include:

  • Desired to increase physical activity. Larger breasts can limit an active lifestyle, such as affecting arm motion when participating in golf or tennis.  The additional weight on the chest can make running more challenging and sometimes can result in back pain.
  • Dissatisfaction with appearance. After several years of having implants, some women want to return to their smaller figures.  
  • Deflation or scar capsular contracture. A small percent of implants can rupture, or the body can create a hard scar around the implant, leading to an abnormal appearance, which can only be corrected with implant removal and replacement

The Common Cosmetic Reasons for Breast Implant Removal and Replacement

This is the most common reason for revision breast implant surgery.  Of course, is no way to guarantee a bra cup size after surgery, as all bras fit differently and every implant size looks different from person to person, depending on many individual physical traits.  However, the implant must match the patient’s frame to prevent deformities and other problems.  It is important to remember that larger implants have a higher risk of complications including stretching soft, rippling, and increased sagging over time.

Some implant sizes just too large on small body frames.  Occasionally, some patients admit they didn’t realize just how big their implants would look; they may feel as if they look heavy with large breasts.  We keep in mind that going much smaller can lead to skin redundancy and increased sagging.

From 1992 to 2006, the FDA banned silicone implants and, during this time, many women received saline implants. However, they may now be opting for surgery to switch from a saline implant to the newer generation of soft and natural-feeling silicone gel breast implants.  Also, patients who have had old leaking silicone devices may choose to have implants replaced with the more modern and durable generation of cohesive gel implants.

Breast implants add volume but they do not treat sagging, and they do not lift breasts.  This added volume of weight from breast implants can create sagging over time for patients with poor skin tone and loose skin.  Sometimes, removal and replacement of implants requires a breast lift to treat sagging.  At the time of surgery, implant size can be increased or decreased, depending on the patient’s desires.

Some patients may have regrets about their initial decision to undergo breast augmentation.  Some women are just “over” having large breasts.  A particular subset of patients notices their bra size increases as they age, while other patients find themselves less concerned about their breast size and appearance as they age.  Explant treatment can be completed with or without a breast lift, but having a simultaneous breast lift often reshapes breasts to create a perkier and more youthful appearance.  Without a breast lift, you can expect some natural drooping of tissue.

For patients that undergo breast augmentation by an experienced surgeon who is certified by the American Board of Plastic Surgery, complications are rare.  However, there is still some risk that complications might occur, as is the case with all surgical procedures.  When difficulties arise, you may be able to correct poor outcomes with a breast augmentation revision procedure.

Your body will form a thin capsule or scar tissue in response to any foreign material placed within the body; most of the time, these scars cannot be seen or felt.  However, everyone heals differently, and some patients form thicker capsules than others for reasons we don’t understand.  When a moderate to severely thick capsule squeezes implant, it can feel uncomfortably firm.  In severe cases, capsular contracture can change the shape of the breast and become painful.

The risk factors below further the risks for development of capsular contracture.

  • The way the surgery is performed
  • The use of a periareolar or transaxillary incision
  • Spillage of blood in the pocket during surgery
  • An infection that is undetected
  • Some patients individual response to a foreign object placed within the interbody

Examples include:

  • Displacement towards the armpits
  • Bottoming out with the implant sits too low, and the nipple points upward
  • An implant that sits too high
  • Symmastia where the implants are too close to each other creating a “uniboob” appearance

Rippling often occurs in thin patients with larger implants.  The breast tissue surrounding the implants thins out, especially with larger implant sizes.  We all know that larger implants often result in more tissue stretch, rippling, thinning, and sagging issues over time.  These problems are very difficult to correct in the future and so you must choose your initial size wisely.  Bigger isn’t always better.

Breast Implant Rupture

A tear or hole in the implant casing is called a rupture.  Most implant failures are due to wear and tear in this outer layer.  An opening here can allow the saline to escape from the implant casing, creating a rapid decrease in volume, as the sterile saline is released and gradually absorbed by the body.

The newer generation of silicone gel breast implants is cohesive or form-stable, which means the silicone stays within the shell and you may have no apparent symptoms of shell rupture; this is called a “silent rupture.”  The casing itself will not degrade. The FDA recommends that women with cohesive silicone implants have MRIs from time to time to make sure that the shell is intact.  The risk of implant rupture increases with the age of the implant — about 1% per year.

The FDA determined that there is no danger from internal exposure to silicone.  There is no relationship between silicone breast implants and autoimmune disease, cancer, connective tissue diseases, rheumatologic disease, or other illnesses.  

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