The Center for Cosmetic Surgery
725 Heritage Road #100
Golden, CO 80401
Phone: (303) 278-2600
Monday – Friday: 8 a.m.–5 p.m.
The Center for Cosmetic Surgery
755 Heritage Road #100
Golden, CO 80401
Phone: (303) 279-6100
Monday – Friday: 8 a.m.–5 p.m.
The Center for Cosmetic Surgery
501 South Cherry Street #900
Denver, CO 80246
Phone: (303) 951-2100
Monday – Friday: 8 a.m.–5 p.m.
The Center for Cosmetic Surgery
501 South Cherry Street #900
Denver, CO 80246
Phone: (303) 951-2102
Monday – Friday: 8 a.m.–5 p.m.
The Center for Cosmetic Surgery
6985 Tutt Blvd Ste 110
Colorado Springs, CO 80923
Phone: (719) 380-1823
Monday – Friday: 9 a.m.–5 p.m.
Breast Revision
Breast augmentation is one of the most popular cosmetic procedures in the United States, with more than 300,000 patients undergoing augmentation in 2022. Advancements in surgical techniques and implant technology have resulted in a safe, predictable procedure, and most women have a trouble-free postoperative course. A variety of challenges can present themselves, however, and between 20% and 30% of women undergo a revisionary breast augmentation within the first 10 years of their original surgery. The most common indications for reoperation are capsular contracture, implant malposition/asymmetry, implant rupture, and a desired size change. Each of these scenarios requires different treatment plans and surgical skills. Like most areas of surgery, a revision may be a significantly more challenging endeavor than the original surgery. A review of the common causes of revision can be illuminating.
Breast Implant Revision
Before & After Photos
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Capsular Contracture
When a breast implant is inserted, it sets off a foreign body response in the surrounding tissue that creates a layer of scar tissue that surrounds the implant. This scar tissue, referred to as the capsule, is typically a thin, soft, compliant layer that provides some support for the implant but doesn’t significantly affect the feel or look of the device. In some cases, however, the scar tissue can become thickened and may tighten down around the implant, a condition known as capsular contracture. The degree of deformity can vary significantly, ranging from a mildly firm but still acceptable result to a dramatic and painful distortion of the affected breast.
There are several proposed causes of capsular contracture, but they all revolve around inflammation and a heightened immune response within the breast. When a contracture develops within a few years of the original surgery, it is often attributed to low-grade bacterial colonization of the implant with the normal bacteria that live in the skin and breast tissue due to contamination at the time of implant placement. Another possible cause is excess blood within the implant space after surgery, either because of significant bleeding during surgery or a postoperative hematoma. Both of these sources of inflammation can be minimized with a comprehensive surgical plan designed to minimize contamination and a well-executed procedure that minimizes bacterial exposure of the implant and blood loss. Tools to minimize contamination include ideal timing of preoperative antibiotics, effective use of antibiotic and/or antiseptic solution during surgery, use of the crease below the breast for implant insertion (as opposed to nipple, axilla, or umbilical approaches), and covering the nipples with a shield during surgery to avoid expressing bacteria onto the surgical field. Historically, implants placed beneath the pectoralis muscle in the chest had a lower incidence of capsular contracture, although newly available implants made by Motiva appear to perform equally well above or beneath the muscle, with very low rates of contracture in either plane.
The treatment of capsular contracture is challenging and there is a lack of consensus on best practices at this time. There are a few non-surgical therapies that have been proposed, including ultrasound therapy, oral medications such as Singulair, and various injections into the thickened capsule. The data supporting long-term improvement from any of these interventions is spotty, however, and surgery remains the mainstay of capsular contracture treatment.
Surgical correction typically involves releasing or removing the thick capsule and, in many cases, exchanging the implant for a new one. In some situations, a biologic material called acellular dermal matrix (ADM) or other animal-derived membranes can be used to both support the implant as it heals and to inhibit future capsular contracture. Drains placed within the pocket at the time of surgery can be helpful to remove blood or inflammatory factors that can lead to increased capsule formation. Despite the application of these advanced techniques, recurrent capsular contracture remains a frustrating possibility.
Implant Malposition/Asymmetry
The breasts are a paired structure, and, ideally, they closely resemble each other. Preoperatively, most women have measurable differences side to side, which may involve breast volume, skin envelope, and underlying rib cage and breastbone anatomy. These underlying asymmetries can set the stage for postoperative dissatisfaction, even when the original surgery was performed at a high level by a qualified surgeon. In many cases, an implant simply needs to be repositioned higher or lower within the pocket, a straightforward process. Some patients, however, have more significant challenges with regard to soft tissue strength, recurrent malposition, and the like. These women often require a more involved and technically demanding procedure that might involve the addition of a soft tissue-reinforcing mesh or biologic material. When the soft tissue is an issue a breast lift/mastopexy may be indicated. This procedure can reshape the breast, tighten the skin, and reposition the gland back up onto the implant, creating a more youthful, balanced appearance. Our surgeons have performed hundreds of complex implant revisions and are well-versed in state-of-the art techniques designed to maximize long-term stability.
Breast Implant Rupture
Breast implants have been in use for more than 50 years, and 6 generations of devices are now on the market. Despite significant advances in implant design and manufacture, the most modern implants available still have the potential for rupture. Older devices are even more prone to failure over long periods of time. When a saline implant ruptures, the liquid leaks out of the device and is absorbed harmlessly by the surrounding tissue. In most cases, the implant completely deflates within a few days and the patient will notice the obvious loss of volume. Some women with saline implants will experience a valve malfunction, however, which can result in a partial deflation that is harder to detect. In either case, deflated saline implants can simply be replaced with new devices in a simple exchange. Silicone implant ruptures are both more challenging to detect and potentially more difficult to correct. Unlike saline that gets absorbed, the gel from a ruptured silicone implant remains within the scar capsule surrounding the implant. Because the volume is still there, the breast may appear essentially unchanged, a so-called “silent rupture”. Some patients will form more scar tissue around a ruptured device and can develop a capsular contracture that will change the look or feel of the breast, prompting evaluation. Due to the unreliability of detecting rupture on physical exam alone, additional screening methods are recommended by the implant manufacturers and the FDA. Per the American Society of Plastic Surgeons,
As of 2020, the FDA currently recommends screening your breast implants with MRI or ultrasound beginning five to six years after silicone implant placement and every two to three years thereafter. Even if you do not have concerns about the condition of your implants, it is important to go for your routine screenings, based on the FDA-recommended timeline. Routine screenings can verify your implant is intact and identify complications such as implant rupture or silicone leakage. Although implant rupture can cause various symptoms, some women with ruptured implants experience no symptoms, which is why routine screenings are critical.
At The Center for Cosmetic Surgery, we offer in-house ultrasound screening to evaluate silicone implants, a convenient and potentially cost-saving option.
In some cases, we may still refer a patient out for a confirmatory formal ultrasound or an MRI. The replacement of a ruptured silicone implant may be straightforward if the pocket is still soft. The old silicone material can simply be washed out and a new implant placed. When the capsule has thickened, however, portions of it or the entire capsule may need to be removed before the new implant is placed. Mesh or ADM may be helpful to support the implant and may beneficially influence future capsule formation. Drains are often placed into the breast after a complex revision to reduce fluid accumulation and facilitate ingrowth of the mesh/ADM.
Breast Implant Options
Learn MoreBreast Implant Plane Change
Breast implants can be positioned above or beneath the pectoralis muscle in the chest. Each location offers its own advantages and limitations. There are several scenarios where it might be beneficial to change from one location to another to create a new, fresh implant pocket surrounded by healthy tissue. A significant malposition, capsular contracture, or dramatic animation deformity might all be situations where your surgeon may recommend changing the implant plane.
Implant Replacement
Breast implants tend to last a long time, but they are not lifetime devices for many women. They should obviously be replaced in cases of failure or rupture. If implants appear to be intact, however, when should they be electively replaced? This is a complex question, and many factors can influence a woman’s decision. There is a common misconception that implants need to be replaced every 10 years. Perhaps this stems from the 10-year warranty that supports most implants. Whatever the source, this is simply untrue, and most women will get significantly more life out of their implants. With saline implants, a rupture is safe and easy to diagnose, so patients can simply live their lives without worrying about the implants until a rupture becomes obvious. For silicone, older generations of implants may last 15 years or longer, while more modern devices should provide a longer trouble-free period. All patients are advised to follow ultrasound/MRI screening protocols and to replace implants if indicated.
There are a variety of reasons why a woman may want to change her implants, even if they are intact and well-positioned. One major motivator for a revision is a size change to go bigger or smaller. Some patients know fairly quickly postoperatively that the size they and/or their surgeon chose is not ideal. Other patients may be happy for a long time, but changes in lifestyle, weight, age, or aesthetic goals may motivate them to change their implants. Regardless of the indication, a size change surgery can be as straightforward as simply swapping implants. If a patient desires significantly smaller implants, that procedure might require tightening the pocket and/or performing a breast lift. When going dramatically larger, the pocket around the implant often needs to be enlarged and the new implant might benefit from mesh support.
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Implant Removal
As a woman ages, her breasts change along with the rest of her body. Time alone can impact the position and shape of the breast. Pregnancy, breastfeeding, and menopause can dramatically alter breast volume and appearance. For some women, the implants no longer serve their needs, and they would like them removed. A desire for smaller breasts, a problem with a current implant, various health concerns, or a wish to be maintenance-free are all common motivators. It is possible to simply remove implants. Thin scar capsules may be abraded to facilitate pocket closure, while thicker capsules may be removed along with the implants. A drain is usually necessary for a few days to help the pocket seal up without collecting fluid. If the implants have significant volume, a breast lift is often indicated to tighten and reposition the now empty breast skin envelope and gland. This can be performed at the same time as the implant removal or done at a later date once the breast has settled.
A Reputation Built on Results
In summary, there are many reasons why a woman may want or need a breast implant revision. These surgeries are sometimes straightforward but, in many cases, can be among the most challenging cases we see. Expertise in all aspects of soft tissue and implant management is vital to achieve success in these difficult circumstances.
A consultation with one of our skilled surgeons is recommended for any patient dissatisfied with her current breast implants. Call us at (303) 278-2600 to schedule an appointment at our plastic surgery practice in Golden or Denver.
OUR EXCEPTIONAL PLASTIC SURGEONS
Our experienced plastic surgeons Dr. Steven Vath, Dr. Andrew Wolfe, Dr. Paul Steinwald, Dr. Matthew Freeman, and Dr. Teresa Cunningham lead our patient-centered practice with warmth, honesty, and respect.