Breast Implant Surgery Points to Consider

Key points to consider whether you are undergoing breast augmentation, reconstruction, or revision:
• Breast implants will not last a lifetime. Either because of rupture or other complications, you will likely need to have the implants removed.
•
• You are likely to need additional doctor visits and reoperations because of one or more complications over the course of your life.
•
• You are likely to have the implants removed, with or without replacement, because of one or more complications over the course of your life.
•
• Many of the changes to your breast following implantation may be cosmetically undesirable, as well as irreversible (cannot be undone).
•
• If you later choose to have your implants removed, you may experience unacceptable dimpling, puckering, wrinkling, loss of breast tissue, or other undesirable cosmetic changes of the breast.
•
Potential local breast implant complications are bulleted below. You may need non-surgical treatments or reoperations (including removal of your implant) to treat any of these local complications. Potential local complications include, but are not limited to:

. Asymmetry
. Breast pain
. Breast tissue atrophy
. Calcification/calcium deposits
. Capsular contracture
. Chest wall deformity
. Delayed wound healing
. Extrusion
. Galactorrhea
. Granuloma
. Hematoma
. Iatrogenic injury/damage
. Infection, including Toxic Shock Syndrome

. Inflammation/irritation
. Malposition/displacement
. Necrosis
. Nipple/breast sensation changes
. Palpability/visibility
. Ptosis
. Redness/bruising
. Rupture/deflation
. Scarring
. Seroma
. Unsatisfactory style/size
. Wrinkling/rippling

it is likely that you will need to have one or more reoperations over the course of your life because of local complications from breast implants.

Reasons for reoperations could include any of the potential local complications bulleted above, such as capsular contracture, wrinkling, asymmetry, rupture/deflation, implant malposition, etc.

The type of surgical procedure(s) performed during the reoperation depends on the local complication involved. More than one procedure may be performed in a single reoperation. Examples of the types of surgical procedures that may be performed in a reoperation include:

• implant removal with or without replacement
• capsule procedure (e.g., removal or surgical release of the capsule)
• scar or wound revision (e.g., surgical removal of excess scar tissue)
• drainage of a hematoma (e.g., inserting a needle or tube through the skin to drain the collection of blood)
• repositioning of the implant (e.g., surgically opening the incision and moving the implant)
• biopsy/cyst removal (e.g., inserting a needle through the skin or cutting through the skin to remove a lump).
Multiple reoperations to either improve the appearance of the breasts, to remove ruptured/deflated implants, or both may result in an unsatisfactory cosmetic outcome.

Removal of Breast Implants

Removal of the implant(s), with or without replacement, is one type of surgical procedure that may be performed in a reoperation. As stated above, you are likely to have your implant removed at some time over the course of your life because of one or more local complications.

Reasons for removal could include any of the potential local complications bulleted above, such as capsular contracture, wrinkling, asymmetry, unsatisfactory size/style, etc. Many women decide to have the implants replaced, but some women do not. Women who do not have their implants replaced may have cosmetically undesirable dimpling, puckering, or sagging of the breast following removal of the implant, or both. Recall that some health insurance companies may not cover implant removal or implant replacement even though the first implant surgery was covered by health insurance.

Rupture/Deflation of Breast Implants

Breast implants do not last a lifetime. Some breast implants rupture/deflate 14 in the first few months after being implanted and some deflate after several years. Others may take 10 or more years to rupture/deflate.

The following surgical practices are contraindicated (not recommended) for the approved saline-filled breast implants because they are known to cause rupture/deflation:

• closed capsulotomy (technique used to relieve capsular contracture involving manually squeezing the breast to break the hard capsule)
• placement of drugs/substances inside the implant other than sterile saline
• any contact of the implant with Betadine® 15
• injection through the implant shell
• alteration of the implant
• stacking of the implants (more than one implant per breast pocket).
•
In addition to the surgical practices above that have been shown to cause rupture/deflation of saline-filled breast implants, there are other reasons for rupture/deflation of breast implants. Companies are currently studying what these other reasons are.

Some possible reasons for rupture/deflation of breast implants include:

• normal aging of the implant
• damage by surgical instruments
• too much handling during surgery
• damage by procedures to the breast, such as biopsies and fluid drainage
• compression during mammographic imaging
• stresses such as trauma or intense physical pressure
• capsular contracture
• overfilling or underfilling of saline-filled breast implants
• placement through an umbilical (belly button) incision site because it involves too much handling of the implant.
•
Doctors usually recommend removal of the implant if it has ruptured, regardless of whether it is saline-filled or silicone gel filled.


Rupture/Deflation of Saline-Filled Breast Implants

 Saline-filled breast implants rupture/deflate when the saline solution leaks either through an unsealed or damaged valve or through a break in the implant shell. Implant deflation usually happens immediately but sometimes it happens slower over a period of days. Deflation of saline-filled breast implants is noticed by a loss of size or shape of the implant.

Rupture/Deflation of Silicone gel filled Breast Implants - Because silicone gel is thicker than saline, when a silicone gel filled breast implant ruptures, the gel may remain contained within the fibrous capsule. This is called an intracapsular rupture. An intracapsular rupture is usually a silent rupture, which means that it happens without a visible change or feel by the woman and is not evident by a physical examination by the doctor. Because the woman and her doctor will not see or feel any changes with a silent rupture, a magnetic resonance imaging (MRI) examination is needed to determine whether or not a silent rupture has happened. MRI with equipment specifically designed for imaging the breast is currently the most sensitive method for detecting rupture of a silicone gel filled breast implant in women with silent ruptures.

With some silicone gel filled implants ruptures, women may notice a decreased breast size, a change in breast implant shape, hard lumps over the implant or chest area, an uneven appearance of the breasts, pain or tenderness, tingling, swelling, numbness, burning, or changes in sensation. Ruptures of this type are called symptomatic (show symptoms) and are usually extracapsular (gel outside the fibrous capsule). However, some extracapsular ruptures can be silent (show no symptoms).

Silicone gel that escapes the scar capsule surrounding the implant may migrate away from the breast. The free silicone gel may cause lumps called granulomas to form in the breast or in other tissues where the silicone gel has migrated, such as the breast tissue, chest wall, armpit, or arm. Silicone gel may also migrate to distant organs such as the liver. Migrated silicone gel may be difficult or impossible to remove.


Capsular Contracture

Capsular contracture happens when the scar tissue or capsule that normally forms around the implant tightens and squeezes the implant. It can happen to one or both of the implanted breasts.

There are four grades of capsular contracture - Baker grades I through IV. The Baker grading is as follows:

Grade I the breast is normally soft and looks natural
Grade II the breast is a little firm but looks normal
Grade III the breast is firm and looks abnormal
Grade IV the breast is hard, painful, and looks abnormal.

Capsular contracture may be more common following infection, hematoma, and seroma. However, it is not known for sure why capsular contracture happens. The literature also discusses other factors, such as a textured implant surface and submuscular placement of the implant, which may decrease the capsular contracture rate.

A reoperation may be needed to correct capsular contracture, usually for grade III or IV capsular contracture. The surgical procedures range from removal of the implant capsule tissue with or without replacement of the implant itself. Capsular contracture may happen again after this reoperation.


Breast Pain

Women may feel pain of varying degrees and length of time following breast implant surgery. In addition, improper size, placement, surgical technique, or capsular contracture may result in pain. You should tell your doctor if you have pain.

Nipple and Breast Sensation Changes

Sensation (feeling) in the nipple and breast can increase or decrease after breast implant surgery. The range of changes varies from intense sensation to no sensation in the nipple or breast following surgery. Changes in sensation can be temporary or permanent and may affect sexual response or the ability to nurse a baby.

 

Removal of Breast Implant without Replacement

There is a high chance that women with breast implants will need additional surgery at some point to replace or remove her implant(s) due to problems such as deflation, capsular contracture, infection, shifting, and calcium deposits. Many women decide to have the implants replaced, but some women do not. Those who do not have their implants replaced may have cosmetically undesirable dimpling and/or puckering of the breast following removal of the implant.

 

Breast Enlargement : Breast Reduction : Breast Uplift : Brow Lift :  Chin Implant : Ear Surgery :

 Eyelid Surgery : Face Lift : Liposuction  : Male Breast Reduction : Rhinoplasty : Tummy Tuck