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Common Reasons for Breast Implant Exchange and Revision Surgery
Breast revision surgery is a general term used to describe secondary surgical procedures that are performed on women who have previously undergone a breast augmentation, lift, reduction, or reconstruction. The reasons can be cosmetic or reconstructive in nature as well as “elective” or “urgent.” The replacement of a woman’s implants for newer ones is referred to as breast implant exchange surgery (a category of breast revision surgery). The implants may have been originally placed during breast augmentation surgery, a breast lift or for breast reconstruction.
Breast Implant Exchange
There are several reasons why a woman would select this course of action. Some of the most common ones are to:
- Change the size of the implant
- Alter the shape with regard to projection and width
- Change from saline to silicone implants or vice versa
- Replace a ruptured implant
- Change the implants as an incidental part of another breast concern such as drooping or capsular contracture
Obtain Larger or Smaller Implants
Usually, the number one reason for breast implant exchange is to get larger ones in order to increase the size of the breasts. However, over the last several years, I have seen a significant increase in the number of patients wanting smaller implants than what they presently have. Some of this is partially related to cultural changes in breast aesthetics where very large or even large breasts are not as desirable for some as they once were. There are also those women who have gained substantial amounts of weight, which has led to too much natural augmentation of their already enlarged breasts.
In my practice, it is extremely rare for a patient to desire either larger or smaller implant sizes soon after surgery. If they do want to change size, it is most often years later and often precipitated by another event such as an implant rupture.
How is it that my implant exchange rate is very low?
During my patient’s consultation, I listen carefully to their desires and concerns, take measurements, have them “try on” different implants, show them photographs of other patients that may be relevant to their situation, and use temporary “sizers” to precisely determine the implants that will be just right for them.
The relative proportions (profile) of the implant, which affect the ultimate breast configuration, are also important. By explaining and offering different profiles, such as moderate, high and ultra-high, my patients can better understand and visualize the customized appearance they desire. For example, a patient who has a very narrow chest and wants a lot of projection without excessive width would benefit from a higher profile implant. A woman who is relatively broad, has a moderate amount of breast tissue, and doesn’t want to be extremely large would be better off with a moderate profile implant.
Switching from Saline to Silicone Implants
Silicone breast implants feel and often look far more natural—like normal breast tissue—especially in comparison to saline ones. Those who had saline implants placed in the past (for whatever reason), at some point in time, may decide that they want to switch to silicone ones. It may be that their skin is thin and so they are experiencing rippling of their skin or that their breasts don’t feel very natural due to the nature of these implants. They may just be coming in to have a lift and/or change in implant size and now want or will benefit from switching to silicone implants.
At least in my practice in this day and age, finding a woman who insists on switching from silicone to saline implants is as common as finding a unicorn grazing in the forest!
Implant Leak or Rupture
Although there is no designated time period that breast implants will last, they are not considered lifetime devices and may need to be replaced or removed in the case of leak or rupture. An implant leak or rupture occurs when the outer shell of the implant wears down, tears, or breaks.
Saline implant ruptures are generally noticeable immediately because the saline solution leaks out of the implant and is rapidly (and safely) absorbed by the body, resulting in a rapid decrease in breast size—often in a matter of a few hours. On the other hand, silicone implant ruptures are not apparent most of the time as there is no change in volume and there may be absolutely no change in shape. If there is a suspicion of a rupture, a radiological evaluation is necessary with an MRI being recommended over a mammogram.
Implant rupture can be addressed by removing the damaged implant and replacing it with a new one.
Other Common Reasons for Breast Revision Surgery
The following are some other common reasons why women undergo breast revision surgery after having had a previous breast augmentation.
Capsular Contracture
After breast augmentation, a pocket or “capsule” of tissue forms around the implant as the body’s natural response to a foreign object. Capsular contracture occurs when this capsule thickens and tightens around the implant, squeezing and deforming it. This results in the breast feeling harder and appearing misshapen. A certain percentage of women with this issue will benefit from the surgical removal of the capsule (capsulectomy) and placement of a new breast implant (implant exchange) in order to correct this condition.
Implant Malposition
Sometimes one implant is placed at a noticeably different level on the chest wall compared to the other side, resulting in a quite obvious asymmetry of the breasts and their fullness. This can also be a result of pre-existing asymmetry of the breast position, a stretching or tearing of supportive tissues over time, the result of trauma or other issues. Finally, both implants could have been placed either too high, too low, or a combination of both.
For more information about breast implant exchange or revision surgery, please call (480) 451-3000 to schedule your consultation with Dr. Turkeltaub today.