Breast Revision

Implant Exchange

Candidates for Surgery

Women with existing breast implants experiencing complications such as:

  • Hardening of the breast implants (due to pressure from a capsular contracture)
  • Feeling of tightness or pulling
  • Discomfort
  • Distorted look to the breast (an unnatural round appearance or assymetry)
  • Rupture or Deflation of an implant
  • Rippling or Wrinkling

Capsular Contraction: The scar tissue that forms around the implant is a natural response to a foreign object implanted in the body. The capsule can tighten and squeeze the implant making it firm. This is referred to as capsular contracture. This firmness (breast capsule) can range from slight to very hard. The firmest ones can cause varying degrees of discomfort or pain. Capsular contracture can occur in one breast or both.

Deflated or Ruptured Implant: This occurs at a rate of approximately 1-2% per year for the first ten years then markedly increase after that time period. A rupture or deflation of the implant may be experienced at any point after the initial augmentation; this complication may be increased by an under-filling or overfilling of saline solution into the implant, excessive compression, or trauma. (If the implant shell if not filled with the correct amount of saline, there may be a crease or fold in the shell which often leads to a rupture). The patient will be able to self diagnose the need for an implant exchange (if using a saline implant) because if the current implant ruptures, the breast will shrink to approximately its preoperative size. A silicone implant that has a rupture is usually noted on a routine mammogram or MRI scan. In either case although the situation needs to be corrected on a timely basis it is not dangerous to your health from our current knowledge base.

Wrinkling of the Implant: The implant shell may ripple beneath the skin creating the appearance of visible wrinkles. This most often occurs in females with thin, soft tissue covering the implant, or with textured implants placed above the breast muscle. Saline implants are generally at greater risk to develop rippling that silicone.

Displacement of Implants: Over time, the implants may shift in any direction causing the need for a revision. In rare cases, a “bottoming out” effect occurs, in which, the implant sinks too low in the chest wall causing the nipple to appear to point upward or be position too high. Generally speaking, if the implant is larger (i.e. heavier) and if a bra is not used regularly during wake time hours there is a greater change toward displacement.

Synmastia: This is a condition in which the tissues in the cleavage area have been over dissected allowing for the implants to touch each other under the skin. This appearance is casually referred to as “kissing implants”, uniboob”, or “breadloafing”. Synmastia is very uncommon and may involve a complicated correction. Extremely large implants make this condition more common.

Intended Result

An implant revision or exchange intends to replace the damaged implants with new silicone or saline filled implants with newer technology. For example, silicone gel implants are more “cohesive” meaning “gummy bear like” which prevents migration of the gel if there is a break in the outer shell. This will reduce future risk of complications.

Secondary breast surgery can be complex and needs to be done by an experienced plastic surgeon. At the Pacific Center for Plastic Surgery, Dr. Nichter and Dr. Horowitz have a special interest and extensive experience each over the past 25 years in secondary, or “redo” cosmetic and reconstructive breast surgery. They are often referred patients treated by other plastic surgeons to correct and improve upon patients with preexisting implants and often combine additional surgeries such as a breast lift using advanced minimal scar techniques (e.g. periareolar (donut), or “lollipop” short scar technique), Liposuction or other aesthetic procedures. Please schedule an appoint with us for an examination and personal evaluation and recommendation.

Procedure Description

The specific procedure to be performed will depend on the complications experienced and the condition of the implants. Dr. Nichter and Dr. Horowitz advise the best course of action based on each patient’s individual circumstances.

If the patient is experiencing firm capsular contracture, there are generally two ways to make the breasts soft. Capsulotomy refers to incisions within the scar tissue that release the capsule allowing more room for the implant. Capsulectomy is a more involved operation that removes all or most of the scar tissue creating a “new, fresh pocket” for the breast implant.

The technique of “closed compression” or “closed capsulotomy” is currently not used in our office because of the possibility of rupturing the implant. This method requires the doctor or patient to squeeze (compress) the breast until the capsule tears open allowing more space for the implant.

Post-Operative Healing

Patients will feel sore and tired during the first 48 to 72 hours following surgery. During these first few days, the patient should engage in light activities, refraining from lifting or raising the arms above the head.

Swelling and bruising will subside during the first week after surgery and will be controlled by pain medication. The initial dressings will be removed a few weeks after surgery during a post operative visit. Patients typically may return to a work a few days after surgery (only a light workload during the first two weeks).

Scars will progressively fade throughout the months following surgery.

Risks of Surgery

General Risks: of surgery include infection, pain, delayed wound healing, hematoma (a collection of blood at the surgical site), bleeding, reactions to anesthetic.

Cosmetic Complications: You may not be satisfied with the appearance of your breasts. Incorrect implant size, inappropriate scar location or appearance, and misplacement of implants may interfere with a satisfactory appearance. Asymmetry (unequal breast size or shape) may occur. The implanted breast may sag or droop (ptosis) over time, much like a natural breast. The explanted breast may droop or be distorted in shape.

Further potential complications will be discussed by our doctors and staff prior to your surgery.