I performed my first breast augmentation in 1990. Over the years a great deal has changed with regard to the approach to this operation. Some surgeons still take the same approach they did twenty years ago. Others, like myself, try to stay current and even set the standard for the procedure (i.e. 24 hour rapid recovery technique)
I have been amazed that patients are still asking the question: When do I need to change my implants? Breast implants are mechanical devices and as such are prone to failure at some point in the future. The question is when. I remember several years ago removing a ruptured saline implant from a woman that was placed sometime in the mid-1970’s. I was amazed that this device, which looked like it was made out of a plastic baggie in comparison to today’s sturdily constructed implants (alright, a little bit of a gross exaggeration!), lasted twenty five years inside this woman’s body before it failed. The fact is, unless I can develop clairvoyant powers and predicts the future, I cannot answer this question. Let me explain. To put it very simply, and understand this is just my opinion, “if you are happy with your breasts then you do not need to change your implants unless you are having a problem.” The following is a list, not necessarily all-inclusive, but a list nonetheless of the reasons that I think a woman should consider revision breast implant surgery:
- Deflation of a saline implant: If you have a saline implant, then any leak, whether in the silicone shell (the bag itself) or in the valve used to fill the implant, will result in a gradual deflation which will probably take about two days to occur. You will then notice a marked difference in the size of your breasts. No further diagnostic testing is required; you simply need to remove the implant. Your options are to replace it with a similar device, replace both implants with similar devices (if the implants have been in place for several years – this is arbitrary – maybe 8 – 10 years or so), replace the implants with saline implants of a different size if you are having issues with the size or replace both implants with silicone gel implants for a more natural feel to the breasts.
- Rupture of a silicone gel implant: Rupture of a silicone gel implant is a bit harder to diagnose. With regard to the more recent implants, a small hole in the implant will most likely not leak any silicone gel due to the cohesive properties of today’s implants. If there is a tear in the implant shell, then the silicone will be contained by the natural scar tissue “capsule” that forms around all foreign bodies implanted inside us (a breast implant is a kind of foreign body). Silicone is biologically inert, which means that it won’t react with our bodies in an untoward and dangerous manner. Because the silicone is not absorbed by our bodies (nor does it travel elsewhere in our bodies), the breast will most likely look at feel the same even though the device is compromised. For this reason, the FDA recommends getting breast MRI’s at three years after surgery and every two years thereafter. Due to the infrequency of rupture, this may not be a very effective use of our health care budget and will be the subject of a future blog.
- Capsule contracture: In this condition, the breast feels hard and may even be uncomfortable. The implant is not changing. Rather, the scar tissue envelope that forms around the implant thickens and contracts, causing the implant to feel firmer. Treatment involves re-exploring the breast, removing the scar tissue causing the problem and replacing with a fresh implant of the same type and size.
- Asymmetry / breast deformity: If there is a shape issue of the breast that concerns you, and your surgeon believes that he/she can correct this surgically, then it may be reasonable to proceed. This can include issues relating to the first implant surgery such as improper pocket creation, improper implant selection, issues due to weight loss or pregnancy/lactation, malposition or displacement of the implant, palpability/rippling/wrinkling or visibility of the implant, ptosis (drooping) of the breast, lower (pole) breast over-stretching or changes in body habitus where your breasts now look too large or small for your frame.
- Desire to change implant size: I am a firm believer that if you want to have the best breast (best looking, most natural in shape) for the longest period of time with the least probability of requiring a revision, then you need to subscribe to the belief that for every breast, there is a specific ideal implant volume that will result in a properly filled, natural appearing breast. If you have attained that now, but wish to go larger, then you are playing with fire. You will risk overstretching your breasts and creating a whole new set of problems, including the development of uncorrectable deformities. If you do not have the proper size implants for your breasts, then revision to a different size (larger or smaller) may be indicated. Your surgeon is best positioned to make that determination.
Capsule contracture and implant deflation/rupture are the most common reasons for implant revision surgery. Ptosis may require a mastopexy (breast lift) and palpability/rippling/wrinkling or visibility of the implant is usually best managed by replacement of the implants (if they are saline) with silicone implants.
Nationwide, the three year revision rate for breast augmentation surgery is about 25%. Who would want to undergo such surgery if there were 1 in 4 chances that you will need a second surgery to fix something in within the next three years? This is simply too high. In my practice, the revision rate is around 1 – 2%. Almost all of these cases are due to device deflation and capsule contracture.
Short of the above, if you are happy with the way your breasts look and feel, and are having no problems with them, then there is no reason to re-operate on them. I hope that this article helps to dispel some of the rumors that have circulated for years about breast augmentation surgery.