Breast Revision Orange County
Dr. Aiello receives many referrals for breast revision surgery. He has great success correcting many varied issues leaving our patients with an outcome closer to what they envisioned when they first sought out their augmentation. Breast implant revision surgery, involves removal and/or replacement of saline or silicone breast implants and can include correction of any complications from your primary breast augmentation. Breast implants are like any other man-made implantable medical device (such as heart valves and artificial joints), and realistically, some patients will require revision procedures. The first step when seeking revision surgery is to be properly evaluated. Revision surgery is generally much more complex than an initial breast augmentation and very individualized based on your specific circumstances. During your consultation for implant revision, it is very helpful if you can bring your existing implant information card or your previous surgeon’s op reports. It’s not mandatory, but will help a great deal by removing some of the guess work or waiting until you are in surgery to get answers to questions like your implant size, manufacturer, etc. This page will review some of the most common reasons we see patients seeking a breast revision surgery.To view Before & After photos of Dr. Aiello’s Breast Revision patients, click HERE to go to the gallery.
changing implant size or type
Dissatisfaction with the size of one’s implants is the most common reason patients seek a breast revision, almost always switching to a larger implant. This procedure can be as simple as adding fill to existing saline implants to achieve a larger size or exchanging saline implants for silicone. When an existing implant is simply exchanged for a similar size, we call it a “Remove & Replace”. However, going down to a smaller implant often requires a Breast Lift (Mastopexy) for the outer breast tissue and a Capsulodesis to make the inner pocket small enough for the new implant size. Patients may also require a lift if they’ve had significant changes in their breasts since their initial augmentation. A mastopexy may also be needed to address sagging due to thinning of the breast tissue as a result of aging, weight gain/loss, pregnancy, or breastfeeding. All of these may result in the implants becoming more visible and the appearance less natural as well as sagging (ptosis).
Improper implant placement or position
Another common complaint among patients seeking revision surgery is the position of their implants. One implant may be higher than the other or located too far away from or too close to the other implant. Sometimes implants may not “settle” into a low enough position and remain high on the chest wall. Also, pre-existing natural asymmetry may not have been corrected and now seems amplified by the added volume of the augmentation. The final implant positioning issue is referred to as “bottoming out”. The implants may have been positioned too low on the chest wall in relation to the nipple position. Or it is sometimes due to over dissection of the pocket in the region of the inframammary crease (breast fold) or cutting of the lower portion of the pectoralis muscle during surgery. It also can occur naturally with implants that are placed above the muscle.
Breast implant waviness or rippling most often occurs when there is insufficient soft tissue coverage due to little overlying body fat and breast tissue. It is not due to any defect with the implant, it is just a possible phenomenon usually seen in thinner breast augmentation patients with saline implants placed over the muscle. This issue can happen with both silicone and saline implants, but is more prevalent with saline. Implants placed beneath the muscle help to minimize it, but the lower and outside breast may still show some rippling as pectoralis muscle is no longer present to give coverage. It is often accentuated with certain positions (bending over,or leaning). Rippling that is felt but not noticeable to the eye is very common and should not be a concern. However, when rippling is visible, patients are often self-conscious about their appearance.Once rippling occurs it can be very difficult to correct, but it can be minimized by replacing larger implants with smaller, placing under the muscle and possibly incorporating biologic fabrics.
Deflation (rupture of an implant) with saline implants this is usually quite obvious because the augmentation effect is rapidly lost over the course of a day or two. Although the saline is harmlessly absorbed by the body, replacement of the implant should be performed within a few weeks to keep the pocket from shrinking. With silicone implants, rupture may be less obvious and may require further testing to confirm, such as an ultrasound or MRI. (Mammogram tests are not designed to diagnose an implant rupture, and we actually see many patients incorrectly diagnosed with rupture from this test.) Breast implants used today have a full replacement warranty that will provide you with replacement implants at no cost to you. Depending on how long it has been since your original operation, you may also be eligible for financial assistance towards the operating room costs as well.
Capsular contracture occurs when the scar tissue capsule your body naturally forms around your implants thickens, tightening around the implant. This may occur on one or both sides and may cause a shape change, discomfort, and may cause the breast to feel more firm. You may notice that one or both of your breasts are not as soft as they once were or may actually begin to harden, your breasts may begin to look or feel different, or you may experience some discomfort from the tightening of the capsule. The appearance of any of these signs should alert you to the need to have your breasts examined and your capsular contracture graded for severity. Although capsular contractures following breast augmentation can occur just about any time, most women start having symptoms around three months after their breast implant surgery. This is because it takes some time for a capsule to form and then to start to contract. After grading your level of contracture and assessing any other issues, Dr. Aiello will make his best recommendations to you for treatment. Early in diagnosis, contracture may be treated with massage and medications to help the scar tissue soften. In more advanced cases a revision surgery is needed, the most common procedure being a complete capsulectomy. This procedure involves removal of the entire thickened capsule surrounding the breast implant and replacement of new implants in a new breast pocket.
Total removal of breast implants with no replacement is known as an “explant” procedure. There many varied reasons women choose to have their implants removed. For some, it’s just a personal realization that after a number of years their lifestyle has changed, sometimes the long term upkeep has become bothersome, while others may have a history of complications. Dr. Aiello sees more and more patients desiring explant surgery and whatever the reason, he is happy to oblige patients to remove their implants. No matter the reasons, for all patients considering explant surgery, it’s important to remember this procedure is sometimes more than just simply removing the implants. Patients with complications such as rupture and capsular contracture will require the scar tissue in the breast pocket removed. Patients who had very small breasts and were augmented with very large implants will experience very thin and stretched out skin due to the loss of volume and structure from the implant. These patients often require a mastopexy (breast lift) either during the time of the explant or in a few months time after it’s determined the remaining breast tissue will not shrink any more. At the time of your consultation, Dr. Aiello will give you his best opinion on your options. It can never be predicted what the breasts will look like once the implants are removed, but we do our best to prepare the patients considering this procedure for the image adjustment and give them all options available to give them the best possible aesthetic outcome.
More information on Breast Revision in greater detail (including implant warranties) may be obtained from the references listed below:
- American Society for Aesthetic Plastic Surgery www.surgery.org
- FDA www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants
- American Society of Plastic Surgeons www.plasticsurgery.org
- Smart Beauty Guide www.smartbeautyguide.com/procedures/breast/breast-revision
- Breast Implant Safety breastimplantsafety.org
- Mentor 800-235-5731 www.mentorcorp.com or Natrelle 800-362-4426 www.natrelle.com
We understand the importance of having well-informed patients, and will take the time to thoroughly review all of your options for breast revision so that you are confident with your choices. If you would like to learn more about breast revision at Ocean Plastic Surgery Center, CLICK HERE to contact us! We look forward to speaking with you and to scheduling your complimentary consultation with Dr. Aiello.