Women who opt for breast augmentation (breast enlargement) with implants may choose to change their implants for a number of reasons: The implants’ shape, size, and/or position may be problematic, or post-surgical complications, such as leaking, wrinkling, implant displacement, capsular contracture or symmastia, may have occurred. Although considered safe, revision surgery to correct problems with breast implants may be more complicated, cost more and take longer to recover from than the initial surgery.
Reasons for Breast-Implant Revision Surgery
After undergoing breast augmentation with implants, women who become pregnant, or lose significant amounts of weight, may no longer be happy with how their breasts look and decide to undergo revision surgery. Other reasons for breast implant revision surgery, related specifically to the implants themselves, including those listed below:
Unhappiness with Size of Implants Chosen
Wanting a different implant size is the most common reason that a patient seeks revision surgery. A patient is advised to wait up to 1 year after the initial procedure before undergoing revision surgery; time is needed before swelling subsides and the implants settle, allowing for a true evaluation of the surgical outcome. Exceptions are when there is a pronounced asymmetry between the breasts, or the implant has leaked or ruptured.
During revision surgery, the incisions made during the initial surgery are often used to remove the implants and replace them with either larger or smaller ones. If larger implants are wanted, the pockets in the breasts that hold the implants are made larger. If smaller implants are wanted, the pockets are made smaller using sutures; a mastopexy (breast lift) may also be performed.
Implants are Leaking
Implants can leak because of age or defect, injury to the breast, or overfilling. Whatever the reason, a leaking implant should be replaced as soon as possible. The incisions made during the initial surgery are often used when replacing the implant.
A leak to a saline implant is immediately noticeable; the implant deflates and the saline is absorbed by the body. When there is a leak in the types of silicone implants used today, because the silicone is designed to hold its shape, a compromise of the implant shell is often only discovered during routine radiological studies.
Implants are Causing Complications
There is always a risk of complications from a breast implant procedure. These can include wrinkling and rippling of the implant (usually a saline implant); capsular contracture, in which scar tissue forms around the implant, hardening the breast and changing its look and feel; or symmastia, in which the implants drift together and meet in the middle of the chest, sometimes referred to as a “uni-boob”.
Even when breast-implant revision surgeries are successful, new implants remain at risk for the same potential problems as the original implants.
Why would I need an implant exchange?
A woman may choose to exchange her current implants for a number of reasons. For example, implant rupture is a common reason for implant exchange. Saline implants are expected to last 10-15 years without failure, while most silicone implants will have a lifetime warranty, depending on the company that manufactures them.
A ruptured saline implant will appear deflated. If a woman finds that she suddenly has a “flat tire” in one breast or both, her saline implants most likely have failed. Saline is safe in the body, and is often used in IV solutions throughout the medical field. The body will safely absorb and eliminate excess saline in the urine.
A ruptured silicone implant is harder to identify. The “gummy bear” implants we use now are 5th generation, form-stable gel – meaning the silicone gel inside is cohesive, not runny. Much like a candy gummy bear, these implants can be cut in half while the gel inside remains exactly where it was. This is beneficial for both patient and surgeon in that the implants are easier to remove in total, making for a quicker, more efficient surgery. However, a compromise in the shell of a cohesive gel implant is “silent” and must be diagnosed by an imaging test, such as ultrasound or MRI. Implant rupture may be caused by normal aging of the implant, a needle during a biopsy or other medical procedure, trauma to the chest (such as during a car accident) or other factors. Silicone is not absorbed by the body.
Are breast implants safe?
Yes! There is a wealth of scientific information on the safety of breast implants in the human body. They have been used in both reconstructive and cosmetic surgery for over 60 years, and as such are among the most researched implantable medical devices.
Implants are composed of a silicone shell, filled with either liquid saline or form-stable silicone gel. Saline is safe to use in the human body as it is a cornerstone of intravenous solutions used in medicine. If a saline implant were to rupture, the saline solution is simply absorbed by the body. Excess saline is safely eliminated by the kidneys and bladder.
Silicone gel implants are composed of a silicone shell and filled with a form-stable silicone gel. Silicone is a biologically inert compound, primarily composed of the element silicon, which you may recognize in its other forms as sand or glass. Many misunderstandings surround the removal of silicone implants from the market in 1992. These second and third-generation implants of the 1970s and 1980s were very different from the implants of today. Old silicone breast implants were composed of a thin silicone shell and filled with a silicone gel that had the consistency of thick maple syrup – meaning if the implant shell ruptured, this syrupy gel could run out of the shell and into the biological capsule around it. Many patients questioned whether such leakage could conceivably lead to the development of other illnesses. When these second and third-generation implants were removed from the market, large-scale, nationwide, multi-center, prospective, double-blinded studies (the so-called scientific “gold standard”) were performed on silicone breast implants, leading to the development of today’s fourth and fifth-generation implants. While these studies showed conclusively that there is no systemic human disease associated with exposure to silicone gel, an improved cohesivity (and thicker shell) was developed to address the difficulty with complete removal surgeons often experienced with these older implants following their rupture.
Studies of all types continue to be done on breast implants to this day. The scientific and medical communities collaborate on these studies to ensure the safety and longevity of these devices for patients around the world. If we had any doubt that breast implants of any type were safe to use on our patients, we would not use them.
What are the benefits of breast implant exchanges?
Breast augmentation is the most popular aesthetic surgery, year after year. That being said, aesthetics (and breasts!) change over time. Women who decide to exchange breast implants may make this decision for a number of reasons, including:
- Desire for size increase or decrease
- Switch from saline to silicone breast implants (or vice versa)
- A problem with your current implants, such as capsular contracture
- Need for a breast lift to address ptosis due to weight gain/loss, pregnancy, or age
As with anything man-made, breast implants are not perfect. Breast augmentation patients should know that breast implants are not guaranteed as lifetime devices, but the notion that implants should be exchanged every 10, 15, or 20 years is outdated.