Breast Implants Can Be Revised

While it is expected for patients to replace their breast implants after 10-20 years, there are several reasons they may need to be replaced sooner.

If your breast augmentation does not deliver the natural-looking results you were hoping for, you experience complications with your implants or you have noticed your natural breast skin aging and sagging, a breast implant revision can help.

Signs You May Need a Revision

Your breast implants are causing pain or discomfort

Painful or uncomfortable implants can indicate a number of issues that require a breast implant revision, including capsular contracture, damaged lymph nodes, a developing seroma, pinched nerves or poor implant placement. If you have silicone implants, pain may be a sign your implant has ruptured or is leaking.

Even if there is no serious issue causing pain, some patients find implants are uncomfortable enough to disrupt their daily lives, especially if the implant used was too large or poorly placed.

Regardless of the cause, persistent pain or irritation is not a normal result of breast augmentation surgery. Patients who are experiencing either should schedule an appointment with their surgeon.

Your breast implant has ruptured

Implant rupture can be caused by abrupt or intense physical pressure (like in a car accident) or through the aging and weakening of the implant shell.

A rupture in a saline implant causes a nearly immediate deflation of the affected breast, making it easy to diagnose. The saline solution inside the implant is the same as IV solution and is easily absorbed by the body.

By contrast, ruptures in silicone implants cannot be diagnosed without an ultrasound or an MRI because the viscous silicone gel inside the implant leaks out slowly.

While the rupture of a breast implant is not a life-threatening emergency, it is important to have the damaged implant removed to prevent infection or the development of excessive internal scar tissue.

Your breast implant has bottomed out

If the skin and tissue cannot adequately support the breast implant, it is possible for the implant to gradually fall below the breast crease, or “bottom out.” This condition is more common with large or heavy implants, but post-surgery pregnancies or skin laxity due to age can also cause an implant to bottom out.

Drooping breasts are not uncommon. But unlike breasts that naturally fall over time, where nipples fall with the breast tissue, bottomed-out implants cause nipples to move upward as the implants fall lower. It is also common for patients to be able to feel and see the outline of a bottomed-out implant.

Your breast implant is moving or rotating

It is normal for breast implants to settle into a slightly different position over time. It is not normal for implants to move to a dramatically different location on the chest wall. This is called implant displacement, and there are several ways an implant can shift.

Lateral displacement of implants (implants moving too far away from the midline of the chest) can occur when the implant pocket is too large. Symmastia, or implants merging in the middle of the chest, is a rare complication caused when too much tissue is removed near the breastbone, which in turn causes the muscle between the breasts to detach.

An overly large implant pocket can also result in implant rotation. Patients may not be able to tell if a round implant has rotated, but a rotation of teardrop implants yields a top-heavy, unnatural appearance of the breast.

Your breast implant has changed shape

Implant shape can change if the implant ruptures, shifts, rotates, bottoms out, or becomes otherwise displaced.

Changes in implant shape usually occur asymmetrically, meaning in one breast or the other. Even if both implants change shape, they may not change in the same way. This asymmetry is not medically risky, but it can cause patients significant emotional distress and make it very difficult to find bras and clothing that fit properly.

Your breast implant is causing capsular contracture

The formation of scar tissue is a normal part of the healing process after placing any kind of medical or plastic surgery implant. Usually, this process is a good thing because the capsule of scar tissue helps support the implant, keeping it from slipping.

In some cases, however, the body mistakes the implant for a dangerous foreign object and creates excessive amounts of scar tissue to isolate it. Known as capsular contracture, this overproduction of dense, hard tissue around the breast implant can affect the success of the augmentation procedure.

There are four grades of capsular contracture, ranging from normal to severe. Grade one is asymptomatic and doesn’t interfere with the results of the implant. Grade two capsular contracture has only minor cosmetic symptoms, leaving the breast normal in shape but firmer to the touch.

Capsular contracture of grades three and four causes hard, misshapen, and overly round breasts that look and feel unnatural. Grade four contracture also often results in breast pain. Patients with either grade three or four capsular contractures usually require a breast implant revision.

You are unhappy with your breast size

While most patients are happy with the results of their breast augmentation, some patients find they wish they had gotten a different size implant – larger or smaller.

If you want to change the size of your implants, most doctors will recommend waiting about a year after your initial surgery before proceeding. Not only will this waiting period allow your body to fully heal, but it will also give your implants time to settle into their final position before you make this major decision.

Setting Expectations

Breast implant revision surgery can be much more complicated than initial breast augmentation because revisionary procedures require managing scar tissue and changes in breast tissue, as well as any complications from the original procedure. Breast implant revision also almost always involves the removal of the original implants. Many patients express hesitancy considering revision surgery if they have had a bad outcome or experience with another surgeon. We encourage our patients to review credentials and before/after galleries while considering options for revisional surgery.

Are There Risks?

Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedures you will undergo and any risks or potential complications.

The possible risks of breast implant revision surgery include, but are not limited to:

• Anesthesia risks
• Asymmetry
• Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)
• Breast implant-associated squamous cell carcinoma (BIA-SCC)
• Bleeding
• Deep vein thrombosis, cardiac and pulmonary complications
• Fatty tissue found deep in the skin might die (fat necrosis)
• Fluid accumulation (seroma)
• Hematoma
• Infection
• Numbness or other changes in skin/nipple sensation
• Persistent pain
• Poor healing of incisions
• Recurrent looseness of skin
• Skin loss
• Skin discoloration and/or prolonged swelling
• Suboptimal aesthetic result
• Unfavorable scarring

These risks and others will be fully discussed prior to your consent. It’s important that you address all your questions directly with your plastic surgeon.