Breast Implant Revision Surgery

Breast implants are well made and problems with them are unusual.  There is a chance over time however, that problems may develop with breast implants and breast implant revision may be required or preferred.  

Reasons why women with breast implants may need or want to have them replaced include

  • wanting to go bigger
  • capsular contracture or scarring around implants
  • implant rupture or leak
  • displacement of implant causing breast distortion
  • rippling of implants
  • slippage of implants to low position
  • breast sag or droop off implants (requiring a lift)
  • original surgery was not done satisfactorily

Wanting to go bigger

Most women are very happy with the implant size they choose, with the help and advice of their surgeon.  Some women however become disappointed or unhappy with their breast size and in Dr Drielsma’s experience, it is almost always that they wished they had chosen a bigger size.  Dr Drielsma is very aware of this and when advising his patients having breast implants usually recommends a bigger size if any uncertainty or confusion exists.  Breast implant revision for bigger ones is actually the most common reason for replacement surgery.

Capsular contracture or scarring around implants

Apart from wanting to go bigger, capsular contracture is the most likely reason women with breast implants may one day require a further  surgery to replace them.  Capsular contracture is the build up and thickening of scar tissue around the implants that over time can lead to hardening or distortion in breast shape.  Capsular contracture generally takes many years to develop and typically becomes a problem towards the 10 year mark after initial surgery.

The incidence of capsular contracture is around the 4% to 5% mark per implant.  Patients who develop problematical capsular contracture with hardening of implants, distortion of breast shape or breast pain will usually want breast implant revision, scar tissue released or removed, and implants replaced.  Dr Drielsma may discuss or recommend the use of alternative style implants to replace those that have undergone capsular contracture.

Implant rupture or leak

Modern breast implants are very well made. Dr Drielsma mainly uses high quality cohesive gel textured implants.   All implants are man made devices however and there is a known incidence or implant rupture over time.  The incidence of implant rupture is around 5% per implant over 10 years.  Cohesive gel implants don’t “leak” like older liquid gel implants were prone to do.  If a cohesive gel implant ruptures in a minor way (pin hole or tiny tear) you may not even realise.  With a more serious rupture, which may occur spontaneously or following trauma, distortion or symptoms like pain and discomfort may be noted.  If rupture is suspected, an x-ray (ultrasound or MRI scan) will usually be arranged.  If you have a ruptured breast implant, removal and replacement will be recommended.

Displacement of implant causing breast distortion

Over time, in some cases, capsular contracture as described above could lead to breast implants shifting to abnormal positions causing distortions of breast shape.  Revisional surgery whereby implants are removed, implant pockets are repaired and reshaped and new implants re-inserted may be required.

Rippling of implants

Minor rippling of implants, noticeable as shadowing in certain lights or visible and palpable irregularities can be noticed following breast implant insertion.  Usually these issues are minor and only noticed by the patient, not by others.  Dr Drielsma generally advises his patients in this situation not to intervene as further surgery is not warranted unless strongly requested by the patient.  Severe visible rippling or implant edge palpability may in some cases warrant revisional removal and replacement of implants.

Slippage of implants to low position

Very uncommonly, some patients experience a downward migration of their breast implants to a lower than ideal level. In such cases, re-operative surgery to repair the tissues at the lower crease of the breasts may be required.

Breast sag or droop off implants

Over time, or following weight loss or pregnancy, the breast may descend lower and hang down off breast implants. In this situation, breast lifting is likely to be recommended. Removal and replacement of breast implants will usually be involved with such breast lifting surgery.

**Results may vary for individual to individual