Breast Implant Revision - Breast Implant Deflation
Dr. Mele is a Board Certified Plastic Surgeon in the San Francisco Bay Area and a Breast Augmentation Revision Specialist. As many as 25% of all Breast Augmentation patients will require some sort of Breast Augmentation Revision within 10 years of their original surgery, and Breast Implant Deflation remains on of the most common reasons Breast Implant Revision.
Newer Breast Implants, with more solid high-strength silicone gel fillers, are more reliable. They have demonstrated lower 5-year deflation rates, will help reduce Breast Implant Failure as a reason for Breast Implant Replacement.
Breast Implant Deflation is a common reason for Breast Augmentation Revision. Unfortunately, Breast Implants are not considered lifetime devices. They can be damaged during an injury to the breasts, or they can wear out, due to fatigue of the Breast Implant's shell.
When due to injury, the reason for Breast Implant Deflation is obvious. It is understandable that a Breast Implant may fail after severe chest trauma. Dr. Mele has replaced Breast Implants after car accidents, falls and even after breast biopsies. Thankfully, all US FDA approved Breast Implants come with a manufacturer's Breast Implant Warranty.
Breast Implant Warranties also apply when Breast Implant Deflation comes without a clear cause or warning. Sometimes Breast Implants simply wear out, and need to be replaced. The outer shell of the Breast Implant can fatigue, exposing the contents. What happens next, and how the Breast Implant leak presents, depends on the the type of Breast Implant you have.
If you were considering a change in size before your Breast Implant deflated, Breast Implant Deflation provides the perfect opportunity to make the change. For size changes, both Breast Implants will need to be changed to maintain symmetry.
The presentation of a deflated breast implant varies with the type of implant. Saline Breast Implant Deflation is usually very obvious, as they empty very quickly, while Silicone Gel Breast Implant Deflation can be more difficult to detect.
Saline filled breast implants are "honest" implants. If you saline filled breast implants leak, the volume is lost quickly, and no special testing is required to make the determination. The saline safely is absorbed by your body, and the breast goes flat. Since the saline disappears quickly, your body does not react to the leak. The capsule around the implant will slowly close around the empty breast implant, so it is best to replace the implant promptly to reduce the need for a capsulotomy. Recovery is quick, similar to that experienced after a breast augmentation revision to change the breast implant size.
If your breast implants are filled with liquid silicone gel (not form stable or gummy-bear style), determining if there is a leak is more difficult. The silicone is not absorbed by your body, instead, the silicone gel is walled off by a layer of scar tissue. This occurs if the gel leaks outside the original breast implant capsule. If it is contained by the original capsule, there may be no reaction, and this is what is called a "silent leak". Silent leaks are best investigated with a breast MRI. This is currently the best test available to determine if there is a leak in a silicone gel breast implant. The FDA currently recommends an MRI of the breasts at three years after Breast Augmentation, and every two years after that, to detect the presence of a silent leak.
Form-Stable or Gummy Bear implants are essentially a more solid form of cohesive silicone gel. They are made of high-strength silicone gel and act like soft solids, like Jell-O. They are less likely to leak, and if they do leak, the gel filling does not flow like water. The high-strength silicone gel tends to remain a single mass, and migrates much less easily. This is one of the biggest advantages of form-stable breast implants. This class of implant has been available outside the US for a decade, and has a good track record. The FDA's subcommittee recommended approval for use in the US several years ago, and to date on Sientra offers this type implant in the US currently. The FDA has not made its final recommendation for Natrelle's 410's or Mentor's CPG Breast Implants, but the decision should be forthcoming soon.
The before picture, on the left, shows a deflated saline breast implant. The asymmetry is obvious because this woman has very little natural breast tissue, and because she had saline breast implants. When saline breast implants deflate, they normally lose all their volume. This patient's right breast implant is still intact.
Options for treatment of a deflated breast implant are discussed in detail below, but include, removal of both breast implants, replacement of the deflated right breast implant or replacement of both breast implants. In this case, both saline breast implants were removed and replaced. The advantage of removing both implants in that the size of both breast implants can be modified. In this case, as with most Breast Implant Replacement, slightly larger breast implants were selected. Replacing both breast implants also allows you to switch from saline to silicone breast implants if desired.
The breast implant replacement after photo, on the right, shows improved symmetry, with a larger, yet still proportionate Breast Augmentation. When rippling is present, saline breast implants are often exchanged for silicone breast implants, in an attempt to decrease visible folds in the breast implants. Additionally, if the breast implants were originally placed in front of the pectoralis major muscle, they can be moved to behind the muscle. Retro-pectoral placement provides better soft tissue coverage and often improves the shape of the breasts.
Often the same incision can be used for the Breast Implant Replacement; however, since silicone breast implants require a slightly longer incisions than saline breast implants do, an inframammary fold (IMF) incision may be necessary for the placement of the silicone gel filled breast implants, even when a peri-areolar incision is already present.
The Treatment for Breast Implant Deflation is usually straightforward. If you want to maintain your Breast Augmentation, the implants are replaced. If the you no longer desire Breast Augmentation, the Breast Implants are removed. If other issues were present before the deflation, these can often be addressed at the time of the treatment. Some additional treatments are easier than others. If you are changing Breast Implant size, or doing a lift, the goal is usually easy to visualize. If there was asymmetry before Breast Implant deflation, sometimes this is be difficult to see, with the additional asymmetry that the deflated breast implant causes.
When your Breast Augmentation was good before deflation, >Breast Implant Replacement is a simple procedure. The broken Breast Implant is removed from the the Breast Implant Capsule and replaced with a similar Breast Implant. If an increase in size is desired, both implants are removed and replaced with new. larger breast implants. If a decrease in size is desired, both implants are removed and replaced with new smaller breast implants; however, the larger the decrease, the more likely a Breast Lift will be needed.
More information about Breast Implant Replacement is available on the Breast Implant Replacement Page.
If you no longer desire Breast Augmentation, both your Breast Implants can be removed. The cosmetic result will depend on how much breast tissue you have, and how large your Breast Implants are. The more natural breast tissue present, and the smaller the Breast Implants used, the better the cosmetic result. In cases where there is very little breast tissue, larger Breast Implants were used or there was already some sagging even with the inflated Breast Implants, a Breast Lift may be recommended.
More information about Breast Implant Removal is available on the Breast Implant Removal Page.