Breast Revision | Breast Implant Replacement

Recovery after breast revision surgery may be easier than the initial surgery. When the implants are placed during the first surgery, there are raw surfaces that can cause the expected post-surgical pain. When implants are exchanged, the capsule has fully formed around the implant and is not a raw surface. It is possible to have less pain with a secondary implant surgery as the area of raw surface is minimal. However, if the implants are being exchanged for a larger size, there may be an element of muscle stretching that causes spasm-type pain. Capsule tightening and refinement can create soreness or referred pain. 

From a surgical standpoint, revision surgery is typically more complicated than the initial procedure. Often, a different surgeon placed the initial implants, or the implant information was lost or destroyed, meaning there will be an unknown element of what will be found during your surgery. Dr. MaDan prepares for the unknown components of revision breast surgery by using sizers and having a large consignment of implant volumes and profiles.

There is no specific limit to the number of breast revision surgeries that can be performed. Dr. MaDan recommends waiting a minimum of 12 months before considering implant revision surgery. This time frame ensures implant and tissue stabilization so the most appropriate surgical plan can be developed to address your concerns with precision and accuracy. Breast implants are not considered lifetime devices and will require future surgery for exchange or removal. In general, exchange is recommended every 10 years.

Breast implant revision surgery is common, considering the recommended time frame for implant exchange is roughly 10 years. Breast revision surgery may be offered before that 10-year timeframe if you are unhappy with your outcome or experience physical changes like significant weight loss or pregnancy/breastfeeding.

The average cost of breast implant revision varies with the procedures required to achieve your desired results. In certain cases, the warranty of your breast implants may cover some of the cost. Sometimes your revision surgery is more costly than your initial procedure due to surgical time needed to make pocket adjustments, additional materials like Galaflex or Durasorb mesh, or additional procedures like capsulectomy or mastopexy.  Breast revision or implant exchange surgery is not always more affordable than the initial breast augmentation surgery. Much of the cost depends on what needs to be done to achieve your breast goals.

No breast implant is considered a lifetime device. All implants will require exchange or replacement surgery. In general, implant exchange is recommended around every 10 years. During this surgery, the capsule is examined and can be adjusted if needed. Capsule tightening is routinely performed with implant exchange.

If there is a problem with a saline implant shell or valve, the implant will deflate as your body absorbs the fluid. This is an obvious way to detect rupture, as your breast would essentially deflate. A silicone implant may have a “silent” rupture– no outward signs or symptoms of shell failure. An MRI is considered the gold standard for rupture surveillance of silicone implants. Dr. MaDan offers an in-office evaluation of your implants using the Clarius L15 high-resolution ultrasound. This device can help assess the integrity of the implant shell and identify free silicone or fluid within the pocket.

Breast implant removal (without replacement) is always an option. Some patients may decide that implants just aren’t for them, or their preferences may have changed over time. In certain cases, saline implants may be amenable to removal in the office setting. Silicone implants are usually removed under anesthesia in the outpatient surgery center. Usually, the capsule is left in place, so no drainage tubes or accessories are needed. When the capsule has to be removed, a drainage tube is often placed. Your natural tissues will remain intact, and some element of tissue tightening will occur over the 3 months after implant removal. Some patients undergoing implant removal will have a breast lift performed at the same time. This can be indicated when the nipple position remains ptotic or pointing downward after implant removal. With a breast lift after implant removal, all of your natural breast tissue is maintained. The excess skin is removed, and the nipple is repositioned to the most projecting part of the breast. A breast lift after implant removal does not require the use of drains. 

Breast implant removal does require an incision through your old scar to access the implants. Pain can be expected any time an incision is made in the skin. When indicated, a capsulectomy, removing the entire capsule from the breast pocket, creates fresh raw surfaces, which result in postoperative inflammation and pain. Pain is less likely when the capsule can remain intact. After implant removal, there is minimal muscle stretch and spasm on the pectoralis muscle.   

Some breasts will return to their pre-surgery shape and position. However, this depends on many factors, including the size and shape of the prior implants, amount of natural breast tissue, skin and tissue quality, age, genetics, and the duration of time with the implants in place. For breasts that have excess skin or that have significantly stretched after implant removal, a lift can be performed to reshape the breast and reposition the nipples. All of your natural breast tissue remains, only excess skin is removed from the lower pole of the breast.

While there is no diagnostic test to confirm breast implant illness (BII), the most common symptoms are fatigue and brain fog. Symptoms have been reported in association with silicone and saline breast implants. There is a high satisfaction rate in BII patients after implant removal alone. There is no guarantee that implant removal will alleviate the symptoms of BII. Typically, procedures like ‘en bloc capsulectomy,’ which removes the normal capsule and breast tissue are specific for oncologic treatments, not breast implant illness. 

Breast implants can be removed at any time. In certain cases, like with Grade IV capsular contracture, pain may be the motivating factor to remove and not replace the implants. Capsular contracture has a high recurrence rate and may require multiple additional surgeries. In this scenario, implant removal may significantly improve quality of life and minimize the risk of recurrence and additional surgeries.

Breast implants can be removed in the setting of breast implant illness (BII). Research studies* have shown symptomatic improvement and high satisfaction after implant removal. Removal of the capsule and implant has been shown to negatively affect the cosmetic outcome and does not improve patient satisfaction. “En bloc” capsulectomy removes the implant, capsule, and breast tissue. It is typically reserved for cancer treatments.

A ruptured silicone implant should be removed. Implant rupture can be identified on MRI (“linguine” sign) and high-resolution ultrasound. A ruptured silicone implant can be found incidentally during an implant exchange procedure. In this scenario, the implant and all silicone would be evacuated from the breast pocket, and the ruptured implant should be returned to the manufacturer for evaluation.