Revisional breast implant surgery

(capsule removal, explantation, implant exchange)

Revisional breast implant surgery on previously augmented or reconstructed breasts may be required for a number of medical reasons including:

1. Breast firmness or pain (from capsular contracture)

2. Deformed or distorted implants

3. Malpositioned implants

4. Ruptured or leaking implants.

5. Severe rippling or wrinkling of the implant.

6. Substandard implants e.g., PIP, trilucent, hydrogel implants

Such redo breast implant operations may also be performed merely because of the patient's desire for larger or a different make or shape of breast implants.

At the time of implant removal the scar envelope (capsule) around the implant may be left in place (capsulotomy), or removed (partial or total capsulectomy) or mobilised and used to support the implant (capsulorrhaphy. The breast implants themselves are almost always exchanged for new larger or smaller ones, or those of a different make or filler material or shape. Sometimes loose breast skin has to be removed at the same time (breast lift).

The treatment options therefore are

1. capsulotomy and implant removal

2. capsulotomy and implant exchange

3. capsulectomy and implant removal

4. capsulectomy and implant exchange

5. capsulectomy and implant exchange + change pocket

6. capsulectomy and implant exchange with a breast lift

7. capsulotomy and implant exchange + a breast lift

8. capsulotomy and implant removal + a breast lift

9. capsule repair (capsulorrhaphy) and implant exchange.

Where breast implants are removed and not replaced it is often necessary to perform a breast lift (mastopexy) either simultaneously or after a few months. Rarely enlarged lymph nodes are removed at the same time.

In breast reconstruction implant exchange is sometimes the planned 2nd stage of breast reconstruction especially after receiving radiotherapy – the implant pocket is often adjusted in this scenario.

Professor Malata will discuss with you the exact surgery required in your specific situation.

For Professor Malata’s publications on revisional breast implant surgery see the Breast Surgery Publications PDF

As in any cosmetic surgery, there are risks as well as benefits and the final results are not guaranteed. The chance of complications following revisional breast augmentation surgery depends on the exact type of operation needed and other factors such as your general health and smoking status. Professor Malata will explain how the risks apply to you. Detailed postoperative instructions will be discussed during consultation and a procedure-specific handout given to you by Professor Malata.

Some risks of revisional breast implant surgery

Frequent:

• bruising & swelling

• temporary numbness

• altered nipple & skin sensation: usually temporary

Infrequent:

• Bleeding & haematoma: more common than in primary surgery

• Recurrent breast firmness (capsules): common especially if previous radiotherapy

• Seroma formation: uncommon; very careful aspiration if gross/ causing discomfort.

• Implant malposition: infrequent: caused by fluid collection, Xs activity, smaller implants,

• Wound breakdown and implant exposure (if previous radiotherapy)

• Silicone controversy

• Wrinkles or rippling (palpable/visible): especially slim patients, medially, or in implant-only reconstructions

• Need for further revisional surgery: infrequent

Rare:

• Infection: very rare

• Exposure & loss of implant: very rare

• Poor scars: rare

• Permanent numbness of the breasts, skin and nipples/ nerve injury - rare.

• Pneumothorax (collapsed lung) – rare risk in posterior capsulectomy

• Unsatisfactory results: asymmetry, scars, pain, etc