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Remove and Replace Breast Implants

remove-replaceThere are many reasons for wanting to remove and/or replace your breast implants: original implants are leaking, capsular contracture has caused breast deformity or hardening of the breast, saline or liquid silicone implants needing replacement due to age of implants and possibility of rupture, patient desires larger or smaller size implants, natural breast size has increased with age more than desired.

The best candidates for breast implant removal and replacement are women who are looking for improvement, not perfection, in the look and feel of their original implants. If you’re physically healthy and realistic in your expectations, you may be a good candidate.

Breast implant removal and replacement can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

If you have liquid silicone implants you should consider replacement. If your liquid silicone implants are more than 15 years old you should definitely look at replacing them. The lifespan of a liquid silicone implant is approximately 20 years and therefore gradual wear of the silicone shell would be evident by this time, leading to the possibility of rupture. A ruptured implant will cause the formation of siliconomas; hard lumps of scar tissue surrounding the leaked silicone gel. See “Liquid Silicone Gel Implants”

A breast implant is a silicone shell traditionally filled with either liquid silicone gel or a salt-water solution known as saline. The latest and best implants use a soft but solid silicon rubber called cohesive gel. Breast implants were initially round in shape, and these implants are still available. However, new technology has given us tear drop shaped implants which allow for a more natural looking breast.. All modern implants are anatomically shaped or breast – shaped (like a teardrop).

Breast implants are also available with smooth or textured surfaces. Originally all implants were smooth, but experience has shown us that the textured shell implants dramatically reduce the incidence of capsular contracture (hardening and distortion of the implant). Smooth implants are less expensive and have a thinner wall, but suffer a 40 – 60% risk of capsular contracture. The risk for the textured implants is 1.7%. Cohesive gel implants are only available with a textured surface and these are the implants of choice for our surgeons.

For those patients who have had capsular contracture in the past, we now have a new polyurethane implant by Silimed. This implant has been specifically designed to disallow any movement inside the pocket of tissue and therefore reduce the incidence of a capsule forming to almost nil.

Breast implant removal and replacement is relatively straightforward. But as with any operation, there are risks associated and specific complications associated with this procedure.

The most common problem, capsular contracture, is still possible after removal and replacement, however is much less likely with textured shell implants. The new polyurethane implants will reduce this possible side effect even further.

surgeryAs with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood. Polyurethane implants require the use of a drain to drain away excess fluid therefore avoiding the problem of excessive bleeding.

Less than 1% of women develop an infection around the implant. In most cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted. This complication is rare provided you follow all the recommended guidelines.

Some women report that their nipples become oversensitive, under sensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear with time, but may be permanent in some patients.

There is no evidence that breast implants will affect fertility, pregnancy, or your ability to breast feed. If, however, you have breast fed a baby within a year before augmentation, you may produce milk for a few days after the surgery. This may cause some discomfort, but can be treated with prescribed medications, if persistent.

If a break occurs in a liquid silicone gel-filled implant, however, one of two things may occur. If the shell breaks but the scar capsule around the implant does not, you may not detect any change. If the scar also breaks or tears, especially following extreme pressure, silicone gel may move into the surrounding tissue. The gel may collect in the breast and cause a new scar to form around it, or it may move to a nearby area. There may be a change in the shape or firmness of the breast. Both type of breaks may require a second operation and replacement of the leaking implant. In some cases, it may not be possible to remove all the silicone gel in the breast tissue if rupture should occur.

In the case of cohesive gel implants, the manufacturers state the risks to be similar to liquid silicone gel. However, these same manufactures are continuing to face a legal witch-hunt, and so are guaranteeing nothing to anybody right now. The cohesive gel implants have been designed to solve this very problem of liquid silicone gel implant rupture, and appear at this early stage of follow up to have done so.

A few women with breast implants have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. These symptoms may include joint pain or swelling, fever, fatigue, or breast pain. Research has found no link between silicone breast implants and the symptoms of what doctors refer to as “connective – tissue disorders,” with numerous large studies showing identical or lower than normal incidences of these diseases in women with breast implants.

Breast implants do not increase your risk of breast cancer, with studies showing augmented women to have only 43 – 47% of the normal risk for this killer disease. This presumably arises due to augmented ladies having less than half the normal amount of breast tissue, rather than to any protective effect of silicone!

While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology centre where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.

While the majority of women do not experience these complications, you should discuss each of them with your plastic surgeon to make sure you understand the risks and consequences of the breast augmentation as these may have changed since your original surgery.

In your initial consultation, your surgeon will evaluate your breasts and explain which surgical techniques are most appropriate for you, based on the condition of your breasts, any noted capsular contracture, any suspected leaking, your original scars and skin tone and elasticity. If your breasts are sagging, he may also recommend a breast lift.(For more information on this procedure, click Breast Lift or Mastopexy).

Your surgeon will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking and taking or avoiding certain vitamins and medications .We also request that you prepare the incision site with topical antioxidants for at least 6 weeks prior to surgery. While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

Your surgeon performs removal and replacements in a dedicated operating theatre in one of our local hospitals. These are – Sunshine Coast Private Hospital, Sunshine Coast Day Surgery, and Caloundra Private Hospital. Most ladies choose day surgery. Occasionally, those with little support or little children at home choose to stay a day or two.
Breast implant removal and replacement is usually performed under general anesthesia, so you’ll sleep through the entire operation. Some surgeons may use local anesthesia, combined with a sedative, to make you drowsy. However significant discomfort during the procedure is then frequent. Your surgeon will recommend general anaesthesia.

Every effort will be made to ensure that the incision is placed so resulting scars will be as inconspicuous as possible. Working through the incision, your surgeon will lift your breast tissue and skin to locate the original implant, which is then removed. The new implant will either be placed in the same pocket, or a new pocket will be made, depending on the difference in size to the original and the placement of the new implant. This will either be directly behind the breast tissue or more commonly underneath your chest wall muscle (the pectoral muscle).

Putting the implants behind your chest muscle may reduce the potential for capsular contracture.

The implants are then centered beneath your nipples. To ensure accurate placement of implants and symmetry we will be sitting you up and adjusting implant position whilst you are under the anaesthetic.

Subpectoral implant placement may also interfere less with breast examination by mammogram than if the implant is placed directly behind the breast tissue. Placement behind the muscle however, may be more painful for a few days after surgery than placement directly under the breast tissue.

The surgery usually takes approximately one hour to one and a half hours to complete. Absorbable stitches are used to close the incisions, which will also be taped for greater support. A subpectoral stabilizer device will be applied over your breasts to help keep the implants still in their optimal position. This is essentially two velcro straps.

recoveryYou may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades. Your stitches will not need removal but the swelling in your breasts may take three to five weeks to disappear. You should not have new bras fitted or wear any bra for 6 weeks after surgery.

You should be able to return to work within a few days to a week after surgery, depending on the activity level required for your job. Follow your surgeon’s advice on when to begin exercises and normal activities. Your pectoral muscles will be sore when you contract or stretch them, for about one month. Your breasts will be sensitive to direct stimulation for two to three weeks, so you should avoid firm physical contact.

After that, breast contact is fine once your breasts are no longer tender, usually three to four weeks after surgery. Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely.

Routine mammograms should be continued after breast augmentation for women who are in the appropriate age groups, although the mammographic technician should use a special technique to assure that you get a reliable reading, as discussed earlier. (See All surgery carries some uncertainty and risk.)

For many women, the result of implant removal and replacement can be satisfying, even exhilarating, especially if capsular contracture or leaking of implants was the reason for the replacement. However, in some cases, the degree of capsular contracture may have impinged on the breast tissue itself leading to the possibility that some of your breast tissue will need to be removed along with the scar capsule. This may result in slight changes in breast shape even after replacement. Your surgeon will discuss all the parameters of your surgery and the specific changes to expect.

Your decision to have breast implant removal and replacement is a highly personal and possibly medically necessary one that not everyone will understand. The important thing is how you feel about it. If you’ve met your goals, then your surgery is a success.

If you have further questions, write them down and ask your surgeon and his friendly staff at your consultation.