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. As such you may require or prefer breast implant revision.
BEFORE AND AFTER PHOTOSReasons why women with breast implants may need or want to have them replaced or removed include:
- the desire for a larger implant
- 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 mastopexy)
- original surgery was not done satisfactorily
- wanting implants out
The desire for larger implants
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 wish they had chosen a larger size. Dr Drielsma is very aware of this and when advising his patients having breast augmentation mammoplasty, he often recommends a larger size if any uncertainty or confusion exists. Breast implant revision for larger implants is actually the most common reason for replacement surgery.
Capsular contracture or scarring around implants
Apart from wanting larger implants, capsular contracture is the most common reason that 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 also very well made. 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, you may note distortion or symptoms like pain and discomfort. If you suspect a rupture, your doctor will arrange an x-ray (ultrasound or MRI scan). If a breast implant ruptures, your surgeon will recommend breast implant, removal and replacement.
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. You may require the removal of implants, the repair and reshape of implant pockets, and new implants as part of revisional surgery.
Rippling of implants
Minor rippling of implants, noticeable as shadowing in certain lights or visible and palpable irregularities are noticeable 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, you may require re-operative surgery to repair the tissues at the lower crease of the breasts.
Breast sag or droop of implants
Over time, or following weight loss or pregnancy, the breast may descend lower and hang down off breast implants. We will generally recommend breast lift (mastopexy) in this situation. Breast lift (mastopexy) surgery will also usually involve removing and replacing breast implants.
Unhappy with results of original surgery
This may include concerns over implant placement, distortions and scarring. It may also be dissatisfaction with size, either too big or too small. The wrong operation may have been done to start with – the commonest example of this seen is having a breast augmentation mammoplasty alone when in fact a breast lift (mastopexy), either with or without implants, should have been done initially.
You want the implants removed
There are a variety of reasons why you may wish to have your implants removed. These include complications of breast implants such as rupture and capsular contracture, as outlined above, but you don’t want them back in anymore. Other reasons include concerns you may have over the safety of your breast implants. This is a very controversial issue at present and opinion amongst experts varies greatly around the world. It may be that we identify types of implants that we should no longer use but this has not happened conclusively yet. For more information from on implant safety follow this link to read an article prepared by the Australian Society of Aesthetic Plastic Surgeons (ASAPS).
If you have your implants removed and not replaced, you will obviously return to a much smaller size but this may also lead to sagging. Undergoing a breast lift (mastopexy) will be effective in tightening the breast and giving a perky, natural look.
**Results may vary for individual to individual