Breast implant revision surgery is indicated to rectify the results of previous breast augmentation. In revision surgery, old breast implants are replaced with new implants and associated breast problems are addressed. Patients desires and expectations are diverse and an elaborate consultation is recommended to understand their goals and desires.

Breast implant revision surgeries are performed to address following concerns:

• Capsular contracture
• Breast implant rupture
• Breast implant displacement or shift
• Breast tissue drooping below the implant
• Breast asymmetry
• Some women simply want to replace breast implants due to personal preference for volume or profile. While some women desire larger implants, others want to downsize due to back pain and shoulder pain.
• Malposition or displacement of the fold under the breast
• Patients with saline implants would request silicone implants for a more natural feel or due to visible rippling
• Some patients request change from textured to smooth implant or vise versa.

Breast implant revision surgery is challenging and requires experience. This surgery is not performed regularly and is customized to patient goals and desires. Therefore, these surgeries need to be performed by board certified plastic surgeons who are well experienced in performing all types of breast surgeries. Commonly performed revision procedures are capsulotomy, capsulectomy, implant capsule repositioning, change of implant type, size and profile, breast lift, areola repositioning or reduction.

What is “Capsular Contracture”?

When implants are placed in the body, there is formation of scar tissue around it. This is true for any type of implant, whether it is breast implant, pacemaker or artificial joints.  With time, usually over the years, the scar tissue surrounding the breast implant thickens leading to hardening and breast deformity. With modern, new generation breast implants, capsular contracture is seen in less than 5% of patients.

Capsular contracture can be treated with capsulotomy or capsulectomy.

In capsulotomy, the capsule surrounding the implant is simply divided at multiple areas to allow expansion of the space to be occupied by the implant. While in capsulectomy, the entire capsule is removed. En bloc capsulectomy is when the entire capsule is removed intact along with the implant without opening the capsule. The term en bloc means “all together”.

What happens when implants rupture?

When a saline implant ruptures the saline leaks outside the shell of the implant and is absorbed by the body without any harmful effects. The breast size shrinks over a few days and it is easily recognized by the patient.

The new generation, FDA approved Silicone gel implant contains cohesive gel which are unlikely to diffuse far from the implant. The FDA recommends regular screening of breast implants with a high quality ultrasound or an MRI every 2 years to detect breast implant rupture. If an implant rupture is suspected it needs to be replaced.

Why do implants displace?

Implants can drop to a lower position or they can displace sideways. Implants can displace after few months or years later. Many factors are responsible for implant displacement including initial pocket dissection, tissue integrity and the size of implants. In general, textured implants displace less than smooth implants. If the appearance of the breasts bothers you due to implant displacement, then breast implant revision is indicated. Surgical correction requires capsule repositioning by reconstructing the capsule either with sutures or “ADM” Acellular Dermal Matrix.  ADM is a bio-absorbable material which when placed inside the body, is replaced with your own collagen over time, resulting in a stronger layer giving additional support to the implant.

Is it recommended to change breast implants after certain number of years?

It is recommended to regularly screen the condition of breast implants with high quality Ultrasound or MRI. As long as the breast tissue is healthy and the implants are intact with no signs of capsular contracture, it is not necessary to change the implants.

Why does breast tissue droop over the implant and how is it treated?

After several years of breast augmentation, breast tissue can droop over the implants. This can result following pregnancy, weight gain, weight loss and stretching of breast tissue over large implants. Patients can request implant replacement or no replacement of implant. In patients who request implant replacement, an additional breast lift is advised to correct the drooping breast tissue. Patients who do not want implant replacement, can be offered implant removal with breast lift with or without fat grafting.