Breast Implant Revision

Breast implant revision is a cosmetic procedure to correct a deformity of the breast after augmentation. This procedure is common among women who have had their implants for many years, those who are experiencing the effects of gravity with age and patients who have had significant weight fluctuations that impact the appearance of the breasts. Breast implant revision can also be performed to remediate unsatisfactory results from the initial breast implant operation. This type of revision may be performed months, or years, after the initial implants are placed.

Some of the most common causes for breast implant revision include:

• Malposition of the implants
• Changing the size of the implants
• The desire to have a breast lift
• Implant rippling
• Capsular contracture (a tightening of scar tissue around the implant)
• Elevation of the nipple and areola position

Am I a Good Candidate for Breast Implant Revision?

GOOD CANDIDATES for breast implant revision are:

• Patients whose breast deformity can be corrected by modifying their current pocket
• Patients who wish to increase or decrease their implant size
• Those who wish to change the placement of the implant from subglandular to submuscular
• Women who had breast implants followed by pregnancy and excess sagging skin
• Patients with saggy breast tissue and/or nipples that point downward
• Patients experiencing implant rippling, shifting or a severe infection which does not respond to medications
• Patients who choose not to have a breast lift during the initial implant placement
• Patients who desire to have their implants removed

The following patients are NOT GOOD CANDIDATES for breast implant revision:

• Women who are pregnant or nursing
• A patient with a history of implant infections but who wants to keep the implants
• Patients who plan to lose a significant amount of weight after breast implant revision
• Patients with unrealistic expectations about the amount of revision possible

How is Breast Implant Revision Performed?

Breast implant revision depends on the reasoning for the revision. Breast implant revisions are outpatient procedures usually performed under general anesthesia. Most revision procedures involve the surgeon using the original incision so no additional scarring will occur. Some of the most common techniques for breast implant revision are:

If the breast implant revision is due to malposition, the surgeon will need to manipulate the scar tissue from the capsule surrounding the implant. The pocket will be reconstructed in a more appropriate position using suturing techniques. Other tissues, such as acellular dermal matrix products, may be needed to help reinforce the new pocket and to add additional support.  

When a patient wants breast implant revision to change the size of the implant, the surgeon will enlarge the pocket to accommodate a bigger implant. To decrease the size of the implant, the pocket size will be reduced using sutures that properly hold a smaller implant. A breast lift can be done at the same time to address any sagginess of the breast tissue.

When capsular contracture is the reason for revision, the surgeon removes the hardened capsule that surrounds the implant as well as the implant itself. A new implant will be placed (if desired). The surgeon may recommend that implants originally placed subcutaneously, or above the muscle, be placed below the muscle to minimize the recurrence of capsular contracture. In this case, a new pocket will be created just under the pectoralis muscle.

Implant rippling can cause the edges of the saline implants to be visible and palpable. In this case, the surgeon can reposition the implants or a completely different pocket can be created. The new pocket generally has thicker muscle coverage or it uses other tissues to cover the edge of the implant. Some patients decide to exchange the saline implants for silicone or simply have them completely removed.

When a breast lift or an elevation of the nipple and areola position is required, additional incisions will be necessary. An incision around the upper portion of the areola may be sufficient if minimal elevation is needed. However, if a large amount of lifting and tightening is necessary, an incision around the entire areola and an incision extending from the areola to the natural crease of the breast might be necessary. The nipples and areolas remain attached to the underlying tissue when being lifted into a new position. If an excessive amount of skin needs to be removed, an incision along the crease of the breasts may also be required.

Breast Implant Revision Cost

Breast implant revision can cost more than the initial breast augmentation depending on the issue. The higher cost is due to the fact that the procedure usually takes longer and is more complex than the initial placement. Breast implant revision can range from $3000 to $8000 but this does not include hospital fees and surgeon fees.  Some surgeons may offer to correct their work without charging a fee. However, there will still be anesthesiologist fees and facility fees. While breast augmentation is typically considered cosmetic, and is not covered under health insurance, some implant complications pose a health risk and certain insurance companies may cover at least a portion of the cost.

Recovery and Downtime

During RECOVERY from a breast implant revision, the incisions will be covered with a bandage and drainage tubes may be attached to the breasts. Patients are often fitted with a compression garment to help control swelling and support the implant placement during healing. Patients can expect to feel the same level of discomfort as the initial breast surgery. The extent and duration of discomfort is contingent on the size and placement of the implants. If a breast lift is being performed in conjunction with implants, the recovery can take a little longer. On the contrary, if the implants are being removed completely, the recovery time will be brief.

Patients should enjoy some DOWNTIME for the first few days after surgery. However, it is important for patients to take short walks around the house to improve blood circulation and speed healing. The patient should sleep with their head and back elevated during the first week to help minimize swelling. External stitches will be removed at a follow-up appointment in about one week. Patients can usually return to light duty work within seven to ten days. However, it can take several weeks or months for all of the swelling to diminish and for the implants to settle into place. Numbness and/or tingling at the incision site can continue for weeks but will usually subside on its own. Full activities can usually resume after six weeks.

Results

The results can be seen immediately and will continue to improve over a three-month period as the swelling subsides. The final results are usually long lasting and the new breast shape should remain stable if the patient does not have significant weight fluctuations or become pregnant. However, the weight of the implant can affect the shape of the breasts over time. To maintain the results, patients should consider wearing a bra with an underwire to properly support the implants and breast tissue.

Limitations of Breast Implant Revision

Limitations of breast implant revision include:

• The availability of good skin with adequate blood supply to use during the procedure
• Patients who are thin with little body fat will have more visible implants
• Patients who had implants that were too large (initially) may not be able to sustain large implants due to bottoming out or thinning of the skin
• Patients who are unhappy with the shape or size of their breasts will be limited from having breast implant revision until at least 3 months after the initial augmentation because it takes time for swelling to resolve and for the implants to settle

Risks of Breast Implant Revision

The risks involved with breast implant revision include:

• Hematoma
• Seroma
• Bleeding
• Infection
• Poor wound healing
• Scarring
• Damage to the underlying structures
• Additional surgery to correct unsatisfactory results or asymmetry
• Rupture
• Rippling
• Capsular contracture
• Adverse reaction to anesthesia

Listen to the Doctor

Revision breast surgery requires a plastic surgeon with experience in the entire spectrum of breast procedures. The surgeon should be board-certified and able to present “before and after photo” of his, or her, own breast implant revision patients. Patients should keep in mind that the amount of change that can, or should, be done during breast implant revision surgery may be recommended or limited for a reason. Therefore, patients should listen to the recommendations from their doctor for obtaining better-shaped breasts.

Cosmetic Town is the premier online cosmetic surgery news and information resource. We connect patients with the best doctors for cosmetic procedures. Get the answers to all of your questions and find a doctor near you.

Written by Cosmetic Town Editorial Team through exclusive interview provided by Dr. Jeffrey Poulter in Bloomington, IL.