Most women are very happy after their first breast implant surgery. They feel better about their proportions, curves, fit and look better in clothes. They feel more feminine, sexy and have more self confidence. . They finally have the breasts they have always desired in terms of size, shape and look. This result can last for many years. However, everyone knows that breast implants do not last forever and will need to be replaced at some time in the future.
Some patients will choose to replace the implants for new implants if they wish to change the size or improve on the appearance.
With an evaluation by a plastic surgeon, usually the breast implant leak may be confirmed. Occasionally, an additional test such as a mammogram, ultrasound or MRI may be performed to confirm this as well.
Replacement of the implant should be done as soon as possible using the same incision that was used before; crease (underneath the breast), transaxillary (armpit) or periareolar (underneath the nipple) incision. Usually the surgery is easier with less pain and faster recovery than the first breast augmentation procedure. If your breast implants leak within the first 10 years after the first surgery, they may be covered under a warranty. You need to check this with your original plastic surgeon or review your paperwork that you received after the first surgery. Most of my patients have the extended 10 year warranty. Your breast implant replacement surgery( with or without warranty) can be performed by any plastic surgeon as well as your original plastic surgeon.
With Silicone Breast implants: If you have silicone breast implants, it can be more difficult to tell if there is a leakage or rupture of the implant. The silicone gel tends to stay in the area of leakage and the volume or size of the implant is maintained. When rupture or leakage occurs with the saline implants, the saline or salt water is harmlessly absorbed by the body and the size of the breast gets smaller. With silicone implant leakage, the size of the breast remains about the same but you may or may not notice a change in the shape of the breast. This is referred to as silent rupture. The best way to evaluate the silicone breast implant is with a personal examination by a plastic surgeon and confirming with mammogram or MRI. With silicone breast implant leakage or rupture, it is recommended that the implant be replaced as soon as possible. The new 3rd generation silicone implants currently being used are safer. They are often referred to as Cohesive Gel or "gummy bear" implants because if leakage occurs, the gel stays solid and in one spot without moving around like the old liquid silicone gel. There is no current evidence to suggest that the silicone gel outside of the implant is harmful to you.
Using your original incision whether it was crease(underneath the breasts) or periareolar( around the areolar), the leaking silicone implant may be removed, any free silicone gel removed, and the new silicone implant replaced. Usually the surgery is easier and less painful then the original breast augmentation surgery.
Because it can be very difficult to evaluate the status of your silicone breast implants, it is recommended that regular evaluation with mammograms or MRI be performed.
Usually, it is several years after the first surgery that a woman might wish a different size. This can happen if the natural breast volume has changed through weight changes, pregnancy, childbirth and breast feeding or just gravity and aging.
Usually for a moderate change in size whether smaller or larger, the same incision or cut may be used(crease, armpit, below the nipple) and the surgery is easier, less painful and faster recovery. For larger changes in size whether smaller or larger, the breast pocket or capsule may need to be modified to accommodate the size change which requires more surgery and slightly longer recovery. To go smaller, occasionally a breast lift may be necessary as well as a smaller implant.
My breast implants are too low: With time and gravity, your implants may sit too low on your chest and this causes your nipples to turn up. In severe cases we call this "bottoming out". This may be corrected by performing an inferior capsulorraphy. This involves raising your breast crease by placing internal stitches in the breast capsule and raising your breast implant higher to a more normal position. This will also give you more perkiness and fullness up top which will improve the look of your breasts. Your nipples will now be in the normal position being level and horizontal.
My breast implants are too far off to the side; Your breasts may fall to the side touching your arms especially when lying on your back. The breast pocket may be too large on the outside of your breasts or have stretched with time. Besides looking abnormal, sometimes this can be painful. This condition can be corrected by performing a lateral capsulorraphy and closing the breast pocket and repositioning your implant more to the middle. This will improve the position of your implants and give you more cleavage.
My breasts are too close together: When you breast are too close together, this can look abnormal and is sometimes referred to as symmastia( "unibreast or uniboob"). This may be corrected by moving the breast implants away from the center of your breast bone(sternum) and recreating the normal space between your breasts. Depending on the situation, one or both breasts may need to be operated on to close off the medial or inside of the breast capsule with internal stitches. This is called medial capsulorraphy.
My breasts are uneven; can you help me? After breast augmentation or breast implant surgery, your breasts may be uneven for many reasons. All women's breasts are different from right breast to left breast. I try to make the breasts as even as possible during the surgery but there are always little differences in shape, size and position of the breasts after the surgery and this is normal.
However, there may be severe differences which may be corrected especially if it worsens over the years. There are many reasons for the breasts to become uneven over time. Usually one or both breasts may need to be revised or adjusted with techniques that I described above such as capsulotomy, capsulorraphy, changing implant size and breast lift. These techniques all involve revising a breast capsule to the proper size and position and positioning the implant in the right position on the chest behind the nipple.
If the capsular contracture is severe, then surgery may be required to remove the scar tissue that has developed around your breast implants which is causing the hardness. If the breast implants are subglandular, then placing the implants submuscular or underneath the muscle may be recommended as well as cutting out the hard scar tissue or capsule. Unfortunately, the capsular contracture can come back even with surgery.
Sometimes, if the capsular contracture is not severe, we can treat this with certain medications that are still being studied.(Accolate)
The best way to treat capsular contracture is to try to prevent it from happening. For breast augmentation, I recommend placing the implant underneath the muscle or submuscular and performing breast implant massage exercises after the breast implant surgery.
Techniques to minimize the risk of wrinkling and rippling are to maximize the volume of saline implants to manufacturer specifications, using different types of saline implants, placing the implant submuscular, not using too big of a breast implant to avoid stretching the skin, and using silicone implants. Based on my evaluation of your situation, I will recommend possible solutions to improve or correct wrinkling or rippling.
Performing breast lift and breast reduction surgery in Philadelphia, Pennsylvania, New Jersey and Delaware.
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Philadelphia Plastic Surgeon Disclaimer: Board Certified Plastic Surgeon, Adrian Lo, M.D, has provided this cosmetic surgery web page for informational purposes only. It is not intended for medical advice. For more information about plastic surgery in the Philadelphia, Pennsylvania, Delaware and New Jersey areas, please Contact Dr. Lo for a free consultation.