Breast Augmentation Revision

The Second Time Around with Breast Implants

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.

When should my Breast Implants be evaluated?

Usually, I follow my patients for about 1 year after the first breast augmentation procedure. After 1 year, I see my patients only as needed. If you continue to have the soft breasts that look and feel as good as 1 year after the surgery, there is no need for a routine evaluation. However, I encourage my patients to have an evaluation whenever they have a question or concern about their breast implants or wish to have a routine check up.

When should my Breast Implants be replaced?

If you are not having any problems with your breast implants, there is no need for replacement no matter how much time as past whether it is 5, 10 or more years. If your breasts look and feel as good as 1 year after the surgery, there is no need to replace the implants.

Some patients will choose to replace the implants for new implants if they wish to change the size or improve on the appearance.

What about mammograms?

Mammograms should be done as per your primary doctor's recommendation but usually begins at age 35- 40. Usually regular mammograms can be done. Sometimes, extra views may be necessary. An ultrasound or MRI may be recommended for a more complete examination of the breasts or to focus on a particular area. With this evaluation, breast cancer screening may be performed accurately and the status of the breast implants may be evaluated. Any rupture or leakage may also be detected.

What about Breast Implant leakage?

With Saline Breast Implants: Most patients will notice that one breast is getting smaller with time and does not fill the bra as before. This can happen over days, 1-2 weeks or even months depending on the situation. Usually it is not painful as the saline or salt water is absorbed by the body. Sometimes, women will notice a "cool" sensation with the leakage. The implant may be more easily felt and show wrinkling and rippling when touched.

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 transaxillary(armpit) or 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.

Dr. Lo, I want a different breast size! Can you help me?

After your first breast augmentation surgery, you may want a different size whether bigger or smaller. I usually advise patients to wait at least 3 months to allow the breast implants to settle and all the swelling to go down. At the 3 month time, one can make a true evaluation of the size and shape of the breasts and offer recommendations.

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.

Can you make my breasts look better?

My breast implants are too high: Over time, the breast implants may sit too high for your liking. This can be corrected by performing an inferior capsulotomy by lowering your breast pocket or crease and positioning the implant properly in a lower, more normal position. This will give your breasts a sloped more natural look with good projection and perkiness with nice fullness and roundness in the lower part of your breasts. Sometimes, a small breast lift may also be required for best results.

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.

My breasts are hard, do I have capsular contracture?

After healing from breast implant surgery which may take 6 months to 1 year, your breast should feel soft and natural. Over the years, your breasts may get slightly firmer but still remain soft. If there is severe hardening, then capsular contracture may be happening. One or both breasts may begin to feel more firm or harder. With capsular contracture, the shape of the breasts may become different and not as natural. Sometimes with the hardening, there is pain. You should be evaluated as soon as possible.

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.

How can I correct the wrinkling and rippling of my breasts?

Some wrinkling and rippling of saline and silicone implants are normal. When a woman has very thin skin or a small amount of natural breast tissue to cover the implant, then the risk of wrinkling and rippling is higher. Usually, one can only feel wrinkling and rippling when touching the breast. However in severe cases, one can see wrinkling and rippling of the skin surface. This occurs most commonly on the side of the breast, sometimes on top of the breast or around the cleavage area. Wrinkling and rippling is more common with saline implants than silicone implants.

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.

What can you do to correct my breasts that droop even with the Breast Implants?

Depending on your situation, skin elasticity, aging pattern and genetics, your breasts may seem droopy over time even with the breast implants. A full evaluation would be required but correction would involve repositioning your breast implants and performing a breast lift that may be a minimal periareolar lift, short vertical scar lift(lollipop lift) or the more traditional inverted T or anchor scar breast lift.

How do I get my Breast Implants removed?

This is not a common request but some women after a certain time and for different reasons, wish to have their breast implants removed. This is done through the original incision whether crease, armpit or below the nipple and is relatively easy and painless. Depending on the size of the breast implants and the length of time the breast implants have been in place, the skin may be stretched and droop or hang. Usually with time, the skin will rebound a small amount. If this does not happen, then a breast lift may be recommended as a second procedure at a later date to improve the breast appearance. Dr. Lo has extensive experience with breast augmentation revision techniques with saline and silicone implants. If you have questions or concerns about your situation, call Dr. Lo at (215) 829-6900 for your immediate consultation or Email Dr. Lo at