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Revision Breast Surgery

Saline to Silicone Implant Exchange

Sometimes after the initial breast operation (even years later) patients may experience fluctuations in their weight. In terms of breast appearance, weight loss is probably more unfavorable than weight gain. As patients become thinner, they have less tissue to cover their breast implants. Sometimes it gets to a point where the implant edges become visible and patients can benefit from removing their saline implants and switching to silicone gel for a more natural appearance. This type of exchange can also be helpful for patients who initially went with saline implants that were larger than the breast tissue envelope. When implants are wider than the base diameter of the breast, then the outer edge may become visible. Silicone implants perform better in general than saline in these situations.

Capsular Contracture

Capsule formation (the development of scar tissue around an implant) is common to all procedures involving devices made of foreign (to the body) material. It happens even in hip and knee replacements. This tissue is a barrier constructed by the body to separate itself from whatever device is implanted.

In the case of breast implants, the capsule is very thin (similar to the thickness of a standard sheet of paper). In approximately 25 % of patients this tissue surrounding the implant “squeezes” and makes the implant (which is as soft as the day that it went in) feel more firm. In 5% or so of patients this tightening can progress to a point where the breast becomes distorted and even painful. The treatment at this point is to have the scar tissue around the implant surgically removed. This allows a “fresh” start, but there is a 10% higher risk of developing the same condition in the future. Historically, less than 1% of women are unable to tolerate implants due to capsular contracture.

Breast Implant Removal

There are certain situations which necessitate implant removal. Although it is becoming more and more infrequent, there are cases of implant deflation or rupture. Some women gain weight and therefore develop extra tissue in their breasts and feel that they no longer require implants. Although it is rare, some women have difficulties with capsular contracture or infection and require implant removal. One in nine women today will unfortunately develop breast cancer in their lifetime. Existing implants may need to be removed to facilitate the treatment process. Some women just reach a place in their lives where they would like to have their implants removed.

If a patient needs to have their implants removed for the above reasons, or any other reason, the options available depend on their personal situation, as well as the amount and condition of their breast tissue and skin. If the patient elects to not have the implants replaced, the remaining breast tissue (most of the time) can be rearranged into a smaller but still shapely appearing breast.

Breast Implant Deflation

Breast implant deflation is usually associated with saline implants. If one of these implants ruptures, the saline leaks out and the implant goes flat (the body absorbs the harmless saline). This is a quick process. If the patient has a question as to whether a saline implant is ruptured or not, it probably is not. Both of the major implant manufacturers (Allergan and Mentor) have done an excellent job creating lasting quality products. Manufacturer’s defects are very rare but do happen on occasion. 95% of these implants will make it 10 years. Most implants are removed for reasons (usually trauma related) other than rupture.

Silicone implants can rupture as well. However, because of their gel nature they don’t experience the deflation that saline do. The gel tends to stay in and around the implant shell. It is not absorbed. That tendency may make it somewhat more difficult to detect a rupture. Imaging studies such as mammograms, ultrasounds, or MRI’s may be necessary to properly evaluate the implant.

Fortunately both implant companies offer both “built in” and additional warranty programs that at minimum replace the both the ruptured implant and the intact implant on the other side. They also offer varying levels of financial support to cover associated surgical costs.

Previous Breast Surgery

There are a lot of variables that come into play to determine the final outcome in breast surgery. Some are surgeon-influenced, some technique-related, some patient-related, and some beyond anyone’s control. There are situations where the results are not what the patient might have expected. There are many surgeons who are performing breast surgery and are not plastic surgeons, even though they may claim they are. We see many patients of non-plastic surgeons after they have already had a problem. Having said that, patients can have an unfavorable result even from a well-respected and well-trained plastic surgeon. In most cases, it is prudent for patients to return to their original plastic surgeon if they are having a problem. They have the best idea of what surgically was done in the first place and what the original anatomy looked like. If it is not possible for patients to go back to their original plastic surgeon, or if they just don’t feel comfortable, then I am happy to assist them in any way possible.

The recent introduction of acellular dermal products have significantly expanded our ability to improve very difficult secondary breast procedures that otherwise could not have been corrected. The addition of structural fat grafting may also provide benefits that were not possible before this technique. Its potential improvement to radiation damaged tissue is especially promising. Fat grafting has the additional side effect of improving the contour of the donor site (where it is taken from) via liposuction.

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