Breast Implant Revision Surgery

Breast Implant Revision Surgery

Breast Implant revision surgery is a common procedure to remove and/or replace breast implants that were placed for cosmetic or medical reasons given breast implants don’t last forever.  Some breast implant patients even choose to explant or remove their implants completely later in life due to changes in their body, changes in personal preferences or health concerns. There are a range of factors to consider and a number of options available.

Why breast implant revision surgery?

There are many reasons for considering breast implant revision surgery. Patients may feel their breast shape and appearance has changed over time or they may want to return to a more natural shape. There can often be more than one reason at play. Some of the more common reasons include:

Personal Preferences – one of the most common reasons for implant revision surgery is dissatisfaction with the results of the original procedure. Following the initial surgery patients may feel they are unhappy with the size and shape. Patients preferences may also change over time due to natural changes to the body from things like pregnancy, hormones, and weight fluctuations.

Medical Complications – while breast implants are common, there is a chance of medical complications occurring. For example, ultrasound scans may have confirmed ruptured breast implants.  Other medical complications may include:

• Capsular contracture or development of firm breasts due to scar tissue
• Implant rupture
• Differences in size or position of the breasts
• changes in appearance after  pregnancy or weight loss including:

– ptosis or sagging

-hypertrophy or increased size of natural breast tissue

Concerns About Breast Implant Safety – Patients experiencing illness or negative symptoms related to their breast implants is also a reason for implant removal. Some patients have described a variety of symptoms commonly referred to as Breast implant illness, which they attribute to their implants including anxiety, fatigue, and autoimmune issues.  Despite these reports, there is currently no scientific evidence linking breast implants to the above symptoms at this point in time.

Whatever the reason for wanting to remove and or replace your breast implants, there are a number of options available.

How can I prepare for my breast implant revision consultation with Dr Eddie Cheng?

• Typically you have seen your GP or contacted your original surgeon (depending on whether your original surgery was performed internationally).
• Imaging – has your GP sent you for an ultrasound scan to assess the integrity of your breast implants?  Dr Cheng may arrange an MRI scan if the Ultrasound Scan results are inconclusive 
• Mammogram scans usually aren’t used to check breast implant integrity
• We ask that you send in your current breast photos and scans to be reviewed prior to booking your appointment 
• Our patient coordinators will spend time listening to your key concerns and help you collate the relevant information prior to your consultation
• Previous breast implant operation records are helpful along with your preoperative images from your original surgery
• Start thinking about your WHY?  Are you considering explant surgery or revision and replacement surgery
• Original preoperative photos ie before your breast augmentation surgery are really helpful for Dr Cheng to revisit with you as this often assists in making decisions about whether to explant or replace breast implants. 
• if a replacement is already your preferred surgery start thinking about implant size and any other key concerns you may wish to address
• Look at before and after photos and send in your ideal size and look prior to your consultation. 

Tip: How can I find my previous surgery details and breast implant information?

• The best starting point is with your original surgeon if based in Australia.  You will need to sign a release of information to share this information with another surgeon or obtain your records from your surgeon independently. 
• Your GP may have a letter from your surgeon so worth checking if you happen to have the same GP
• If you can recall the Hospital you originally had your surgery they may have archived operation notes that you can request with a signed release of information form. 
• The Australian Breast Device Registry or ABDR may have your records retained for your to access providing your previous surgeon registered your details and surgery was in Australia. 
• If you can recall the brand of your implants we can often locate your breast implant details via the device company. 
• Tip!!  If you have implants contact your surgeon now and keep good records including before and after photo and implant records in a safe place. 
• The TGA has a hand little fact sheet that outlines what you need to know if you have breast textured breast implants and how to find out more.

Breast Implant Revision Options

I want my breast implants removed and replaced

Breast implant revision typically involves removing the old breast implants and the scar tissue or capsule around the implants and replacing them with new breast implants. This may be to correct any complications such as capsular contracture or rupture or to improve the overall appearance. For example, the breast implant pocket may be reshaped to reposition the implant on the chest or the implant size is changed to suit the patient’s preferences. Removal and replacement of breast implants typically involves the following:

• 2-2.5 hrs under general anaesthetic with a specialist anaesthetist looking after you while your surgeon completes the operation
• Typically this is a day surgery admission i.e. 4-6 hours from admission to discharge time
• This procedure does not attract medicare or private health insurance rebates as medicare now deems this cosmetic surgery unless implants were originally placed due to a medical condition such as breast cancer or developmental conditions.
• Surgical drains are placed in each breast and may remain in place for 3-7 days depending on the complexity of your surgery 
• Typically Dr Cheng prefers the incision to be in the breast fold or inframammary incision as this provides the best visibility of the breast implant pocket and improved safety in terms of maintaining blood supply to the nipple.  
• The scar length may be longer than your original breast implant surgery due to the scar tissue and implant to be removed.

What if I need a breast lift as well as breast implant replacement surgery?

Safety is always Dr Cheng’s number 1 priority when it comes to any treatment plan.  If I am replacing breast implants there are some circumstances where I would suggest performing a breast lift as a second stage and these are:

• breast implant size – if the patient is upsizing and the breast implant is significantly larger then I would frequently suggest a 2 stage procedure
• if I am performing a total and/or enbloc capsulectomy typically this requires more surgery and more risk hence I may also recommend a 2 stage procedure ie. perform the breast lift 3-6 months later. 
• if the degree of breast sagging is significant  I would opt for a 2 stage procedure 

Why two stages?

• safety including wound break down or delayed wound healing and the risk of breast implant exposure and loss of the nipple-areola complex 
• allowing 3-6 months between procedures gives time for the scar and skin to contract and settle before placing the wound under further pressure with an implant

How will the capsule be removed? 

This depends on your preference and also the safety of the procedures but in general, the options include: 

Total capsulectomy

Involves removal of the old implant followed by the scar capsule. Safety is by far the biggest priority here and if the scar has firmly adhered to the chest wall it may be unsafe to perform total capsulectomy. Total capsulectomy overlaps in some ways with enbloc capsulectomy.  

Partial capsulectomy

Removal of part but not all of the scar capsule.  In some situations, this may be the best option e.g. if a patient is downsizing breast implant size or the scar is adhered to the chest wall and presents a significant safety risk. 

En Bloc Capsulectomy

In an En Bloc breast implant removal, the implant, as well as the scar tissue (capsule) surrounding it, are removed together as 1 piece. This technique is often done in cases where the patient has a strong preference for this removal. En Bloc is often sought by patients who want reassurance that the implant and any remaining affected tissue are completely removed. However, the procedure may not be suitable for all patients and will depend on individual circumstances.  Enbloc often results in longer surgery times and a longer incision and therefore scar.

I want my breast implants completely removed – explant surgery – what options do I have?

This depends on a number of factors.  During your consultation, your surgeon will evaluate the following with each patient:

• Your images before breast implant surgery which show your baseline breast shape and provide clues about any issues that may present after explant
• Skin tone and laxity characteristics as this will provide clues about the likelihood that the skin envelope will contract after explant or implant removal surgery
• The amount of breast tissue the patient now has and where it sits in relation to the breast implant and the nipple-areola complex
• Nipple-areola position and size
• Your expectations around outcome and results

These factors will determine the treatment plan which may involve one or a combination of the following procedures:

Breast implant removal with capsulectomy

For patients where the skin envelope, breast tissue and nipple-areola position and shape are good then I would aim for this less invasive approach to breast implant removal as a first stage.  Allow up to 6 months for the skin to shrink or contract back to its original size before considering breast lift surgery.

Will I need a breast lift with breast implant removal surgery?

There are a group of women who have experienced pregnancy and breastfeeding and/or significant weightless patients where the skin envelope, breast tissue and nipple-areola complex is sagging.  I often combine breast implant removal and capsulectomy with a breast lift or mastopexy for this group of patients.  Breast lift surgery is a procedure to lift and tighten the skin envelope, breast tissue and nipple-areola position. This is done by removing and/or tightening the excess skin along with repositioning the nipple-areola and breast tissue to reshape and improve the breast contour. This is common for patients who choose to remove their implants without replacing them. This can give the breasts a firmer and more rejuvenated appearance. For more information on breast lift procedures see our breast lift page.  Some of these women may have developed additional breast tissue after pregnancy and weight gain, hence a breast reduction may also be more suitable for some of these women.

Depending on the severity of the droopiness, a breast lift can also be performed as a stage 2 procedure.

Fat Transfer

This procedure involves removing the original breast implants and using liposuction to transfer fat from other areas of the body to the breasts. This is also referred to as lipoaugmentation, with fat usually taken from the hips, thighs or abdomen region. This procedure is often preferred by patients seeking a relatively small increase in breast size or augmentation with a more natural look and shape.

Recovery After Breast Implant Removal

Every patient recovers differently from surgical procedures however in the first few weeks especially, rest and recuperation should be prioritised.  As we always say, recovery is just as important as the surgery itself!!

What to expect during the acute recovery phase week one

• All surgical patients have Dr Cheng’s direct mobile contact for any immediate concerns
• You will wake up in recovery wearing a protective bandage around your breasts immediately after surgery
• Keep the wound clean and dry for 2-3 days
• Typically this surgery is performed as a same-day discharge with breast drains remaining  for 5-7 days
• Day 1 review with Dr Eddie Cheng and our Nurse.  Our nurse will progress you to a compression bra at this stage
• Sleep with your head elevated for a week or 2
• Light walking is encouraged around the house to avoid DVTs
• Gentle range of movement for shoulders and arms are encouraged
• No lifting heavier than a teacup
• Take pain relief medications as instructed by your surgeon and anaesthetist

Recovery Week 2-6

• Drains are typically out by now
• Dressings on incision lines remain and are changed weekly
• Driving after 2 weeks for short distances 
• Office-based workers typically return to work after 2 weeks rest
• Workers with more physical duties including lifting allow up to 6 weeks or return earlier on modified duties 
• Recovery bra is worn for 6 weeks – no underwire
• No sex for 3-4 weeks
• incision line care involves weekly tape changes until week 6
• Incision line scar gel is commenced at week 6, 2 times daily.

Recovery Beyond 6 weeks

• Ease back into normal activities, including gym 
• Incision line care continues for 12 months or as needed
• Bra fitting for size 
• Breast implant massage may be introduced at this stage depending on the breast implant
• Monitor your breast implants long term and as per Dr Cheng’s instructions
• Attend your follows as guided.