There are several hundred thousand patients who have breast revision surgery in America each year. The majority have cosmetic surgery for the first time. There are some patients in a subset of previous breast surgery patients who are dissatisfied with the result or would desire to improve some aspect of their breasts. One category of breast revision is implant replacement.
The most common cause or need to replace breast implants is when there is a problem. If the existing implants are saline, they may have leaked so that one or both breasts have lost their volume. This revision can be performed by removing the implants, re-expanding or re-creating the pocket, and replacing it with new implants. Preferably to replace with silicone gel.
The silicone gel quality today is far superior to what it was previously. It also comes in several levels of cohesiveness or thickness of the gel. Some are even suitable to place over the muscle with potentially minimal wrinkling. The most cohesive that I use are the Natrelle gummy bear implants.
Breast Revision
The capsule or scar tissue around the implant may need treatment. In older implants, the capsule may calcify in which case it should be taken out in its entirety with the enclosed implant. Some capsules are thick and must be taken out partially or also completely. Other capsules are very thin and can be put to use in order to reinforce the tissue housing the new implants.
When a breast revision of a previously placed silicone gel implant is needed and the gel implant is ruptured this requires the majority of the free silicone to be removed. It is impossible to remove every last droplet of silicone but the majority can be taken out. Silicone is an inert substance and does not cause known disease.
Patients must remember that implants do not create perkiness. They only improve volume. If the nipples point down or are greater than 23 or so centimeters from the sternal notch, then a mastopexy or breast lift may be indicated. There’s a certain population of patients that I have seen who have had large implants placed at a younger age.
Some of these patients present to me wanting to either remove them completely or have a lift with smaller implants. Breast revisions can take many forms. We have just gone over the major aspects of breast revision.
THOMAS TREVISANI, MD
BOARD CERTIFIED PLASTIC SURGEON
MEMBER AMERICAN SOCIETY OF AESTHETIC PLASTIC SURGERY
