Breast implants can achieve optimal results in terms of enhancing the shape and volume of the breasts. However, it is important to keep in mind that they are synthetic, which means they are not a life-long solution.
Understanding the Reasons for Breast Implant Removal or Revision
Implants may need to be removed or replaced for a variety of reasons. One of the most common reasons is breast implant rupture, which can occur due to trauma or a breakdown in the integrity of the implant shell, causing the implant to leak. Other reasons include bottoming out or double bubble formation.
If an implant ruptures, it causes a change in the shape of the breast. However, most implant ruptures are silent and are first detected during a routine breast scan. Capsular contracture is another side effect associated with breast implants, causing the breasts to harden. In the past, there have been various theories about the causes of capsular contracture, but the most common theory is that it’s linked to implant infection or contamination.
There are various stages of capsular contracture, ranging from a mild hardening of the breast implant (and breast) to a more noticeable hardening, pain and distortion of the breast. A classification system, known as the Baker Classification system, can be used to grade the severity and extent of capsular contracture. Grade 3 and 4 capsular contracture can result in the breast taking on an abnormal shape, leading to noticeable differences between the two breasts.
Here are some of the other reasons why breast implants are removed:
- A personal decision not to have implants anymore
- The decision to replace the implants with a natural alternative such as breast fat grafting
- Eliminate the symptoms associated with breast implant illness
- The implant contours have become visible due to thin skin
- The decision to undergo a breast lift or breast reduction
Here are some of the other reasons why breast implants are replaced:
- The decision to change from textured to smooth implants
- The desire to change breast implant volume
- Unwanted visibility of the implant contour
- A change in implant position
- To correct breast abnormalities such as double bubble or waterfall deformity
When undergoing breast implant removal or revision, there are various factors that need to be considered, including:
- The quality of your native breast tissue
- Degree of sagginess
- Whether or not you want the implants to be removed and replaced at the same time
- Placing the implants back into the same pocket or not
- How the breasts will be affected after removal
A consultation with Dr Chaithan Reddy can be arranged at any one of his North Shore, Central Coast, and Norwest Plastic surgery clinics to discuss all of the above factors pertaining breast implant replacement or revision surgery.
Breast Revision Surgery: What You Can Expect
The procedure takes approximately 1 – 2 hours depending on your specific requirements. The duration of your surgery will be longer if you are also having a breast lift procedure to restore your breast shape following implant removal, or if you are also having a breast fat grafting procedure to optimise the results of your breast implant revision surgery.
Dr Reddy performs Breast implant revision surgery in fully accredited hospitals in Sydney and the Central Coast region. The procedure is performed under general anaesthesia. Once you are asleep, the incision will be typically made in the inframammary crease (under breast crease) and the breast implant capsule will be identified. The need to undertake capsulectomies will largely depend upon the state of the breast implant capsules and the reason for the implant removal. Factors that will be considered include the presence of capsular contracture, infection, and the extent of calcification.
If your implants are being replaced, it is generally advisable that the new implants be inserted into a new pocket. This minimises the risk of potential implant rotation, malposition and infection in the future. The type and volume of your new implants would have also been discussed at your pre-operative consultation. In some instances breast fat grafting may be desired or needed to optimise the results of your breast implant revision surgery. In women with rippling or very thin skin, fat grafting can serve as a very effective tool in addressing unwanted implant visibility.
A breast lift (mastopexy) procedure may also have been planned during your breast implant revision surgery. This is because the presence of implants can change the shape of your breasts over time and this is more likely if you previously had larger implants in place. A mastopexy procedure will lift and restore the position and contours of your native breast tissue. The procedure is also more likely required if you have chosen not to have your implants replaced or if you have elected to downsize your implants. This is because the resulting loose breast tissue that follows implant removal will require tightening in order to optimise breast contour.
Breast Implant Removal & Revision Surgery FAQs
If you’ve undergone breast surgery in Australia or overseas and are not happy with the results, a consultation can be arranged to discuss the various treatment options available. Breast implant revision surgery does not necessarily mean that the implants will have to be removed or replaced. If breast implant replacement is required, Dr Reddy has a proven track record and an excellent safety profile.
Even though your implants may have been inserted using a different technique, breast implant removal typically requires an incision to be made in the infra-mammary fold (under the breast crease). Most implants will have been inserted using this approach anyway, so revision surgery can be performed using the existing scar. If you choose to undergo a breast lift at the same time as breast implant removal, the implants can be removed via your breast lift incision.
Breast capsulectomy refers to the removal of the capsule that forms around your existing breast implants. Capsules routinely form around breast implants because it’s the body’s natural response to the implants. The capsules are usually made up of normal, healthy tissue but in some instances, they can calcify or become hard – this is known as capsular contracture. If the breast implant capsules have become hard or calcified, they should ideally be removed.
If the capsules are healthy, they don’t always need to be removed. In some instances, the breast capsule can be modified and used to support new implants if you are having your implants replaced or repositioned. This is sometimes referred to as an ‘internal bra’. The decision to have part or the entire breast capsule removed would be based on the reason for implant removal, which will be discussed with you prior to your surgery.
If the entire capsule needs to be removed, it is known as ‘total capsulectomy’. This is typically performed on women who have capsular calcification or hardening (capsular contracture). It may also be performed on women with ruptured breast implants or in cases where the implant needs to be removed following breast implant illness. En bloc capsulectomy can also be performed, which entails removing the implant and capsule as one entity. This is particularly important when an implant has ruptured because it prevents any silicone gel spillage.
Breast implants can be placed in a subpectoral, subglandular, subfascial position or a dual plane position.
- Subpectoral. This means that the implants are placed under the chest (pectoralis) muscle. There are various advantages to placing implants under the muscle. The muscle helps camouflage the upper border of the implant, particularly in thin-skinned individuals. The risk of capsular contracture is also reduced in women with subpectoral implants. Implants placed in a dual plane position are placed primarily under the muscle, with the lower portion of the implants covering the breast gland only, which allows for better shape control.
- Subfascial. This means that the implants are placed under the muscle lining (fascia). The ability to put implants in a subfascial position will depend on how defined the fascia is, which varies between patients.
- Subglandular. This means that the implants are placed under the breast gland and over the chest muscle. This is feasible in women who have enough breast tissue to adequately conceal the underlying breast implant. There is less risk of a waterfall deformity with subglandular implants (when compared to submuscular implants), but this needs to be carefully weighed up against the higher risk of breast capsular contracture.
In women undergoing breast implant revision surgery, it is recommended that the implant be placed in a new pocket. The ‘pocket’ is a descriptive term referring to where the implant is located (over or under the muscle).
If the implants being removed are situated above the muscle, the new implants should ideally be placed under the muscle. This ensures that the new pocket is tailored to the size of the new implant. Furthermore, the pockets from which the old implants are removed won’t be suitable for new implants due to size variability and breast capsule issues.
There is one exception to this rule though. When the old implants are situated under the muscle, it may not be suitable to place the new implants above the muscle. This is particularly the case when the patient has thin skin, which means the new implants would be poorly camouflaged. In these instances, the implants can be placed in a neo-plane position, which means the new implants are still placed under the muscle but in a new pocket – typically between the existing breast pocket and the muscle.
There are a number of breast implant sizes and styles on the market. There are various factors to consider when deciding what implants to use, including:
- Breast implant volume
- Breast implant shape
- Breast implant texture
Breast implant volume considerations
The size you choose is a personal decision. However, you should consider the existing width of your chest as well as your overall body shape. Sometimes, going too large can lead to what is referred to as excessive ‘side-boob’. This means that the outer contour of your breasts project well beyond the side of your chest. While this can be appealing to some, others might find it annoying, particularly when exercising or running. Similarly, a large implant can lead to a top-heavy appearance and change your overall body shape. The weight associated with larger implants can also cause long-term changes such as stretched skin and early-onset breast sagginess. While most implant sizes can be accommodated, it is important to consider these factors before making your final decision.
Breast implant shape considerations
Breast implants come in round or teardrop (anatomical) shapes. Teardrop implants offer more of a natural breast shape, while round implants tend to create a more projected appearance, particularly at the top of the breast. One issue that is specific to teardrop implants is breast implant rotation. If rotation of a teardrop-shaped implant occurs, the shape of the breast is altered.
Breast implant shape is, again, a personal choice, but it is important to note that the final shape is not reliant on breast implant shape alone. Your native breast shape will significantly influence the final result, regardless of the implant you choose. In many instances, it is very difficult, and sometimes impossible, to determine whether a round or teardrop implant has been used based on breast appearance alone.
It’s also important to consider the type of gel that is used in silicone implants. This can have a significant impact on the final breast shape and is something Dr Reddy can discuss with you in more detail during your consultation.
Breast implant texture considerations
Breast implants can be smooth or have a textured surface. As the name implies, smooth implants have a shiny, smooth surface. Textured implants have a rough feel to them. There are various processes used by breast implant manufacturers to produce textured implants. The degree of texturing can also vary, which is why there are macro-textured, micro-textured, and nano-textured implant options available. Textured implants are known to reduce the rate of capsular contracture. It is also said that the texture leads to stronger capsule formation, which reduces implant migration risks.
Of late, the media has highlighted concerns about breast implants with a higher degree of surface texturing (macro textured implants). It is important to consider the data pertaining to textured implants when coming to a suitable decision about implant choice.
Please refer to our blog on BIA-ALCL for relevant information pertaining to textured implants.
Yes, this is certainly feasible. A good alternative option for women wishing to preserve breast volume after implant removal is breast fat grafting.
Please refer to our breast fat grafting page for a detailed overview of this option.
A Medicare item number will commonly apply to patients requiring breast implant revision surgery. Furthermore, if you are part of a private health fund, and depending upon your level of cover, the cost of new implants (if required) and any associated hospital costs may be completely covered.
Breast augmentation revision surgery may be performed as a day procedure, although, it is more likely that a one to two night hospital stay will be required, particularly if additional procedures are performed at the same time. A specific post-operative instruction plan will be discussed and given to you at the time you are discharged from the hospital to ensure that you are completely at ease during your recovery period at home. A community nurse is also usually arranged to assist you with aftercare at home.
Discomfort can range from minimal to moderate depending upon the individual and the extent of the breast revision surgery. Most patients can comfortably walk around on the same day as their surgery. Bruising may be evident along and near the incision lines but it will gradually subside and shouldn’t last longer than two weeks. Patients should generally allow for up to two weeks of downtime, although you may return to work sooner if your job is not overly strenuous. It is generally advised that you do not drive for the first two weeks after surgery. It is also important to avoid any strenuous activities for approximately four weeks in order to minimise potential bleeding, bruising and swelling.
Dr Reddy will see you throughout your recovery period. You will be able to attend to your self-care needs shortly after surgery and you will be able to shower on day one post-surgery. Following your discharge from hospital, a community nurse may be arranged to assist you with wound and drain care at home, if required. You will have to attend a post-operative check-up approximately 5-10 days after being discharged from hospital – all dressings will be removed during this visit. Instructions on taping the incision line and advice on scar management will be provided. It is recommended that you wear a compression garment without an underwire for a total of six weeks. Underwire bras may be worn after this point in time. Sufficient bra support will help minimise the risk of breast ptosis (sag) in the future. Providing you have a referral letter from your general practitioner, all subsequent follow-ups for the first year are included in your surgical fee and you will continue to be monitored until Dr Reddy is completely satisfied with your progress.
Your new breast size and shape will be apparent immediately after your revision surgery. Bruising and some degree of swelling will, however, be present at this stage. This will subside completely by the 1- 2-month post-operative mark.
Breast Implant Revision Surgery
Every patient is unique and results may vary. Surgery and all health-regulated services carry risks, which need to be discussed with your doctor to ensure you are fully informed and have realistic expectations.
If you would like to read more about the link between breast implants and ‘BIA-ALCL’ you can read Dr Reddy’s blog post here.
If you would like to read more about the role of fat grafting with breast implant revision surgery, please refer to our breast fat grafting section.