Revision Breast Reconstruction

It is not uncommon over your lifetime to eventually desire a change in the size of your implants. Whether its from pregnancy and breast feeding, implants that were too big to begin with, changes with age or a desire to switch from saline to silicone, implants can be reduced in size to accommodate your desired result. If the skin and soft-tissue support of the breast has been stretched out, you may also need a breast lift with your implant exchange to get a better, more natural result.

Yes, you can. Depending on the reason you are removing them, there are two methods for implant removal. You can just remove the implant. This option requires less surgery and less risk, but leaves behind the capsule. Alternatively, you can remove the capsule and the breast implant at the same time with an en-bloc resection or total capsulectomy. The cosmetic result of removing implants varies depending on your tissues and remaining breast tissue.

While implants can change shape over time, the more likely issue is that your own tissues have changed over time (bigger, smaller, droopier with stretch over time). If the implant is changing shape, it likely represents a rupture. With saline implants, a change is usually very noticeable as the breast implant deflates over a few days to weeks. Signs that your silicone implants are ruptured can include changes in breast shape, swelling over a period of weeks, capsular contracture or even pain.

Implants do not actually expire, however, they will not likely last you a lifetime. The current gummy bear implants have a rupture rate that is less than 10% at 10 years. By thirty years, that number is likely much higher. More common than an implant issue, is a breast tissue concern. As you get less young, your own breast tissue may droop and sag or change in size enough that you desire a revision

In the early stage of capsular contracture, one breast is slightly firmer than the other side or is sitting slightly higher than the other. For some women, it does not progress beyond this. However, in other women, capsular contracture can get worse. More advanced capsular contracture, when the breast is hard or hard and painful, is not likely to respond to non-surgical options and is best treated with complete removal of the capsule. Implants can be replaced at that same time if you desire.

Early signs of capsular contracture (one breast is slightly firmer than the other side or is sitting slightly higher than the other) may resolve with non-surgical interventions like medications and ultrasound. More advanced capsular contracture, when the breast is hard or hard and painful, is not likely to go away by itself and is best treated with complete removal of the capsule.

Yes, you can. Depending on the reason you are removing them, there are two methods for implant removal. You can just remove the implant. This option requires less surgery and less risk, but leaves behind the capsule. Alternatively, you can remove the capsule and the breast implant at the same time with an en-bloc resection or total capsulectomy. The cosmetic result of removing implants varies depending on your tissues and remaining breast tissue. Implants can be replaced at that same time if you desire.

With saline implants, a rupture is usually very noticeable as the breast deflates over a few days to weeks. Signs that your silicone implants are ruptured can include changes in breast shape, swelling over a period of weeks or even pain. Capsular contracture, where the scar tissue around the implant hardens, can happen. Silicone implants can also rupture and not cause any symptoms at all, silent rupture. In those cases, you would only know if you got an MRI to check.

Insurance will cover breast revision surgery in the setting of previous breast cancer. By law, all insurance companies have to cover both the breast that had cancer and surgery needed on the other breast to make them more symmetric (matching surgery). Insurance will not cover the cost of cosmetic breast enhancement surgery (augmentation, lift, a combination of the two, or other revisions).

We still do not know what exactly causes capsular contracture and so fixing it remains a big issue. Once you have considerable capsular contracture, the best recommendation is to have a total capsulectomy and implant replacement. By removing all of the old scar tissue and the old implant, you give the body the best chance not to have a recurrence. The surgeon may also recommend changing position from above or below the muscle to again minimize the risk.

For most patients, a breast lift will last at least 10-15 years and many of our patients tell us that they are happy with their results for much longer than that. Factors that may contribute to the result not lasting as long include pregnancy and breast feeding, significant weight changes, your skin quality (be sure to ask about skin care products to extend the life of your result), smoking and support of your breasts (gravity does not stop working after a lift so be sure to wear a bra when exercising)

This is going to really depend on what you are having done and how extensive the revision is. Most breast revision surgery is done as an outpatient surgery and you are back to your normal routing within a few days. With a straight-forward implant exchange or fat grafting, you can have the surgery on a Thrusday and be back to work on Monday. More extensive revisions may require a little more down time and some time away form the gym / work (depending on your job).

There are three timeframes when you may get a revision: immediately after surgery, if the result is just not right and there is no hope that it will improve over time (this is fortunately extremely rare); around the three month mark, as this is when you will best be able to appreciate the final size; and then time you can get a revision any time after that when you feel that your breasts dont fit your desired result.

Breast revision surgery is really surgery designed to adjust or modify a previous breast surgery. This can be as simple as an implant exchange to a larger or smaller size to as extensive as total capsulectomy, implant exchange, fat grafting and a lift. Our surgeons are highly sought after for their expertise in revision surgery and they will work with you to both understand your concerns and create a comprehensive plan to achieve the end result that you are looking for.

The most common implant sizes range from 300-500cc (cubic centiliters). For reference, 1cc is equivalent to 1 ml. Studies show that for every 150cc, your breasts will increase or decrease roughly one cup size. More important that the size, is the fit. Our surgeons will measure your chest and breast and from that give you a range of implants that will fit your body. Too big and they may cause you serious issues early on. Too small and you may not achieve the look you are going for. We customize the implant selection to fit the patient.

The NHS, like many other national health care systems and insurance companies, may cover breast implant removal when deemed medically necessary. In the setting of previous breast cancer and reconstruction, removal is very likely to be covered. Removal for other reasons, for example breast implant illness (BII), ruptured cosmetic implants or capsular contracture around implants placed for cosmetic reasons, may or may not be covered.