Norman B. Day, MD, FACS - Revision Breast Implants
Revision surgery for breast implants is common. A frequent question all patients ask prior to having breast augmentation is how long my surgery will last. Unfortunately there is no clear cut answer. Revision surgery can happen for various reasons. There are patients that have the same set of implants their whole lives and they are comfortable with them. Others may not be happy with the way their bodies are aging and wish to have them revised. And a small subgroup may develop problems with their implants with aging and the progression of time.
Like all other devices breast implants also have a lifespan. That time frame is hard to determine. What I do know is the manufacturers have warranties on their products for a limited time frame. Two companies namely Mentor and Inamed guarantee their implants for 10 years. A third company called Sientra has a lifetime warranty. I have all of these implants available for use.
Most bodies will have some degree of aging over this 10 year span. This may or may not be accelerated with pregnancy and other factors. These factors include weight changes, an increase of the fat content of the breast with normal passage of time and thinning of the breast because of the presence of the implants. These changes will cause the breast to age with time, causing thinning of the breast skin, ptosis or drooping of the nipple and areola, widening of the areola with pregnancy and breast feeding, and loss of the central breast volume.
If the deflation occurs within the warranty period, the implant manufacturer will help cover part of the costs of the surgery and replacement implants.
Capsular contracture is the most common problem. It happens in a very small percentage of patients. Exchange of the implants, saline for silicone and smooth for textured with release of the capsule may easily solve the problem. Ptients with more extensive capsular contracture may need more extensive surgery such as full capsulectomies plus or minus other options discussed below.
Thinning of the breast skin and tissue is common. It can, and will manifest in different ways. Some patients will feel or see the rippling of the implants. Others will just have progressive ptosis or drooping and complain of a deflated look.
The treatment options will vary but they include a variety of choices. Some of these options are longer lasting solutions and therefore more complicated and costly.
The easiest way to treat a minor amount of deflation with no ptosis and minimal to no rippling is to change the implant type. If there are saline implants then converting them to silicone may help. Changing the profile of the implant may also help. The higher profile implants may have less visible rippling and increase the visual fullness. Only with the patients consent, I will sometimes recommend to deflate the saline implants weeks prior to the surgery to allow the native skin to regain its tone. This is not always acceptable to the patients. The surgery can be performed without this step anyway.
The more surgically fundamental improvements can only be made with the addition of volume to the thinned breast tissue. This can be easily performed with fat grafting. The addition of biological substitutes will provide with even greater long lasting support.
Finally fat grafts, biologic supplemental grafts are not substitutes for actually lifting the breast if true ptosis exists. Smaller and fuller implants can be used to create a beautiful end result.
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