Breast Implant Revision - Breast Implant Replacement
Breast Implant Replacement is performed when there is a problem with the current Breast Implant(s). It is not necessary to routinely replace Breast Implants. A Breast Implant Exchange may be elective, like a Breast Implant size change, or more urgent, like Breast Implant Replacement after a Breast Implants deflation. During the Breast Implant replacement, changes can be made to the Breast Implants' volume, filling, profile or shape. Modifications can also be made the the Breast Implant Pocket with with a capsulotomy, capsulectomy or capsulorrhphy as indicated. Additional procedures, such a Breast Lift, can also be performed. This is particularly helpful when the original Breast Augmentation was years ago, or the breasts have changed due to childbirth or weight gain or loss, to restore a more youthful shape.
The most common elective reason for Breast Implant Replacement is to change the breast implant size. Overwhelmingly, the desire is to increase the size of the breast implants; however, decreasing the breast implant volume is also possible. Since the Breast Implant Capsule is already mature, the Breast Implant Replacement, and the recovery, is usually simple and quick.
To change a Breast Implant, close in size, often the previous Inframammary or Periareolar incison can be used. Umbilical and Axillary incisions may not provide enough access, and sometimes the Periareolar incison is not large enough when switching from Saline to Silicone Breast Implants, especially the high-strength silicone (gummy bear type) Breast Implants. The incision is opened and the old implant removed. If the pocket is satisfactory, the new Breast Implant is inserted and the incision closed. Recovery is normally a few days, and there are minimal limitation on activities. Most patients feel well in one to two days, and can resume normally activities quickly.
For significant increases in Breast Implant volume, capsulotmies may be necessary to enlarge the pocket to accomodate the larger Breast Implants, For signifiacnt decreases in size, capulorrhaphies may be necessary to tighten the pocket and position the smaller Breast Implants in the proper position. If the pocket is too large, and the implants would rattle-around in the available space.
If you do not currently have Breast Implants, or if you are looking to go larger, tips on how to select the best breast implant size are included on the Breast Implants Page.
This can help minimize the need for a second operation to change the breast implant volume again. It is hard to imagine what a particular volume will look like, so normally a desired cup size is determined. Cup sizes are not exact, and will depend on who makes the bra, and how tight or loose you like your bra to fit. If you come to your consultation appointment with a good idea of your goal size, Dr. Mele will help you choose the implant best suited to your desired results.
Even if you where happy with your initial Breast Implants, sometimes goals change, and breasts always change. If you already have Breast Implants, and want to Change Breast Implant Size, it is very helpful to come to your consultation with your Breast Implant information (size, type) and the operative report (when, location of implants). This provides a concrete starting point, and helps improve the predictability of the result for any changes in size, style or filling of your Breast Implants.
The most common urgent reason for Breast Implant Replacement is to replace a deflated Breast Implant.
Saline Breast Implants usually deflate completely. Since the go completely flat, it is usually obvious that there is a problem. The saline itself is quickly, and harmlessly, absorbed by breasts lymphatics and disappears quickly form the breast. There is no Fix-a-Flat for Breast Implants, so the broken implant is removed and replaced with a new one.
Silicone Breast Implants can also break. Unlike their saline conterparts, silicone gel is more solid, and does not get absorbed. As a result, a ruptured silicone gel filled Breast Implant may look and feel normal. The first sign of a leaking silicone gel filled Breast Implant may be found on an MRI. If the gel gets outside the Breast Implant capsule, the breast may form additional scar around the gel to contain it, and this may for a palpable lump in the breast. regardless of how a leak is found in a silicone Breast Implant, even if the leak is silent, the Breast Implant needs to be removed and replaced.
More about the presentation of Breast Implant Deflation is available on the Breast Implant Deflation Page
Sometimes Breast Implant Replacement is desired to change the filling or style of Breast Implant. The procedure is very similar to that described above, with a few minor variations noted below.
During the 1990's, when the Silicone Breast Implant controversy began, many women changed from silicone to saline for peace of mind. Unfortunately, the feel of the Saline Breast Implants was not as natural as the feel of the Silicone Breast Implants, especially for thinner women with smaller breasts. After the FDA reapproved Silicone Breast Implants, many women who made the switch to Saline, made the switch back to Silicone.
Women with Saline Implants are more likely to feel the bag around the saline. Saline Breast Implants feel firmer and have a higher incidence of rippling, especially for smaller breast, and bigger implants. For severe rippling, exchanging Saline for Silicone Breast Implants may improve Breast Augmentation results.
If the original Saline Breast Implants where placed through the inframammary (IMF) incision, the original incision can be utilized. If the original Saline Breast Augmentation was performed through the periareolar incision (around the “nipple”) it may be too small to insert the pre-filled Silicone Breast Implants. It is not recommended to insert silicone breast implants throught the umbilical or axillary incisions, as they are more easily damaged with these approaches.
When switching from Silicone to Saline the variations in the procedure come from changes in size decribed above, and if there was any leakage from the Silicone Breast Implants.
Smooth Breast Implants sit inside of the Breast Implant capsule, and are not atached like their textured sisters. When a Textured Breast Implant is removed a mature textured capsule is left behind. This capsule is textured too. It is rough, and has a large surface area. Leaving this lining may lead to a seroma, a collection of fluid collecting around the new Smooth Breast Implant. Removing the textured capsule is usually done to reduce the risk of seroma formation.
Textured Breast Implants are designed to adhere to the inside of the Breast Implant capsule. When a mature capsule is present, the texturing on the implants cannot properly integrate. Removing the mature capsule, a complete capsulectomy, is necessary to allow the texturing to integrate with the new Breast Implant capsule.
Shaped Breast Implants need to be oriented with big end down. If they spin, the shape of the breast will change, and not in a good way. The particulars described above about changing size, and filling also apply here. The main difficultly with replacing round implants for shaped implants is preventing the shaped implants from rotating. This a bigger problem when the existing Breast Implant pocket is too large. Often a complete capsulectomy is necessary to allow the texture of the shaped Breast Implant to properly adhere and prevent rotation, and then the pocket needs to closed to fit the new shaped implant to prevent it from spinning.
Shaped Breast Implants can be exchanged for Round Breast Implants relatively easily. Most problems come from the textured Breast Implant capsule, so it needs to be addressed as described above in the Changing from Textured Breast Implants to Smooth Breast Implants section.