Breast implant revision surgery, which commonly involves removal and/or replacement of saline or silicone breast implants and capsule removal, is performed to change the size or type of your implants and to correct any complications from breast augmentation. The overall goal is to restore a natural contour and feel to the breasts.
When to Consider Breast Revision
- Your saline breast implants have deflated or an MRI shows signs your silicone implant has a leak
- If you want to change your breast size or shape
- If you have tightening of the scar tissue around the implant (capsular contracture) or your breast implants are uncomfortable
- If your breasts have begun to sag
Some people who consider breast revision also consider breast augmentation, breast lift, breast reduction, and liposuction
- You will regain a natural breast shape.
- You may increase or decrease your breast size.
- You will improve breast symmetry.
- Gravity and aging may alter the size and shape of your breasts.
- The weight of your implants may also affect your breast appearance with time.
- Dr. Jensen will need to have as much information as possible about your first breast surgery.
These are the top three pros and cons to consider when thinking about breast revision. If you wish to focus on what is unique to you, please consult with Dr. Jensen.
Am I a good candidate for breast revision?
Even if your breast implant surgery was perfectly planned and executed, changes often occur over time.
The following are some common reasons why you may want to consider breast revision:
- You wish to increase or decrease the size of your breasts.
- You wish to correct asymmetry.
- You want to address problems that have developed with your implants and/or surrounding breast tissue.
- Pregnancy has changed the appearance of your breasts.
- Weight loss or weight gain has negatively affected the appearance or feel of your breast implants.
- You should have undergone a breast lift with your initial augmentation, but did not.
- You are unhappy with the results of previous surgery due to poor implant placement or other problems.
- You wish to remove your breast implants permanently.
If you are in good general health, have a positive attitude and realistic expectations, you are a good candidate for this procedure.
How is a breast revision procedure performed?
The exact procedure(s) Dr. Jensen will use for breast revision varies depending on the reason for your surgery.
Change in size: If you decide to change your implant size, Dr. Jensen prefers to use your original incision for implant removal and replacement. If you want a larger implant, Dr. Jensen will surgically enlarge the "pocket," to accommodate a larger implant. If you want smaller implants, Dr. Jensen may reduce the size of the pocket with sutures to properly fit smaller sized implants. A breast lift may be done at the same time.
Capsular contracture (hardening around the implant): Dr. Jensen will use an inframammary crease incision to remove the hardened capsule and implant. He will then insert a new implant through the same incision.
Implant rippling: When the edges of saline breast implants are visible and palpable (implant rippling), Dr. Jensen typically recommends using a different type of implant (silicone) or placing the new implant into a different breast pocket that either has thicker muscle coverage or uses other tissues to cover the implant.
Implant malposition: Sometimes implant pockets are created too far apart or too close together, resulting in poorly positioned breasts. Capsular contracture can also cause the implants to move. To correct this, Dr. Jensen will excise the scar tissue from the capsule surrounding the implant and reconstruct the pocket in the appropriate position using suturing techniques. Dr. Jensen may need to utilize other tissues (tissue grafts) to reinforce this new implant pocket or may recommend using an acellular dermal matrix product to add additional support.
Implant removal: If your implants are too large and your skin has stretched, Dr. Jensen may recommend a breast lift, using a smaller implant, or implant removal, but implant removal alone may suffice. The original incision created to insert the implant will almost always be the same one used to remove it. The capsule around the implant is often removed at the same time to facilitate rapid healing.
Elevation of nipple and areola position: If it is necessary to elevate the position of your nipples and areolas, you will need additional incisions around the areola. Incisions around the upper portion of the areola will be adequate in cases where slight elevation is needed. When more lifting and tightening is necessary, an incision all the way around the areola, including a vertical scar extending down from the areola to the crease under the breast, (lollipop incision) may be necessary. For cases where significant excess skin needs to be removed (such as in women who have had massive weight loss), a third incision may be necessary that will extend horizontally beneath the breast (anchor incision), following the natural curve of the breast crease. If your nipples need lifting, the nipples and areolas remain attached to underlying mounds of tissue and this usually allows for the preservation of sensation and the ability to breast-feed.
The goal of Dr. Jensen and the entire staff is to help you achieve the most beautiful and natural-looking results, as well as making your surgical experience as easy and comfortable as possible.
What are my options?
Good communication with Dr. Jensen and our staff is the key to achieving the results you want. It is your job to clearly state your goals so we can suggest the right options. During your consultation, you and Dr. Jensen will resolve these issues:
- What type of implant will be used?
- Saline-filled breast implants are filled with sterile salt water. They are filled at the time of surgery to allow for minor modifications in implant size.
- Silicone-filled breast implants are filled with soft, elastic gel (gummy bear) and are available in a variety of shapes. All silicone breast implants are prefilled and require a longer incision for implant placement.
- Shaped gel silicone implants, also known as "gummy bear" or "form stable" implants, are filled with a cohesive gel, made of cross-linked molecules of silicone, which makes them a bit thicker and firmer than traditional silicone implants. This enables them to hold their shape better. Approved by the FDA for use in the United States in 2013, these implants have been available in much of the world since 1992.
- Will your implant be located above or below the pectoralis muscle?
- Placement of the implant beneath the pectoral muscle (the muscle underlying your breast) may interfere less with mammograms and breast-feeding. Dr. Jensen will discuss the pros and cons of each option.
- What size of implants will be used?
- Will you also need a breast lift?
- Will you undergo general anesthesia or intravenous sedation?
What will my breast revision incisions and scars be like?
The original incision used to insert the implant is most often the same one used to remove it; however, if you undergo a breast lift, elevating the position of your nipple and areola will result in breast additional scars.
How do I prepare for a breast revision procedure?
Dr. Jensen and his staff will provide thorough preoperative instructions, answer any questions you may have, take a detailed medical history and perform a physical exam to determine your fitness for surgery. In some instances, you may need to have a mammogram before revision surgery.
In advance of your procedure, Dr. Jensen will ask you to:
- Avoid taking aspirin, all anti-inflammatory drugs and some herbal medications that can cause increased bleeding.
- Stop smoking at least four weeks before undergoing surgery.
- Hydration is very important before and after surgery for safe recovery.
- Keep alcohol consumption at less than two to three drinks per week.
- Be sure to arrange for a responsible person to drive you home after surgery and stay with you for the first day or two, unless you and Dr. Jensen have decided on other postoperative recovery options.
- Before surgery, stock your refrigerator with high-protein, low-sodium foods, including premade meals, fresh fruits and vegetables, and lots of caffeine-free beverages and water. Avoid food and drink containing salt during your recovery.
- As you heal, your arms will have a limited range of motion, so store all the supplies you'll need during recovery where they're easily accessible.
- Stockpile movies or prerecorded programs, or novels and magazines. If possible, have a speakerphone by your bed and a remote control for the TV.
- Establish reliable support system for the recovery period indicated by our staff. This is critical to your recovery. If you have children less than five years of age, you must have someone to take care of them for a week.
- Rest and sleep on your back continuously in an inclined position (25- to 45-degree angle) for the initial week or while significant swelling remains. You can achieve elevation with wedge pillows with an incline design or by sleeping in a recliner chair.
- • Avoid hot showers, hot tubs and saunas for three weeks.
- • Decide what you will wear for the first few days; pick items that open in front. Wear slip-on shoes so you don't have to bend.
Breast revision is usually performed on an outpatient basis. Be sure to arrange for a reliable person to drive you home after surgery and to stay with you at least the first night following surgery.
What can I expect on the day of breast revision surgery?
Your breast revision surgery will be performed in our office-based surgical suite. Dr. Jensen will give you an estimate of how long your surgery will last based on the details of your surgical plan.
- You will be asked to wash your body with antibacterial soap prior to surgery.
- Make sure not to wear makeup (including nail polish), lotions, perfumes or other substances.
- Dress in or bring soft, comfortable clothes that you'll be able to wear after the surgery, including a top that opens in the front and shoes that slip on.
- Bring only the essentials and leave other personal belongings such as jewelry and valuables at home.
- Medications are administered for your comfort during and after the surgical procedure.
- Intravenous sedation is commonly used during your breast revision procedure, although general anesthesia may be desirable in some instances.
- For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
- Dr. Jensen will follow the surgical plan agreed upon with you before surgery.
- Once the operation has begun, Dr. Jensen may decide to combine various techniques or change a technique to ensure the best result possible. It is important that you feel comfortable and trust Dr. Jensen to make these decisions.
- The nursing staff will place following the surgery a surgical bra. Drainage tubes may be attached to your breasts.
- After your surgery is completed, you will be taken into our recovery room, where you will continue to be closely monitored.
- When you are fully alert, you will be able to go home with the assistance of a friend or family member. Before leaving for home, you (or the person looking after you) should feel comfortable in emptying and resetting the drains.
You will be permitted to go home after a short observation period unless you and Dr. Jensen have made other plans for your immediate postoperative recovery.
Dr. Jensen will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your postoperative care, including information about:
- Drains, if they have been placed
- Normal symptoms you should expect
- Potential signs of complications
Immediately after your breast revision surgery
Your postoperative discomfort and recovery time will be less than that of your primary breast augmentation. You should be up and walking frequently on the day of surgery. It will take several days to return to normal activities after your breast revision surgery, but it is important to your recovery that you get up and move around. The extent and duration of discomfort depends largely on the size and placement of the implants, and may include pain, stiffness, swelling, bruising and itching.
When the anesthesia wears off, you may have some pain. If the pain is extreme or long lasting, contact our office. You will also have some redness and swelling after the surgery. Contact our office to find out if your pain, redness and swelling are normal or are signs of a problem.
Recovery time frame after breast revision
It important that you follow all patient care instructions provided by Dr. Jensen. This will include information about wearing compression garments, care of your drains, taking an antibiotic, if prescribed, and the level and type of activity that is appropriate. Dr. Jensen will also provide detailed instructions about the normal symptoms that you should expect and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.
Undergoing a breast lift in conjunction with implant removal will lengthen your recovery time. If your breast implants are removed only, your recovery will likely be brief, with minimal discomfort. Avoid heavy physical activity for at least the first six weeks following surgery. After that, be gentle with your breasts for at least the next month. Dr. Jensen will give you specific instructions and restrictions about physical activity.
The first week after surgery
- For the next week, it is best to sleep with your head and back elevated to reduce swelling in the chest area. You can use pillows, a wedge pillow, or sleep in a recliner chair.
- Dr. Jensen will permit you to shower five days following surgery, but do not immerse your breasts in a tub, spa or Jacuzzi for at least four weeks after surgery.
- Your dressings will be removed the first day after surgery.
- If drains are placed, don't shower until 24 hours after the drain have been removed, which is usually after three to four days.
- You may be instructed to wear a compression bra during your early healing period to prevent fluid accumulation, control swelling and keep implants in place during the initial healing period.
- Some bruising and swelling may occur initially, but this will resolve as you heal.
Two to six weeks
Most swelling will resolve within a month. After breast revision surgery, it is often possible to return to work within a few days, depending on the type of activities you perform. If you selected large implants, the skin around the breasts may feel tight as your body adjusts to accommodate the new size.
It may take several weeks or months for new implants to "settle" into their final position. Altered sensation, such as numbness or tingling, may be present around the incision site or nipples, but this should decrease over the following weeks or months.
Fortunately, significant complications from breast revision surgery are rare. Every year thousands of women undergo successful breast revision surgery and are pleased with the results. This surgery is usually performed without any major problems.
All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:
- Adverse reaction to anesthesia
- Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
- Infection or bleeding
- Loss of sensation
- Allergic reactions
- Damage to underlying structures
- Unsatisfactory results that may necessitate additional surgery
You can help minimize certain risks by following the advice and instructions of Dr. Jensen and his staff, both before and after your breast revision surgery.