Breast Revision | Implant Removal

No, to the contrary. Secondary surgery is always more difficult than primary breast surgery (no matter which surgery) for several reasons. First, the presence of scar tissue makes it more difficult to predict a good result. In addition, the surgeon is dealing with the stretching of tissues or anatomical changes caused by previous implants and procedures. Dr Szpalski has been trained at the largest cancer center in the world. She is used to work with difficult cases and has done some of the most complex cases that can be done. Lastly, the biggest predictor of the success of breast revision surgery is the quality of communication between the doctor and the patient before the surgery.

Theoretically, you can have as many breast implant revisions as necessary to get the look you want. However, we advise waiting at least six months for complete healing to ensure all swelling is gone, then several months to adjust to the new look and feel of your new breasts before considering further surgery

While it is expected for patients to replace their breast implants after 10-20 years, there are several reasons they may need to be replaced sooner. There are seven common signs you need revisionary surgery.

1. Your breast implants are causing pain or discomfort Painful or uncomfortable implants can indicate a number of issues that require a breast implant revision, including capsular contracture, damaged lymph nodes, a developing seroma, pinched nerves, or poor implant placement. If you have silicone implants, pain may be a sign your implant has ruptured or is leaking. Even if there is no serious issue causing pain, some patients find implants are uncomfortable enough to disrupt their daily lives, especially if the implant used is too large or poorly placed. Regardless of the cause, persistent pain or irritation is not a normal result of breast augmentation surgery.
2. Your breast implant has ruptured Implant rupture can be caused by abrupt or intense physical pressure (like in a car accident) or through the aging and weakening of the implant shell. A rupture in a saline implant causes a nearly immediate deflation of the affected breast, making it easy to diagnose. The saline solution inside the implant is the same as the IV solution and is easily absorbed by the body. By contrast, ruptures in silicone implants cannot be diagnosed without an ultrasound or an MRI because the viscous silicone gel inside the implant leaks out slowly. While the rupture of a breast implant is not a life-threatening emergency, it is important to have the damaged implant removed to prevent infection or the development of excessive internal scar tissue.
3. Your breast implant has bottomed out If the skin and tissue cannot adequately support the breast implant, it can gradually fall below the breast crease or “bottom out.” This condition is more common with large or heavy implants, but post-surgery pregnancies or skin laxity due to age can also cause an implant to bottom out. Drooping breasts are not uncommon. But unlike breasts that naturally fall over time, where nipples fall with the breast tissue, bottomed-out implants cause nipples to move upward as the implants fall lower. It is also common for patients to be able to feel and see the outline of a bottomed-out implant.
4. Your breast implant is moving or rotating It is normal for breast implants to settle into a slightly different position over time. It is not normal for implants to move to a dramatically different location on the chest wall. This is called implant displacement, and there are several ways an implant can shift. Lateral displacement of implants (implants moving too far away from the midline of the chest) can occur when the implant pocket is too large. Symmastia, or implants merging in the middle of the chest, is a rare complication caused when too much tissue is removed near the breastbone, which in turn causes the muscle between the breasts to detach. An overly large implant pocket can also result in implant rotation. Patients may not be able to tell if a round implant has rotated, but a rotation of teardrop implants yields a top-heavy, unnatural appearance of the breast.
5. Your breast implant has changed shape The implant shape can change if it ruptures, shifts, rotates, bottoms out, or otherwise becomes displaced. Changes in implant shape usually occur asymmetrically, meaning in one breast or the other. Even if both implants change shape, they may not change in the same way. This asymmetry is not medically risky, but it can cause patients significant emotional distress and make it very difficult to find bras and clothing that fit properly.
6. Your breast implant is causing capsular contracture Scar tissue formation is a normal part of the healing process after placing any kind of medical or plastic surgery implant. Usually, this process is a good thing because the capsule of scar tissue helps support the implant, keeping it from slipping. In some cases, however, the body mistakes the implant for a dangerous foreign object and creates excessive amounts of scar tissue to isolate it. Known as capsular contracture, this overproduction of dense, hard tissue around the breast implant can affect the success of the augmentation procedure. There are four grades of capsular contracture, ranging from normal to severe. Grade one is asymptomatic and doesn’t interfere with the implant results. Grade two capsular contracture has only minor cosmetic symptoms, leaving the breast normal in shape but firmer to the touch. Capsular contracture of grades three and four causes hard, misshapen, and overly round breasts that look and feel unnatural. Grade four contracture also often results in breast pain. Patients with either grade three or four capsular contracture usually require a breast implant revision.
7. You are unhappy with your breast size While most patients are happy with the results of their breast augmentation, some patients find they wish they had gotten a different size of implant – larger or smaller. If you want to change the size of your implants, most doctors will recommend waiting about a year after your initial surgery before proceeding. Not only will this waiting period allow your body to fully heal, but it will also give your implants time to settle into their final position before you make this major decision.

If implants are removed without replacement, there is often a breast volume and skin mismatch, causing breast droopiness or “ptosis.” Due to this fact, for those interested in breast implant removal without replacement, their breasts may not look the same as they did before undergoing breast augmentation.

Breast implant illness (BII) is a collection of symptoms that may be related to breast implants. Though the exact cause isn’t known, BII may be related to autoimmune or inflammatory responses. As researchers are just starting to study BII, it isn’t yet recognized as an official medical diagnosis, but this may change. Other names for breast implant illness include Breast implant disease, Autoimmune/inflammatory syndrome induced by adjuvants (ASIA), and Silicone implant illness. People with BII have symptoms, whether they have saline-filled or silicone-filled implants. Symptoms can start soon after breast implant surgery or not for many years. Many people report that their BII symptoms go away after a surgeon removes their implants, but others don’t.

Common musculoskeletal symptoms include:

• Joint pain.
• Muscle pain.
• Muscle weakness (myopathy).

Common cognitive symptoms include:

• Anxiety and depression.
• Brain fog.
• Fatigue.
• Memory loss.
• Trouble concentrating.

Common systemic symptoms include:

• Autoimmune condition symptoms or diagnosis.
• Chronic pain
• Dry eyes or low vision.
• Hair loss.
• Skin problems such as rashes.

Currently, there aren’t any commonly used tests to diagnose breast implant illness. Healthcare providers diagnose BII by ruling out other conditions. Treatment involves implant removal. Many surgeons will offer to remove the scar tissue around your breast implants at the same time. They call this a capsulectomy. When the breast implant and capsule are removed as a unit, it’s called an en bloc capsulotomy.

As of 2020, the FDA recommends screening breast implants with MRI or ultrasound beginning five to six years after silicone implant placement and every two to three years thereafter. Even if you do not have concerns about the condition of your implants, it is important to go for your routine screenings, based on the FDA-recommended timeline. Routine screenings can verify your implant is intact and identify complications such as implant rupture or silicone leakage. Although implant rupture can cause various symptoms, some women with ruptured implants experience no symptoms, which is why routine screenings are critical.