Breast Implant Revision
Revision of Breast Augmentation Surgery
Have you had previous breast augmentation surgery and want to improve your result, because of size issues, tissue stretch, implant hardening or implant rupture? Dr. Fiala has a great deal of experience with breast implant revisionary surgery.
The most common reasons for breast implant revisions are:
- Size change: whether it’s switching to a larger size or a smaller one, or changing the shape and proportion of the current implants, size change is the most frequent secondary surgery for breast implants in the United States.
- Fixing implant hardness: Also known as capsular contracture, this hardening process of tissue around the implant can cause the breast to become more spherical in shape, more elevated or more painful. It can be fixed, and the breast shape made more symmetrical, more natural looking, and more comfortable.
- Implant Deflation or Rupture: Whether they are silicone or saline breast implants, all implants eventually wear out with time, and will need to be replaced. With a saline implant, a leak in the implant results in an obvious change in the breast size, as the saline is absorbed. With a silicone gel implant, it may be more difficult to tell – and some form of imaging, like an ultrasound or MRI of the breast may be needed to confirm whether or not a leak is present.
- Implant pocket issues: Are the implants too far apart? Do they go under your armpit area when you lie down? If so, then you may have a pocket problem. By re-opening the pocket where needed, or by closing the pocket where needed with an internal suture repair, these issues can be fixed. Sometimes a new implant, of a more proportional width, can help to optimize the cosmetic result.
- Ripples: Do you have ripples or wrinkles that show on the surface of your breast? If you have a "over-the-muscle" saline implant, these can often be significantly improved or eliminated by switching to a silicone gel implant placed "behind-the-muscle".
How does Dr. Fiala figure out what my new implant size should be?
For women that wish to go to a larger size, we can place an air-filled sizer over the current breast, and the patient can preview the shape and size in a sports-bra & T-shirt. By knowing or estimating the size of the current implant, we can then determine the volume of the new implant by adding the volume of the implant and the sizer together, and picking an implant shape that will fit the patient’s frame. Often changing to a higher profile implant may give the larger volume desired, without making the breast too wide for the patient's frame.
For women that wish to go to a smaller size, several options are available. For women that currently have a saline implant, sometimes a pre-operative deflation of the saline implant can be very helpful. This way the patient can “try on” the new implant just like a first time patient – and get the size selection “exactly right” prior to the second surgery.
How does Dr. Fiala fix implant hardness?
For women that wish to continue with implants, the key steps in fixing implant hardness are:
- removing the scar tissue layer
- doing something to reduce the risk of a recurrence of the problem.
Removing the scar tissue layer is known as “capsulectomy
”. Think of it like carefully peeling the orange peel off an orange. Your own normal breast tissue is left intact, and only the abnormal scar tissue, or “capsule”, is removed. Once the tight scar tissue is removed, the implant is no longer squeezed into a tight & unnatural shape, and the breast will feel soft again, and more comfortable for the patient. A drain is usually placed into the pocket when a capsulectomy has been performed. Most commonly, in this situation, Dr. Fiala recommends that a new implant be used at the same time.
To reduce the risk of recurrent hardness, there are several options. If the old implant was “above the muscle”, it’s often wise to convert the implant to the sub-pectoral position. If the old implant was already “behind the muscle”, new advanced options like the use of Strattice may be considered.
What if I just want to remove the implants? Yes, that’s an option too. Implant removal without replacement can be done. For women that have had several episodes of breast hardness, this may be the best choice to minimize the number of future surgeries. At that time, a breast lift can be performed with there is obvious tissue laxity (loose skin) or a droopy shape. Alternatively, fat grafting to the breast can be done, to restore at least some of the volume of the breast. For those women who have a good breast shape, sometimes simple implant removal without mastopexy (breast lift) can also work well.
What if I have a ruptured silicone breast implant?Dr. Fiala is very familiar with this problem. The treatment is a surgical one – consisting of removing the old implant and free-floating silicone gel, and performing a capsulectomy to complete the “tidy up”. At that point, a new implant – either silicone gel or saline – can be placed, if desired by the patient.
Why should I choose Dr. Fiala for my breast implant revision?With a busy breast-implant related practice, Dr. Fiala has extensive experience in these breast implant revision surgeries, and a high success rate in these challenging revisional procedures.
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