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Breast Revision

Overview

A Breast Revision is a procedure to help correct, replace, update, or improve the appearance of the breast from past procedures. A breast revision can correct or improve:

  • Implant Ruptures: When the implant’s shell is damaged causing the contents of the implant to leak.

  • Capsular Contracture: A buildup of scar tissue can cause pain as well as the implant to change shape or placement and create an unnatural appearance.

  • Rippling Palpability: When the wrinkles and folds around the implant can be seen or felt.

  • Implant Displacement: The implant has rotated or shifted causing the breast to change shape and possible discomfort. Large implants are often prone to bottoming out or moving to the side.

  • Infection: Causes the body to not properly heal and may even cause capsular contracture.

  • Implant Extrusion: When the implant starts to become visible through the skin because the body did not properly heal.

Types of Breast Revisions

Implant Rupture

An implant rupture is when the outer shell of the implant tears or develops a hole. But how do you know if your implant(s) have ruptured? If the implant is saline, the patient will know almost immediately when the implant has ruptured. If the implant is silicone, the implant will stay connected and typically does not change shape, but if the implant is believed to be reputed a breast imaging will need to be performed.

  • Saline Implants: Saline implants are filled with saltwater. When the implant ruptures, the saline leaks out into the body and will continue to leak for the next couple of days as the body absorbs the saline and leaves the breast with a deflated appearance.  The saline solution is not harmful to the body and the implant which once held the saline stays within the pocket created for the implant, but the breasts will become asymmetric due to the loss of the saline.

  • Silicone Implants: Silicone implants today are made with thicker shells and a more cohesive gel. If a silicone implant ruptures, the silicone will stay within the shell but the appearance or shape of the implant may change due to scar tissue build up around the implant. The best way to tell if a silicone implant has ruptured is to have a mammogram performed to view the implant. If the implant has ruptured, Dr. Hustak will remove the ruptured implant, and its content, and replace the implant with a new one if desired.

Capsular Contracture is the buildup of scar tissue around the implant causing the implant to change shape, position, and texture in the breast. Correcting a capsular contracture involves removing the implant and scar tissue built up in the breast. Once the implant is removed a new implant will replace the old. Implants that once sat high on the chest, and hardened, are now placed in the correct position with a more natural feel and look.

Rippling and Palpability 

Rippling or palpability is when an implant causes folds or wrinkles in the skin to be seen or felt causing the breast to have an unnatural look and feel. There are several causes for implant rippling or palpability:

  • Type of implant Used:  Implants are filled with either saline or silicone. While both types of implants can cause rippling effects, saline is much more likely to cause wrinkles or creases. Silicone implants are filled with a cohesive gel which is thicker and gives the implant more density. Saline implants are filled with a saltwater solution making them lighter and thinner which can cause the implant to ripple much more frequently than a silicone implant.

  • Breast Tissue: Women who receive Breast Augmentations typically have smaller breasts, to begin with. This means the breast tissue must be stretched out for an implant to be inserted. When the breast tissue is stretched out, the tissue becomes thinner allowing the implant or rippling to be seen or felt. To correct this; the implant is removed, a pocket is made under the muscle, and the implant is placed under the muscle (submuscularly) to give the implant more coverage. GalaFlex, a bioabsorbable mesh which acts as a sling, can often be used for more soft tissue coverage and support. Fat grafting to the breasts can also help support the breasts by adding thickness to the tissue.

  • Implant Placement: When performing a breast augmentation, the implant can be placed above (subglandular) or below (submuscularly) the chest muscle. If the implant is placed above the chest muscle and is visible or causes wrinkling, then the implant may be moved to below the muscle to give the implant more coverage. If the implant is placed under the chest muscle, then the muscle/implant can be repositioned for less tension on the breast tissue. Fat grafting may also be used in both instances to help make the breast tissue thicker and prevent rippling or palpability.

Implant Displacement

Implant displacement is when the implant has shifted or rotated within the pocket causing the breast to change in appearance. Implants can flip from front to back, on to its side, or even rotate from top to bottom. These shifts can result in:

  • Bottoming out:  When the implant drops below the crease of the breast and the nipples are pushed into a position too high on the breast.

  • Symmastia: When the breasts are too close together with little to no cleavage between them. This can be corrected by attaching the skin to the breast bone allowing there to be defined cleavage or by using a bioabsorbable mesh giving the tissue more support.

  • High Rising Implants:  HRI is caused by the muscle not being adequately released, the pocket is poorly made, or a capsular contracture has developed around the implant. To correct a high rising implant Dr. Hustak will release the muscle, correct the pocket size, or remove the capsular contracture.

  • Lateral displacement:  When the implants have settled too far apart causing a large gap between them. This is more common for submuscular implant placements and occurs when the pockets are too large or have separated over time. By correcting the pocket and repositioning the implants, the implants will go back to a natural position.

Infection 

Implant infections can be caused by wounds becoming contaminated with bacteria while the wounds are healing. Infections elsewhere in the body can also move to around the implants since the implants are foreign objects to the body.

Antibiotics are used to help fight the infection. If the infection does not subside with the use of antibiotics, then the implant must be removed to allow the body to heal. Once the infection is cleared, implants can be inserted once again, usually after 3-6 months.

Implant Extrusion

Implant extrusion is when the implant becomes exposed through the skin. This occurs when:

  • When the wound does not properly close because of an infection, hematoma, or overexertion too quickly post-surgery.

  • Skin necrosis (skin dies) after surgery keeping the implant exposed or

  • If the breast tissue is too thin and the implant is too large causing the tissue to pull apart from too much pressure.

To correct an extruding implant, the surgeon will need to remove the implant to keep an infection from arising. Depending on each case, the breast will be reconstructed accordingly to help rebuild healthy tissue and allow an implant to be placed in the breast.

What to Expect

During a consultation, board-certified plastic surgeon, Dr. Kristi Hustak will evaluate the patient’s desired areas he/she would like to improve while asking a series of questions to better understand the patient’s wants and needs. After carefully listening to the patient’s goal(s), Dr. Hustak will design a personalized plan best suited to help the patient achieve his/her desired goal(s).

Recovery

Bruising and swelling will be visible for at least three weeks but Dr. Hustak may require patients to wear bandages around their breast to help reduce the bruising and swelling. Patients are asked to refrain from any overly exerted physical activity to allow the body to heal properly, especially anything that may require heavy lifting for at least 4-6 weeks. Once the bandages are removed, a sports bra will need to be worn during the remaining 4-6 weeks. Underwire bras are not to be worn until after 6 weeks at least.

Combining Surgeries

Breast Augmentation- A breast enhancement procedure that uses implants or fat to add volume to the breasts. Learn more >

Breast Lift (Mastopexy)-  A breast lift is a procedure to lift sagging and drooping breasts. This helps the patient’s breast become perkier and more youthful.  Learn more >

Fat Grafting- Liposuction is used to take fat from donor areas and reuse the fat in areas of the body to add volume and enhance certain features.

Breast Revision FAQs

How do I know when it is time to replace my implant?

Manufacturers recommend 10-15 years but the possibility of an implant rupturing increases after 10 years. If the breasts do not show any signs of the problems listed above then the implants may stay in longer if desired. However, a yearly checkup with your plastic surgeon is highly recommended to ensure the implants are still intact and there are no underlying issues.

Which implant lasts the longest?

All implants last about the same amount of time. As long as the patients are cautious of their implants and maintaining a healthy lifestyle, the implants can at least 10-15 years.

If I need to correct a breast revision for capsular contracture or malpositioning, can I use the same implants or will I need new implants?

New implants are generally recommended and are always replaced for patients who have capsular contractures.

Why is my body rejecting the implants and causing capsular contracture?

The body’s natural response to any foreign object placed inside the body is to create scar tissue around that object. Some patients create more scar tissue than others causing the patient to form capsular contractures.

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