Over 250,000 women undergo breast augmentation every year. Results are typically satisfactory, but there are instances when women are unhappy with their results or change their minds about their desired aesthetics. In some cases, women may experience an implant-related issue that needs to be addressed. When researching surgeons, it is essential to evaluate their qualifications and previous work and to be educated about the potential risks of breast augmentation.
Candidates for a Breast Implant Revision
If you previously had a breast augmentation and are not satisfied with your results, there are options for improving your areas of concern. The most common reasons to undergo breast surgery revision include:
- Saline breast implant deflation
- Silicone gel breast implant rupture
- Capsular contracture
- Desire for a change in breast size
- Breast implant asymmetry or malposition
- Excessive implant rippling
- Sagging of breasts
Breast implant revision procedures can address multiple concerns simultaneously if you identify with more than one issue. Every procedure will utilize different techniques to meet each patient’s unique needs. The results can significantly improve the appearance, shape, and size of breasts.
Saline Implant Deflation
Breast implants are designed to last for many years but will not last forever. Saline breast implants contain sterile saltwater and may deflate within 10 to 15 years. Deflation does not pose a danger to the patient, as the solution will be naturally absorbed by the body. Deflation usually begins with a gradual leak, typically over the span of a few days or weeks. During this time, the breasts will start to feel softer or even mushy. Fullness will reduce, and breasts will begin to appear smaller, which can lead to rippling of the implants. If this issue is not addressed, the capsule of scar tissue surrounding the implants can become tight and hard.
This patient is a 25-year-old woman who presented with a deflated right implant following augmentation with saline implants performed by Dr. Friedman 10 years ago. She was also interested in further enlargement of the breasts.
She underwent placement of larger submuscular silicone implants, 533 cc on the right and 457 cc on the left, due to preexisting asymmetry. Her six-week postoperative results demonstrate restoration of right breast volume and improved contour of both breasts.
This 26-year-old woman presented with a deflated left saline implant following breast augmentation performed by Dr. Friedman seven years ago. She was also interested in further enlargement of the breasts.
Silicone Implant Rupture
Silicone gel implants, like saline implants, are designed to be long lasting but will not last forever. Rupture of a silicone implant is often undetectable by exam, mammogram, or sonogram, so periodic MRI screening is recommended. If your silicone implant has ruptured, the FDA recommends removal. The implant can be replaced if desired.
This 28-year-old woman presented with a ruptured silicone gel implant following breast augmentation performed five years ago. She was also interested in further enlargement of the breasts and improvement in breast symmetry.
She underwent placement of larger silicone gel implants (616 cc) and elevation of the right breast implant. Intraoperative photos show the rupture of the left silicone gel implant. Her 10-month postoperative photos demonstrate increased breast size, improved breast contour, and enhanced symmetry.
As with any surgery, if a foreign object, such as a breast implant, is placed in your body, the body may react in different ways. A capsule of scar tissue is formed around the implant to provide long-term protection and support for your implants. In some cases, the capsule of scar tissue may become thick and hard, which can constrict the implants and result in a difficult breast revision.
|Implant Feel||Implant Look||Breast Pain|
|Grade 2:||Too firm||Normal||No|
|Grade 3:||Too firm||Too firm||No|
|Grade 4:||Too firm||Too firm||Yes|
*Chart used with the permission of Ronald M. Friedman, M.D.
Grade 2 capsules are treated nonoperatively with implant massage and occasional medication. Grade 3 and 4 capsular contractures generally require further surgery, which consists of releasing (capsulotomy) or partially removing (capsulectomy) the capsule to provide more room for the implant. This generally provides a softer, more natural-looking breast.
This 49-year-old woman complained of excessive firmness of her saline implants and elevation of her left implant following breast augmentation performed 12 years ago.
She underwent capsulotomies and placement of 339 cc submuscular silicone breast implants. Her five-month results demonstrate softer, more natural-appearing breasts.
This 46-year-old woman complained of asymmetry and “hard” implants after breast augmentation with subglandular (above muscle) saline implants 20 years ago.
She underwent capsulectomies and placement of 378 cc subglandular silicone gel implants. Her five-week postoperative photos demonstrate softer, more symmetric, natural-looking breasts.
Desire for a Change in Breast Size
Many women decide to further enlarge their breasts after their initial breast augmentation. This may be due to loss of volume from childbearing or aging, “settling” of the implants, or simply a change of mind regarding desired breast size and appearance. Regardless of the cause, further breast enlargement is generally a straightforward procedure with predictably improved size, upper breast fullness, and enhanced cleavage.
If you want dramatically larger breasts, textured implants, or to correct a concern other than size (breast shape, implant position, asymmetry, etc.), these procedures entail more complex surgery to achieve your desired results.
Some women may wish to reduce their breast size following their breast augmentation. This can be accomplished in one of two ways:
- If you do not mind giving up some fullness of the upper and inner breasts, placement of smaller implants is the most direct procedure.
- If you do not want to sacrifice fullness of the upper and inner breasts and have a reasonable amount of your own breast tissue, then liposuction of the breasts (if your breasts are perky) or a breast lift (if your breasts are saggy) may be performed, with or without modification of the implants. This technique better preserves the upper breast fullness and cleavage provided by the implants.
This 26-year-old woman complained of loss of breast volume after breastfeeding two children. She had 300 cc saline breast implants placed by Dr. Friedman eight years ago. She underwent further breast enlargement with 616 submuscular silicone gel implants. Her six-month postoperative photos demonstrate improved size, upper breast fullness, and enhanced cleavage.
This 51-year-old woman requested further enlargement of her breasts. She had 390 cc saline implants placed by Dr. Friedman nine years ago.
She underwent further breast enlargement with 659 cc submuscular silicone gel implants. Her nine-month postoperative photos show improved size, upper breast fullness, and enhanced cleavage.
Breast Implant Asymmetry or Malposition
Most implants settle into final position within six to 12 months after surgery. Occasionally, implants settle too much or too little, leaving them too high on the chest or too close to the midline. Surgery to release (capsulotomy) or remove (capsulectomy) scar tissue surrounding the implants will assist in repositioning breasts to a more desirable position. If an implant is too low or too far from the midline, then a procedure to tighten the implant capsule (capsulorrhaphy) may be performed with a series of carefully placed permanent internal sutures. Tightening the capsule can lift the implant into a better position on the chest. In the unusual circumstance that the capsule begins to appear thin and weak, the capsulorrhaphy may be reinforced with a biological matrix (or internal bra), though these add complexity and expense to the procedure. Capsulotomy may be performed to loosen one breast implant while capsulorrhaphy is performed to tighten the other, providing improved position and symmetry of the breast implants.
This 58-year-old woman complained of breast asymmetry with “sagging” of the left implant following augmentation with saline implants 15 years ago.
She underwent placement of slightly smaller submuscular silicone breast implants (339 cc on the right, 371 cc on the left) with capsulorrhaphies (left greater than right). Her three-month postoperative photos demonstrate “lifting” of both implants and improved symmetry of the breasts.
This 50-year-old woman complained of breast asymmetry, “rock hard” implants, and desire for further enlargement and lifting. She had subglandular (above muscle) saline implants placed 24 years ago.
She underwent staged subglandular capsulectomies, placement of larger submuscular 525 cc silicone gel implants, and a breast lift. Her 18-month postoperative photos demonstrate improved size, shape, position, and symmetry of the breasts.
Excessive Implant Rippling
If an implant begins to ripple, it can become visibly or tangibly evident. Excessive implant rippling occurs most often when overlying breast tissue is unable to completely cover the implants, which most often occurs in women with minimal breast tissue, weight loss, placement of subglandular (above muscle) breast implants, or placement of saline implants. The usual treatment for this issue is gaining weight to improve implant coverage (if feasible), placement of “overfilled” saline implants (rippling decreases as volume increases in most cases), or conversion from saline implants to silicone. Occasionally fat grafting to the area may be helpful.
This 31-year-old woman complained of visible rippling of the inner breasts after placement of submuscular saline implants eight years ago. She was also interested in further enlargement.
She underwent placement of larger, overfilled submuscular saline implants (550 cc implants inflated to 630 cc each). Her two-month postoperative photos demonstrate resolution of the rippling and improved breast size, upper breast fullness, and enhanced cleavage.
This 35-year-old woman complained of visible implant rippling after silicone breast augmentation two years ago. She had undergone two prior augmentation surgeries, and her pectoralis major muscle had been completely divided, leaving minimal tissue coverage for the implants.
She underwent placement of mildly larger silicone gel implants (525 cc on the right and 495 cc on the left) and 10 cc of fat grafting to the right inner breast. Her eight-month postoperative results demonstrate significantly improved implant rippling.
Sagging of the Breasts
After breast augmentation, most submuscular breast implants will remain in a stable position for many years. However, subsequent childbirth, breastfeeding, or aging may cause long-term loss of volume and sagging of the natural breast tissues. If the problem is merely a loss of breast volume, then further enlargement of the breasts may be beneficial.
In some cases, there is fullness of the upper and inner breasts (good implant position), but the overlying breast tissues appear to be falling off (bad breast tissue position). In these situations, a breast lift may be a better option. Breast lift (mastopexy) is usually performed through incisions around the nipple-areolae (to place them higher and perhaps reduce their size) and vertically along the lower breasts.
This 38-year-old woman complained of sagging breasts and enlarged nipple-areola. She had 350 cc submuscular saline implants placed three years ago and felt that her breasts were “falling off” her implants.
She underwent a breast lift to improve breast contour. Her six-week postoperative results demonstrate improved breast position, reduced nipple-areolar size, and overall improved breast contour.
This 54-year-old woman complained of extreme dissatisfaction with “hard and sagging” asymmetric breasts after augmentation with subglandular (above muscle) silicone gel implants placed 19 years ago. She requested larger, softer implants and a breast lift.
She underwent subglandular capsulectomies, placement of larger submuscular 390 cc saline implants, and a breast lift. Her one-week postoperative photos demonstrate improved breast size, shape, position, and symmetry.
Dr. Friedman performs over 130 breast augmentations each year (the average plastic surgeon performs about 35). Approximately 25% of his augmentation procedures are revisions. In fact, many physicians refer patients to our office for breast implant revision. During your consultation, he will discuss your surgical options as well as the specific techniques to be used for your revision. While there is often no easy or perfect solution to address the areas of concern, Dr. Friedman will strive to significantly improve the appearance of your breasts.