Breast Implant Revision
Although breast implants are very stable devices, patients may require re-operation on their breasts at some point. Studies have shown that some of the most common reasons for re-operation following breast augmentation surgery include capsular contracture, hematoma, seroma, and size change.¹ In my practice, I frequently see patients who present for evaluation of implants which may have been placed many years prior. They sometimes note increasing firmness of one or both breasts secondary to capsular contracture, deflation of an implant, or they wish to change the size of their implants. In some cases, patients simply do not wish to have their implants any longer.
Implant removal is usually very straightforward. Under anesthesia, the initial incision is opened, and the intact implant is removed. The exception is cases in which the axillary, or armpit, incision has been used, in which case a new incision on the breast is often used to remove the implant. In cases of very old and ruptured silicone implants, the gel may have to be manually extracted, which can be a little messy. The pocket is then washed out with triple-antibiotic solution, and any adherent scar tissue is removed. If the patient does not wish to have new implants placed, the incisions are closed over a drain. I use a drain in these cases, as the body sees an empty space to fill with fluid, and it’s best if this fluid is drained out primarily rather than being allowed to sit. The drains are usually removed after 4-5 days, and then the skin and soft tissues are allowed to recover. Although I was taught in my training that the skin will not recover its initial elasticity and shape following removal of breast implants, in my experience it almost always does recover most, if not all, of its original form, which is a testament to the remarkable “memory” of the skin and tissues.
If a patient does wish to have new implants placed, the implant pocket is adjusted as needed, and new implants are placed. The implant pocket may need to be adjusted to decrease the size (if a smaller implant is being placed), increase the size (for a larger implant), release scar tissue, or to make other revisions to the shape of the space that was holding the prior implant. In some cases, the implant pocket is changed, for example, from under the breast tissue to under the muscle. The space is then washed out again with triple-antibiotic fluid, and new implants are placed under sterile conditions. The incisions are then closed, and small dressings are applied.
Generally, breast implant revision surgery is associated with an easier recovery. Most patients are able to return to their regular activities within several days, and to exercise within 2 weeks. The vast majority of patients would agree that although they may not have anticipated a second surgery on their breasts, it was worth it for both the health of their breasts and implants.
1. Spear SL, Murphy DK. Natrelle round silicone breast implants: core study results at 10 years. Plast Recon Surg 2014 Jun;133(6):1354-61.[:]