About Breast Implant Revision

Dr. Sardo specializes in breast implant revision surgery for:

Saline Implant Deflation

Smooth saline implants deflate on the average of 1 % per year. It only takes a tiny hole for the saline to completely leak out and get absorbed by the body. This usually occurs over a day to a week time period. Once the volume has been noted to have decreased, it is usually preferable, but not required, to replace the implant within a few weeks. Textured implants have a 2x higher risk of deflation. Therefore after 6 years approximately 6% of smooth saline implants and 12% textured implants will have failed. The procedure to replace a deflated implant is much simpler, faster and easier than the initial augmentation surgery. Recovery is also much easier with minimal discomfort. Replacing a deflated implant gives the opportunity to change to silicone gel implants if desired, improve symmetry, change size and make other adjustments as needed.

Saline Implant Rippling

Rippling is the appearance or feel of ridges on the breast. They often occur at the edge, but can occur anywhere on the breast. Rippling may be increased if the implant is under filled or overfilled, or when the tissue is lax or deficient over the implant. Rippling is most likely to be seen on the lateral or outside edge of the implant. It can also be seen in the cleavage area, upper breast and may be felt on the lower border of the breast where the implant is closer to the skin. It also may be more likely with a sub glandular implant compared to a sub muscular placement. Possible strategies to improve rippling are to add more fluid to a saline implant, place a larger implant, or replace the saline implant with a round or shaped silicone implant.

Silicone Rupture

Old implants may or may not be ruptured. Rupture may be asymptomatic or may lead to increased scar tissue causing firmness of the breast. Mammogram does not necessarily show a rupture especially if it is completely contained by the scar capsule. Sometimes microscopic silicone gets processed by the body's scavenger cells and travels to the axillary (armpit) lymph nodes. Silicone in the lymph nodes may be detectable by X-ray, ultrasound, MRI or mammogram they may feel like a lump if they are swollen. The best way to determine whether an implant is ruptured other than operative exploration is to obtain an MRI. The newer cohesive gel implants may last up to and past 20 years, but older implant styles rarely may rupture much earlier. If the implant is ruptured, it is recommended to have it changed to new implants. Research has shown no relationship of silicone gel to cancer, autoimmune disease, or other systemic conditions. The loose gel may cause benign inflammatory lumps if it gets into the breast tissue. Old silicone implants are more likely to have issues with infiltration into the tissues, if it gets outside of the capsule. Newer implants have "cohesive" gel, which means that it is more "stuck together". If the implant envelope was to rupture, the gel stays together more like "Jell-O."

Replacement of implants is usually done through the same incisions as the original surgery. The silicone material is pulled out. The pocket is rinsed out. Scar tissue is removed if necessary and new implants are inserted.

Capsular Contracture

It is a natural process for a thin film of scar tissue to envelop the implant after placement. If this scar tissue thickens, or tightens, it may make the implant feel firm. Capsule contracture is one of the most common causes of breast revision surgery. Capsular contracture is much more common in implants placed on top of the muscle compared to below the muscle. Doctors use a classification called the Baker System to rate the contracture.

Some people don't mind or even prefer a firmer breast, but most want a soft natural feel (Baker I).

If the capsule is moderate, a capsulotomy may be performed. This consists of incising the scar pocket to make more room for the implant. Depending on where the contracture is in the pocket, a portion of the pocket scar may be removed. If the contracture is III or IV it may be necessary to remove the entire scar capsule (capsulectomy).

Capsule contracture may occur soon after augmentation or years later. It may occur on one or both sides. Increased blood in the pocket during the initial surgery contamination or subclinical infection (not causing fever or redness) may increase the risks of capsular contracture. Depending on how new your implants are and their condition, the same implants may be used, or new implants inserted.

The risk of capsular contracture is anywhere from 1% to 18% depending on the style of the implant, placement (under or over the muscle) and the patient's inherent propensity to develop scar tissue. Capsular contracture may be minimized by daily massage of the breasts. Ask your surgeon for specific postoperative instructions.

Breast Webbing

Breast webbing across the sternum can occur, more often in sub glandular breast augmentation when dissection is carried too close to the center of the chest. If the very adherent skin over the sternum is lifted in an attempt to get better cleavage and/ or too large of implants are placed, the central attachment of skin may become loosened. Once this occurs, it is very difficult to repair. Correction usually requires placing sutures to reestablish the space between the breasts and changing to smaller implants.

Asymmetry

Asymmetry can result from many pre-existing factors or from implant positioning/factors.

Inherent anatomical factors causing asymmetry:

Implant factors:

For anatomical factors, in most cases, implants may improve the symmetry. However, in some cases they may exaggerate the asymmetry.

It may be necessary to perform a lift, reduction or skin altering procedure to improve symmetry. Implant position or size may need to be adjusted.

Double Bubble or High Riding Implants

Double Bubble or "Snoopy-dog" deformity occurs when the implant is too high on the chest and breast is sagging off the bottom. This can happen when the crease under the breast is naturally very high and tight and in an effort to get the implant lower and lower the crease, it places a constricting band across the implant or if the implant is placed above this high crease. Capsule contracture can cause a high riding implant, because the scar tissue pulls the implant upward. A transaxillary augmentation approach may cause this where inadequate release of the muscle prevents proper position of the implant.

It is important that a breast lift is performed when it is needed otherwise the results will be unsatisfactory. If the nipple is located below the level of the crease underneath the breasts, a lift is usually required.

Correction depends on the cause.

Bottoming Out

Bottoming out is when the implant stretches the lower portion of the breast of dips below the inframammary crease. This results in the nipples appearing too high on the breast. It may be secondary to large implants, thin skin, lack of muscle support, or technical error.

Correction is done by "capsulorrhaphy" or sewing the capsule under the breast to push the implant higher in the pocket and getting the nipple more centered on the breast mound. This is a difficult problem to correct because it tends to recur, especially if the implants are large and heavy or the patient naturally has thin stretchy skin/tissues. It may be necessary to excise an ellipse of skin, to give more support to the implant.


Dr. Marialyn Sardo, MD, FACS
Tel: 858-452-6226
Toll Free: 866 DR SARDO
   (866-377-2736)
Fax: 858-452-6235
9850 Genesee Avenue,
Suite 380
La Jolla, CA 92037
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"After the breast augmentation [the staff] talked to my fiancé to make sure he knew how to take care of me. He was extremely impressed with how concerned they were about my recovery."

– Breast Augmentation Patient

 

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