San Diego Breast Implant Revision

breast-impant-revision-san-diegoBreast implant surgery can result in the need for a revision procedure for any number of reasons.  Implant problems can be related to simply wanting a different size or type (saline or silicone), age or pregnancy related changes, a rupture of the implant, the implant not being in the ideal position or the development of excessive scar tissue around the implant – commonly termed capsular contracture.  San Diego breast implant revision surgeon Vincent Marin is experienced with each of these scenarios and can help you correct any of these breast implant related issues.

Implant Size or Type

Despite extensive efforts during the consultation to ensure that the “perfect” implant size is chosen, some women feel that the implant size isn’t right from the start, or that their perspective has changed and the present implant doesn’t fit their current state of mind.  Also, some women had their implants placed before silicone was approved by the FDA in 2006 and want to take advantage of the more natural silicone implant.  Whatever the motivation, these types of changes can be relatively straight forward with a simple exchange to the desired volume or type of implant.  Patients who have undergone the procedure often have a better understanding of the surgery and can more accurately predict what size of implant will make them happy.  This procedure can frequently be performed under local anesthesia without the need for a general anesthetic. Our San Diego breast implant revision patients will usually have very little pain associated with their breast implant exchange and are able to switch to ibuprofen in two to three days.

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WHAT TO EXPECT FOR YOUR

Breast Implant Revision

Length:
1 – 3 hours

Anesthesia:
General or local with sedation

In/Outpatient:
Outpatient

Side Effects:
Temporary swelling, mild bruising, and some pain

Risks:
Pain, bleeding, infection, asymmetry, recurrence, changes in nipple sensation and incomplete correction, implant failure

Recovery:
Back to work: 1 week
More strenuous activity: 3 – 4 weeks

Final Appearance:
2 – 3 months for swelling to completely resolve

Duration of Results:
Permanent: the average lifespan of a breast implant is 10 years and implants may need to be replaced in a relatively minor procedure

Malpositioned or Misplaced Implants

Breast implants are designed to be placed in a position beneath the entire breast and centered on the nipple.  This allows the implant to “augment” the entire breast.  For a number of possible reasons, the implants can be too high on the chest, too far to the side or center (losing the distinction between the breasts) or “bottom out” falling below the existing breast crease.  No matter what the circumstances, Dr. Marin is trained in correcting each of these problems through a number of different techniques.  Often, the internal “capsule” needs to be tightened in the areas where it appears loose or too large.  Certain women have skin with limited elasticity and breast implants can result in excessive skin stretch, looking like a misplaced implant.  This, however, may require tightening of the breast skin to improve the relationship with the existing implant that is in good position.

Capsular Contracture

Capsular contracture is one of the most frustrating aspects of breast implant surgery for both patients and surgeons alike. Every implant (breast, joint, bone) will cause the body to develop a capsule made of collagen (scar tissue).  This is the body’s way of protecting itself from a foreign material (the implant).  Most implants are rigid and much stronger than scar tissue.  However, breast implants are soft and designed to accurately mimic a normal breast.  Thus, even gentle pressure can change the shape of the soft implant.

Our goal is to keep the capsule associated with the breast implant large enough to prevent it from changing the shape of the implant (it is important to remember that we don’t want to make the capsule so large that we produce a “malposition”). Postoperative massage and displacement exercises can be very helpful after surgery.

Despite our best efforts, some capsules (which are normal) act abnormally and contract.  Why this happens and to whom it happens is not fully understood, but it is has been shown to occur in a range of 1-10% of patients undergoing cosmetic breast surgery with implants.  It is impossible to predict which patients are at high risk unless they have had a previous capsular contracture.  Even if this is the case, we do not know with any degree of certainty that this will happen again or if the patient will be contracture free for the rest of their lives.

Capsular contracture is problematic in that it can change the shape of the implants and, in the most severe cases, can be associated with pain.

Bakers Classification (Capsular Contracture Grading Scale)

Class I: The affected breast is soft and pliable. Appearance is normal.
Class II: The affected breast is less soft than normal and the implant can be obviously felt, but not seen.
Class III: The affected breast is considerably harder than normal and the implant can be seen and felt. Distortion of the implant is a common visual indicator.
Class IV: The affected breast is obviously hard, tender, painful and often restricted in movement. The implant is obviously distorted in shape or placement.

The treatment of a significant capsular contracture can involve the release of areas where there is visible tightness or the removal of the entire contracted capsule.  Also, if the implant is placed above the chest muscle, there is the possibility that the implant will be relocated beneath the muscle.  All of your options will be fully discussed with you at your consultation.

Breast Implant Rupture

All breast implants are “medical devices” and can wear out over time or are subject to physical stresses.  Thus, a small percentage of patients may suffer a rupture or deflation of their implants. How you experience a deflation or rupture is very dependent upon whether you have saline implants or silicone implants.  Saline breast implants, once ruptured, will likely empty in several days revealing a significant change in the appearance of the breast.  The saline (salt water) is absorbed in the body leaving an empty silicone shell behind.  A silicone implant rupture will occur in the same manner, but the silicone is not significantly absorbed by the body and will largely remain within the breast capsule.  Thus, the external appearance of your breast will not be significantly different since the “fill” of the implant (silicone) remains in the capsule and continues to provide fullness to the breast despite the shell rupture.  Most women will notice that “something” happened, the breast looks slightly different or behaves slightly different than before.  Sometimes there is no change whatsoever and a rupture is unexpectedly found during a routine or unrelated procedure.

The treatment of a ruptured implant is by its removal and replacement once it is discovered.  A saline rupture is relatively easily diagnosed in the office, but a silicone rupture can be much more subtle.  Occasionally a mammogram or breast ultrasound will suggest a problem, but the best means of diagnosing this is with a MRI.  However, the cost of this can be significant and thus, a clinical diagnosis is often used.

The ruptured implant is approached through an areolar or breast crease incision (you cannot correct this problem through the armpit or belly button approaches).  The implant is removed and a new implant is placed.  Adjustments can be made depending upon the desires of the patient, but we would have to adjust the other implant to match if a different profile or volume is chosen

The two major breast implant manufacturers in the United States (Allergan and Mentor) provide a lifetime warranty for all of their implants. If an implant fails or ruptures during the first 10 years, both companies will provide a new implant and $1200 applicable toward operating room and anesthesia costs which can be upgraded to an extended plan providing up to $2400 for a small fee prior to surgery.  All implants have a lifetime guarantee and will be replaced by the manufacturer in the problem is related to the implant.  If I feel that a different implant is required for some reason, the manufacturers will provide two new implants to ensure and maintain your symmetry.

San Diego Breast Implant Revision Consultations

Contact our La Jolla office to schedule your consultation with San Diego breast implant revision surgeon Marin.

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