Breast implant revision surgery, which commonly involves removal and/or replacement of saline or silicone gel implants, is performed to change the size or type of your implants and to correct any complications from your primary breast augmentation. The overall goal is to restore a youthful breast contour and appearance.
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Before Breast Revision (Breast Implant Replacement) Surgery
When to consider Breast Revision
. Your saline breast implants have deflated or an X-ray or MRI suggests your silicone implant has a shell leak.
. If you want to change your implant/breast size.
. If you have tightening of the scar tissue around the implant (capsular contracture) or your breast implants have shifted in position.
. If your breast tissue has changed as a result of skin stretching or weight loss/gain.
Advantages and Disadvantages
. You will regain a youthful breast shape.
. You may increase or decrease your breast size.
. You will improve breast symmetry.
. Gravity and aging will eventually alter the size and shape of your breasts.
. The weight of your implants will also affect your breast appearance with time.
. Your surgeon will need to have the surgical details of your first breast surgery.
These are the top three pros and cons to weigh when considering a breast augmentation revision. If you wish to focus on what is unique to you, please consult with your aesthetic plastic surgeon.
Are you a good candidate for breast revision (breast implant replacement)?
Even if your breast implant surgery was perfectly planned and beautifully executed, changes can occur over time.
The following are some common reasons why you may want to consider revision surgery:
. You are in good health.
. You are not a smoker.
. You wish to increase or decrease the size of your breasts.
. You wish to correct breast asymmetry.
. You want to address problems that have developed with your implants and/or surrounding breast tissue.
. Pregnancy and/or breastfeeding has changed the appearance of your implants.
. Weight loss or weight gain has negatively affected the appearance of your breasts.
. You should have undergone a breast lift with your initial breast augmentation, but did not.
. You are unhappy with the results of previous surgery due to poor implant placement or other aesthetic problems.
. You wish to remove your breast implants permanently.
If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.
Risks and Complications
Fortunately, significant complications from breast revision surgery are infrequent. Every year thousands of women undergo successful breast revision surgery and are pleased with the results. This surgery is usually performed without any major problems. Your specific risks for breast revision will be discussed during your consultation.
All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:
. Adverse reaction to anesthesia
. Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal).
. Infection and bleeding
. Changes in sensation
. Allergic reactions
. Damage to underlying structures
. Unsatisfactory results that may necessitate additional procedures
You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your breast revision surgery.
Preparing for Your Procedure
How do I prepare for a breast revision procedure?
Your surgeon will provide thorough pre-operative instructions, answer any questions you may have, take a detailed medical history and perform a physical exam to determine your fitness for surgery. In some instances, you may need to have a mammogram before revision surgery.
In advance of your procedure, your surgeon will ask you to:
. Avoid taking aspirin, certain anti-inflammatory drugs and some herbal medications that can cause increased bleeding.
. Stop smoking at least six weeks before undergoing surgery to promote better healing.
. Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.
. Keep alcohol consumption at less than two to three drinks per week.
. If your surgery is to be performed on an outpatient basis, be sure to arrange for someone to drive you home after surgery and stay with you for the first day or two, unless you and your surgeon have decided on other post-operative recovery options.
. Before surgery, stock your refrigerator with high-protein, low-sodium foods, including premade meals, fresh fruits and vegetables, and lots of caffeine-free beverages and water. Avoid food and drink containing salt during your recovery.
. As you heal, your arms will have a limited range of motion, so store all the supplies you’ll need during recovery where they’re easily accessible (at counter level, not in overhead or very low cabinets).
. Stockpile movies or prerecorded programs, or novels and magazines. If possible, have a speakerphone by your bed and a remote control for the TV.
. Establish a no-fail support system for the full recovery period indicated by your surgeon. This is critical to your recovery. If you have children less than five years of age, you must have someone to take care of them for a week. You must not lift, drive, or do laundry and cleaning for the first two weeks.
. Rest and sleep on your back continuously in an inclined position (25- to 45-degree angle) for the initial post-operative days or while significant swelling remains. You can achieve elevation with wedge pillows with an incline design or by sleeping in a recliner chair.
. Avoid hot showers, hot tubs and saunas for two to three weeks.
. Decide what you will wear for the first few days; pick items that open in front. Wear slip-on shoes so you don’t have to bend.
Breast revision is usually performed on an outpatient basis. Be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.
During Breast Revision (Breast Implant Replacement) Surgery
What can I expect on the day of revision surgery?
Your revision surgery may be performed in a hospital/clinic, free-standing ambulatory facility or office-based surgical suite. Your surgeon will give you an estimate of how long your surgery will last based on the details of your surgical plan.
. You may be asked to wash your body with antibacterial soap prior to surgery.
. Make sure not to wear makeup (including nail polish), lotions, perfumes or other substances.
. Dress in or bring soft, comfortable clothes that you’ll be able to wear after the surgery, including a top that opens in the front and shoes that slip on.
. Bring only the essentials (ID, insurance card, cell phone, etc.) and leave other personal belongings such as jewelry at home.
. Medications are administered for your comfort during the surgical procedure.
. General anesthesia is commonly used during your revision procedure, although local anesthesia or intravenous sedation may be desirable in some instances.
. For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
. Your plastic surgeon will follow the surgical plan discussed with you before surgery.
. Once the operation has begun, the surgeon may decide to combine various techniques or change a technique to ensure the best result. It is important that you feel comfortable and trust your doctor to make these decisions.
. Following the surgery, a bulky gauze dressing (bandage) will be wrapped around your breasts and chest, or you might wear a surgical bra. Drainage tubes may be attached to your breasts.
. After your surgery is completed, you will be taken into a recovery area, where you will continue to be closely monitored.
. When you are fully alert, you will be able to go home with the assistance of a friend or family member. Before leaving for home, you (or someone looking after you) should feel capable of emptying and resetting the drains.
You will probably be permitted to go home after a short observation period unless you and your plastic surgeon have made other plans for your immediate post-op recovery.
How is a breast revision procedure performed?
The exact procedure your surgeon will use for breast implant removal and replacement varies depending on the reason for your revision.
. Change in breast size: If you decide to change your implant size, your surgeon will frequently use your original incision for implant removal and replacement. If you want a larger implant, your doctor will surgically enlarge the “pocket,” or space in the breast, surrounding your implant to accommodate a larger implant. If you want smaller implants, you doctor may surgically reduce the size of the pocket with sutures to properly fit smaller sized implants. A breast lift may be done at the same time.
. Capsular contracture (hardening of the capsule and implant): Your doctor will probably use the same incision used to insert the original implants to remove the hardened capsule and implant. He or she will then insert a new implant.
. Implant rippling: When the edges of saline implants are visible and palpable (able to be felt), your surgeon may use the same incision to remove or reposition the implants as was used to originally insert them. Other options include using a different type of implant or placing the new implant into a different breast pocket that either has thicker muscle coverage or uses other tissues to cover the implant edge.
. Implant malposition: Sometimes implant pockets are created too far apart or too close together, resulting in poorly positioned breasts. To correct this, using the prior incision, your surgeon will manipulate the scar tissue from the capsule surrounding the implant and reconstruct the pocket in the appropriate position using suturing techniques. Your surgeon may need to utilize other tissues to reinforce this new implant pocket and may recommend using an acellular dermal matrix product. Known by the acronym ADM, Acellular Dermal Matrix eventually gets integrated into the body and is completely replaced by the patient’s own collagen resulting in a thicker, stronger layer of tissue than the one that would have developed in the absence of the ADM. It is natural and bioresorbable yet maintains its strength over time. ADM is attached with absorbable sutures to the existing capsule, anchoring it to its new position to add additional support.
. Implant removal: If your implants are large and your skin has stretched, your surgeon may recommend a breast lift in addition to implant removal, but implant removal alone may suffice. The original incision created to insert the implant will almost always be the same one used to remove it. The lining around the implant, or “capsule,” is often surgically removed at the same time to facilitate rapid healing.
. Elevation of nipple and areola position: If it is necessary to elevate the position of your nipples and areolas (pigmented skin surrounding the nipples), you will need additional incisions. Incisions around the upper portion of the areola will be adequate in cases where not much elevation is needed. When more lifting and tightening is necessary, an incision all the way around the areola, including a vertical scar extending down from the areola to the crease under the breast, may be necessary. For cases where significant excess skin needs to be removed (such as in women who have had massive weight loss), a third incision may be necessary that will extend horizontally beneath the breast, following the natural curve of the breast crease. If your nipples need lifting, the nipples and areolas remain attached to underlying mounds of tissue and this usually allows for the preservation of sensation and the ability to breastfeed.
The goal of your aesthetic plastic surgeon and the entire staff is to help you achieve the most beautiful and natural-looking results, as well as making your surgical experience as easy and comfortable as possible.
What are my options?
Good communication with your plastic surgeon is the key to achieving the results you want. It is your job to clearly state your aesthetic goals so your surgeon can suggest the right options. During your consultation, you and your surgeon will resolve these issues:
. What type of implant will be used?
. Saline-filled breast implants are filled with sterile salt water. Saline implants may be prefilled at a predetermined size or filled at the time of surgery to allow for minor modifications in implant size.
. Silicone-filled breast implants are filled with soft, elastic silicone gel and are available in a variety of shapes. All silicone breast implants are prefilled and may require a longer incision for implant placement.
. Cohesive gel silicone implants, also known as “gummy bear” or “form stable” implants, are filled with a cohesive gel, made of crosslinked molecules of silicone, which makes them a bit thicker and firmer than traditional silicone implants. This enables them to hold their shape better. Approved by the FDA for use in the United States in 2013, these implants have been available in much of the world since 1992.
. Will your implant be located above or below the pectoralis major muscle?
. Placement of the implant underneath the pectoral muscle (the muscle underlying your breast) may interfere less with mammograms and breastfeeding. Your surgeon will present the pros and cons of each option.
What will my breast revision incisions and scars be like?
The original incision used to insert the implant is almost always the same one used to remove it; however, if you undergo a breast lift, elevating the position of your nipple and areola will result in breast lift scars.
After Breast Revision (Breast Implant Replacement) Surgery
Aftercare and Recovery
Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your post-surgery care, including information about:
. Drains, if they have been placed
. Normal symptoms you will experience
. Potential signs of complication
Immediately after your breast revision surgery
Your post-operative discomfort and recovery time will be similar to that of your primary breast augmentation. You should be up and walking on the day of surgery. It will take several days to return to more normal activities after your breast implant revision, but it is important to your recovery that you get up and move around. The extent and duration of discomfort depends largely on the size and placement of the implants, and may include pain, stiffness, swelling, bruising and itching.
When the anesthesia wears off, you may have some pain. If the pain is extreme or long-lasting, contact your physician. You will also have some redness and swelling after the surgery. Contact your surgeon to find out if your pain, redness and swelling are normal or are signs of a problem.
Recovery time frame after breast revision
It is vitally important that you follow all patient care instructions provided by your surgeon. This will include information about wearing compression garments, care of your drains, taking an antibiotic, if prescribed, and the level and type of activity that is safe. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.
Undergoing a breast lift in conjunction with breast implant removal will lengthen your recovery time. If your breast implants are removed entirely, your recovery will likely be brief, with minimal discomfort. Avoid heavy physical activity for at least the first two weeks following surgery. After that, be gentle with your breasts for at least the next month. Your plastic surgeon will give you specific instructions and restrictions about physical activity.
. The first week
. For the next week, you will benefit from sleeping with your head and back elevated to reduce swelling in the chest area. You can use pillows, a wedge pillow, or sleep in a recliner chair.
. Your plastic surgeon will probably permit you to shower one to three days following surgery, but do not immerse your breasts in a tub, spa or Jacuzzi for at least four weeks after surgery.
. Depending on your plastic surgeon’s preference, your dressings will be removed within a few days after surgery.
. If drains are placed, don’t shower until 24 hours after the drains are removed, which is usually after three days.
. You may be instructed to wear a compression bra during your early healing period to prevent fluid accumulation, control swelling and keep implants in place during the initial healing period.
. Stitches that don’t dissolve on their own will be removed in about a week.
. Some discoloration and swelling may occur initially, but this will resolve as you heal.
. Two to six weeks
. Most residual swelling will resolve within a month.
. After breast revision surgery, it is often possible to return to work within seven to ten days, depending on the type of activities you perform.
If you selected large implants, the skin around the breasts may feel tight as your body adjusts to accommodate the size increase.
. Long term
It may take several weeks or months for new implants to “settle” into their final position. Altered sensation, such as numbness or tingling, may be present around the incision site, but this should decrease over the following weeks or months.
How long will the results last?
Unless you gain or lose a significant amount of weight or become pregnant, your new breast shape should remain fairly stable. However, gravity and the effects of aging eventually alter breast size. The weight of the implant used will also affect how your breasts appear as time goes on. Breast implant revision results are long-lasting; however, you may want to periodically visit your doctor to help prevent any further complications.
Maintain a relationship with your aesthetic plastic surgeon
For safety, as well as the most beautiful and healthy outcome, it’s important to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you notice any changes. Do not hesitate to contact your surgeon when you have any questions or concerns.