Revision breast augmentation

Revision breast augmentation

1. How often do breast implants need to be changed?

Breast augmentation is the most common cosmetic surgical procedure and it is inevitable that some women will require revision breast augmentation at some point. Data from the FDA (the regulator in the USA) suggests that one in five cosmetic implants are explanted (removed and not replaced) or replaced within 10 years.

2. Why do breast implants have to be replaced/ revised?

A. Concerns about the integrity of the implants: Implants, like any medical device, can fail. Failure (rupture) of breast implants can be symptomatic or can go unnoticed. The risk of implants rupturing, increases over time. A study published by the FDA showed that the rupture rate for Allergan implants is 0.5% after two years, rising to 10.1% (cumulative) after 10 years. For Mentor implants, the failure rate at 8 years was 13.6% (cumulative). It is important to note that Allergan and Mentor implants were accepted by the FDA for cosmetic breast augmentation in the USA in 2006, lifting a ban on Silicone gel implants that was started in 1992. The evidence on the rate of rupture of PIP implants compared with other implants is incomplete and this risk cannot be assessed accurately. Rupture rates apart, the fact that a substantial proportion of PIP implants contain industrial grade silicone have led to understandable anxieties and may justify removal of PIP implants with intact shells.

B. The most common indication for revision (apart from the PIP problem) is up-sizing – patient requesting larger implants.

C. Capsular contracture (abnormal scar tissue around an implant) resulting in hardening of the breasts and adverse changes in their shape.

D. Being able to feel/ see the edge of an implant, visible ripples, folds or creases (seen or felt) can all be indications for revision.

E. A shift in the position of implants from their original position (implant malposition) resulting in a wide gap/ poor cleavage, high riding implants or bottoming out (abnormal low lying position) with lack of support.

F. Droopiness of the native breast tissue resulting in the so called “double-bubble” appearance.

G. Breast asymmetry (noticeable difference in size, shape or position)

H. Other indications for revision may include, unsatisfactory scars and/ or disproportionately large nipples.

The above indications for revision surgery may be related to the implant, the initial surgical technique or to problems with the breast tissue surrounding the implant. These might include change in the volume of the breast tissue and/ or loss of skin elasticity. Factors contributing to this include ageing, pregnancy, breast feeding, weight variation, sun damage and smoking.

3. Do breast implants need to be replaced every 10 years?

The answer is no as long as women are satisfied with the long term cosmetic result and there are no concerns about the integrity of the implant and the safety of the filler material.

4. What would breast implant revision involve?

Depending on the patient, revision surgery may involve one or a combination of the following procedures:

A. Removal of the old implants and replacement with “like-for-like” or different size, type or shape implant.

B. Removal of thickened contracted scar tissue lining the implant pocket (capsulectomy).

C. Modification of the existing implant pocket to allow for the insertion of a much larger implant and/ or reducing the gap between the implants (capsulotomy).

D. Modification of the existing implant pocket to correct bottoming out, descent of the breast crease and lack of support.

E. Breast implant pocket switch from above to below the muscle to address rippling and recurrent capsular contracture.

F. Breast uplift/ reshaping (mastopexy) to correct droopiness.

5. How does recovery compare with that of the first operation?

Women contemplating revisional surgery will have some idea of what the procedure is like (having had a previous breast augmentation). There are many similarities to the original procedure but there can also be a number of significant differences depending on the complexity of the revision procedure. Simple exchange of implants for implants of comparable shape/ size can be quite straightforward as no major work is required on existing implant pockets. The surgical procedure can be fairly quick. On the other hand, if the surgery is complex, the procedure will take longer and the recovery would be more involved. Examples of complex revisional surgery include correction of capsular contracture, implant malposition and breast uplift.

6. What are the risks?

Revision breast implant surgery is an operation of varying complexity and a has a degree of unpredictability. There is no guarantee of a satisfactory outcome and further surgery may sometimes be necessary. All operations carry associated risks including those of the anaesthetic and infection. All complications and long term problems that follow the primary breast implant procedure can happen following revisional surgery.

7. What are the costs?

Revisional surgery usually costs more than the initial implant procedure and varies depending on the complexity of the revision. Further information may be obtained from your surgeon.

The options discussed above a purely the personal opinion of Awf Quaba – Consultant Plastic Surgeon – Edinburgh