Breast Revision

Breast Implant Revision Surgery
“Changes in the breasts can occur after any breast implant surgery  and may need surgical correction…”

Breast implants are wonderful devices and have thrilled many women (and their significant others!) over many years.  The latest implants are better than ever, with a good safety record and satisfaction record, as well as a longer average “life span”.  However, breast implants are medical devices, and no medical device lasts forever.  The breast implants can deflate, become encapsulated (hard), become malpositioned or other changes can occur.

Breast implant deflation of a saline implant is often easy to diagnose, because the patient loses volume in the breast fairly rapidly, sometimes overnight.  While this is not a medical emergency, it is best to attend to the deflation within a few weeks time.  Silicone implant leakage may be more difficult to diagnose, especially now with the improved cohesive gel implants,  and may not cause symptoms or volume loss.  Sometimes the leakage does not show up on mammograms because it is enclosed within the natural scar tissue capsule surrounding the implant.  A breast MRI scan may be required.

Some changes may be due to breast changes with age, skin or tissue stretching, weight gain or loss, pregnancy, trauma, or actual complications inherent with the breast implant surgery itself (for example, capsular contracture).  Sometimes women want a change in the breast implant size, or a breast uplift because of sagging.  Some women want their breast implants removed for various reasons and may not want to have them replaced..  Breast revision surgery can be more difficult than the initial breast augmentation surgery itself, so it is wise to choose your plastic surgeon carefully for such an undertaking.  Dr. Guy has had over 28 years of experience in breast implant surgery, as well as various types of breast reconstructions and revisions.

Consultation & Preparation

In your initial consultation, it’s important to discuss your expectations frankly with Dr. Guy, and to listen to her opinion.  Dr. Guy will examine and measure your breasts and chest, and will probably photograph them for reference during surgery and afterwards. She will make a diagnosis of what she believes to be the problem or problems which need to be addressed.  She will discuss the variables that may affect the procedure-such as your age, the size and shape of your chest,  how long you have had your implants, whether you may have an implant leakage, and whether or not you need a simple implant exchange or a more complex revision, such as with a mastopexy or a change in the breast implant pocket or removal of the scar tissue around the breast implants.  If excess skin excision is required (a mastopexy or uplift), more scarring and possibly visible scarring may be required.  To determine if an implant leakage has occurred, a breast  MRI or a mammogram may be ordered before the surgery.  Dr. Guy may recommend that no revision be performed, if she determines there is not a problem with the implants and the result is good for the circumstances.

If you are not sure about the integrity of your implants or if you are confused about why you have had a change in your breasts, you should seek a consultation.

If surgery is decided upon, you will get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, not smoking, and taking or avoiding certain vitamins and medications.

While you’re making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.  The procedure is performed as an out-patient, but a responsible adult is required to drive you home and look after you for at least 24 hours after the surgery.  Breast implant revision is nearly always performed at an out-patient surgery center, under general anesthesia. You’ll be asleep through the entire operation.  You will be able to go home the same day.

The Plastic Surgery

Techniques for breast implant exchange or revision vary widely, depending on the problem.  If a simple saline breast implant deflation has occurred, it may be possible to just remove and replace the side in question.  Sometimes implant exchange for a different size may be just a matter of removal and replacement.  However, sometimes the implant pocket and scar tissue capsule surrounding the implant may need revision.  If capsular contracture (hardness of the implant or implants, causing them to look “shrink wrapped” or immobile on the chest wall) is the problem, a so-called total capsulectomy or removal of the scar tissue around the implants may be necessary,  Drains may be needed for a day or two after such a dissection.

Recovery & Results

After surgery, you’ll be wrapped in gauze dressings and an Ace Wrap. A small tube may be placed in each breast to drain off blood and fluids for the first day or two.  Your post-operative experience will be different, depending on which procedure of procedures will be needed.  Dr. Guy will discuss this with you.

You may feel some pain for the first couple of days-especially when you move around or cough-and some discomfort for a week or more. Dr. Guy  will prescribe medication to lessen the pain.

The bandages and drains will be removed a day or two after surgery and you will be placed in a soft bra. Your stitches may be mostly dissolvable, but a few may be placed which will be removed in about a week.

Although you may be up and about in a day or two, your chest may still ache occasionally for a couple of weeks. You should avoid lifting or pushing anything heavy for two weeks and limit any exercise during that time.  Ask Dr. Guy when you can resume heavy exercise or weight lifting.