What you need to know about breast implant revisions
Breast augmentation is likely one of the first procedures that come to mind when the words "plastic surgery" are mentioned. It consistently ranks in the top five for all aesthetic procedures. Yet, breast augmentation is rarely a one-and-done procedure. It's a procedure that will most likely require modifications some years after the initial operation. This is common and known as breast implant revision. It involves an individualized approach toward revising, replacing or removing implants.
Breast implant revision is an important consideration for patients considering breast augmentation. Implants are not lifetime devices, and patients must understand that they are often signing up for at least two procedures when they get a breast augmentation with implants. Most implants require an exchange every 10 to 15 years.
If you've been considering a breast implant revision and you're curious about the actual process, who it's best suited for and the results that can be achieved, we're happy to help. We reached out to Elise Min, MD, and Peter Krasniak, MD, to gather their insights on this topic.
The breast implant revision patient profile
Breast implant revision is a fairly standard procedure, although not often discussed, despite being necessary for essentially all breast augmentation patients.
"Implant revisions can be somewhat expected following breast augmentation with breast implants," said Dr. Krasniak. "Although some breast augmentations may require a revision early on in the course, this is in the vast minority of cases. However, I counsel all my patients that breast implants are not meant to be permanent, and so there is a very good chance they will need an additional surgery to revise or remove their implants at some point, and so this sort of revision is more common as patients with breast implants age. Being part of a practice that specializes in breast and body plastic surgery, we see a good number of patients seeking revision surgeries after having breast implants in place."
There is no one patient profile for breast implant revision, but there are some commonalities among patients seeking out this procedure.
"Capsular contracture is one of the more common reasons I see patients," said Dr. Min. "However, in recent years, breast implant illness has been a big one – people are more aware of it and concerned about it because of social media."
Many patients also seek out implant revision to address changes in their body that have occurred over time.
"The majority of patients that I see who are seeking a revision surgery after having breast implants have recently undergone a change in their breasts, either through weight loss, pregnancy or menopause," said Dr. Krasniak. "Because of this, these women tend to be years out from their original implant surgery."
It's important to also note that breast implant revision procedures don't always involve the replacement of the implants themselves. Actually, there is a trend towards patients opting for a reconstruction using natural tissues from the body without an implant.
"Some patients lean towards removal and restoring to a natural breast shape, which we rebuild with soft tissue," said Dr. Min.
The breast implant revision process
Breast implant revision is a highly customized procedure based on a patient's needs and goals. Some revisions can be as simple as replacing the implant, whereas others may involve more intensive surgical work, including addressing issues in soft tissue, rebuilding the breast structure or battling breast implant illness.
"Whenever you get an implant placed into your body, you're signing up for at least two surgeries," said Dr. Min. "Most implants require an exchange within 10 to 15 years. This can be as simple as going in and out, removing the previous implant and putting a new one in. However, it can be more complex when you need to address issues around the implant. There may be some degree of imbalance in the implant itself or some degree of change with the soft tissue over it. These changes can be due to weight fluctuations, natural changes as we age and other mitigating factors. This procedure can also involve a breast lift or fat transfer to the breast with mesh support."
If scars are a concern for you, the good news is that your original breast augmentation incisions can be used for replacing the implant, although that isn't always the case if additional procedures are included.
"The revision procedure can often be performed through the same incisions as the original procedure," said Dr. Krasniak. "There are times, especially when the patient has had changes to her own breast tissue, that additional incisions may be necessary, such as in the form of a breast lift."
Adjunct procedures for breast implant revision
Many patients will opt for additional procedures to address other issues with the breast and better meet their goals.
"The adjunct procedures that your plastic surgeon may discuss with you to go along with an implant revision largely depend on the initial reason for the implant revision," said Dr. Krasniak. "For example, if the reason for revision is to decrease the size of your breast implants, your surgeon will likely have to perform work on the inside of your breast to tighten the capsule around the breast implant to accommodate a smaller implant."
Another area of adjunct procedures with breast implant revision involves the restructuring of the support system within the pocket where the implant lives.
"Sometimes we use mesh support structures to help restore the pocket where the implant will live," said Dr. Min. "Sometimes the implant is in a very large pocket, and when patients lie down, it can slide to the lateral chest. Implant mesh is placed to keep the breasts right where we want them to be. This can also help decrease the risk of capsular contracture, especially when it's been a concurrent issue."
Advice for breast implant revision
Patients can take steps before and after treatment to set themselves up for success and the best possible results.
It may seem easy to find plastic surgeons who seem like they can "do it all" for breast procedures, but it's important to look for a surgeon who is well-versed in this breast implant revision and performs it often.
"The procedures can often be more challenging than the original breast augmentation surgery, and so it is important to find a plastic surgeon who routinely performs these operations to get the best outcome," said Dr. Krasniak.
Start by finding a board-certified plastic surgeon who is an ASPS member.
"Because this is a more complex procedure, find a surgeon that is board certified and has a lot of experience in breast cases specifically," said Dr. Min. "The best way to figure this out is to look through their credentials and their before and after gallery to see what is available and if you like the aesthetics of the surgeon."
When you find the perfect plastic surgeon to perform your breast implant revision procedure, the next step is to make sure that they have the full scope of your surgical history, including previous breast procedures.
"Any time you are undergoing a secondary surgery on your breasts, it is important that your surgeon has the information from your previous breast surgery in order for them to perform the revision safely," said Dr. Krasniak.
In today's digital age, there are so many places that potential patients can go to look for advice or to get a perspective on what the results of their breast implant revision procedure may look like. Yet, it's important to remember that this procedure is highly customized to the patient, with special considerations taken for their age, surgical history, goals and unique needs.
"Know that this surgery is very individualized," said Dr. Min. "What you've heard from your friends isn't necessarily what's going to happen to you."
To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.
