Revision Augmentation Including Implant Remove And Replace
There are a number of reasons why a patient may wish to have revision breast implant surgery. The most common of these is that a patient has had implants for a long time and either wishes to revise the size of implant, there may be suggestion on examination or through imaging that there may be an implant rupture or just replace an older implant with a newer model. Implants are not lifetime devices. There are also other reasons, less common, where the implant position may require some adjustment, there may be a ‘double bubble’ appearance or there may be suggestions of a capsular contracture or ‘hardening of the breast implant’.
Revision of a Breast Augmentation may also be performed to lift the breast and implant after either a loss of weight or pregnancy and breastfeeding. During both pregnancy and breastfeeding and weight loss the skin on the breast may stretch, leaving the implant sitting low in the breast and the nipple pointing low. In these cases, a breast lift and change of implants may be the recommended treatment.
Revision of Breast Augmentation can involve anything from a minor position adjustment of the implant, to a complex surgery involving changing of the implant, removal of the implant, fat grafting to the breast region and adjustment of the fold under the breast. In some cases, Dr Craig Layt may recommend multiple stages of surgery.
If you are seeing Dr Layt for the first time and your surgery was performed by another surgeon, we ask that you request information of your previous breast operations from your previous surgeon. It is very important to provide as much information and detail as possible about all of your previous surgeries including implants used. This enables Dr Layt to provide more information about the revision surgery he would recommend and why. Full disclosure is important in order to enable Dr Layt to achieve the best possible results in each individual case of revision surgery.
In some circumstances, you may be requested to obtain clinical imaging, such as ultrasound or MRI scans of your breasts and the implants. If there is fluid around the breast implant, you may also be required to have an aspiration of the fluid and to send this fluid to a pathologist for evaluation.
The costs of any Breast Revision Surgery will depend on many factors such as the complexity of the surgery, the time it will take for the surgery, whether new implants are required or if specific equipment is required. Most revision surgery of breast implants is considered cosmetic and will incur out of pocket expenses.
Risks and Complications
Surgery is not an exact science. Incisions and scars are part of any surgery and the location and extent of the incisions will be discussed with you. Every effort is made by the surgeon to minimise scarring. Scars will fade over time, but they are permanent. They can also become hypertrophic or keloid. Scars vary from person to person and are related to each individual’s skin type, genetics and the ability of their skin to heal.
Every surgical procedure involves certain risks and complications (as per the ASPS brochure) including, but not limited to:
Asymmetry is evident physically in every person. No two sides of the body are ever exactly symmetrical in shape, position or size and the surgeon will make every effort to achieve as close to symmetry as possible but some asymmetry is normal.
Delayed Healing, Infection and Suture Reactions can all be possible healing issues and may require antibiotics or in some cases surgical exploration.
Bleeding, Haematoma or Seroma Collections may resolve themselves but, in some cases may require further surgery.
Loss of Sensation and Numbness may also be experienced. In most cases this will improve over time on its own. In some cases this can be permanent.
Bruising and Swelling may also be a short term effect from surgery and will usually settle in one to two weeks.
Allergies to dressings, medical lotions, sutures or other materials can occur with some patients. You will be advised to cease the use of the dressing, lotion or material that is causing the reaction. In some cases anti-inflammatory medication may be prescribed.
Breathing Difficulties may be due to a general anaesthetic or breathing tube during the operation which has caused some swelling, noisy breathing or discomfort.
Blood Clots can also occur in some surgeries and may require urgent treatment and hospitalisation.
Pain thresholds vary from patient to patient. This may lead to different pain management and/or different recovery times to resume normal activities.
Achieving excellent results with minimal risk is a joint effort. It is important to disclosed to the surgeon and clinic and understand the following:
Full disclosure of your medical history including: allergies, personal, physical and mental history, previous surgeries, current medications and co-morbidities (including but not limited to, smoking, vaping, diabetes, prescription and illegal drug addictions, blood or heart disease, obesity or anorexia).
Co-morbidities may impact on outcome and healing post surgery.
Smoking, vaping, or taking recreational drugs must be ceased in the 6 weeks prior to some operations and during the healing phase. Failure to do so may increase the risk of complications, decrease your healing ability and affect your surgical outcome.
You should not take aspirin based prescription drugs 14 days prior to surgery and during the healing phase of the operation unless advised otherwise by the surgeon.
As per the Australian Health Practitioner Regulation Agency (AHPRA), all non-rebatable (cosmetic) procedures require a validated screening of Body Dysmorphia to be undertaken.
If Dr Layt is concerned about your mental state or physical state prior to the procedure, he may request evaluation by a psychologist, psychiatrist, general practitioner or other specialist. This referral is to assess your suitability, increased risks during surgery or any underlying physical or psychological problems which may affect your recovery or mental health.
In some cases this may require surgery to be postponed or cancelled by the doctor in his primary role to consider your care and personal well-being.
Complications with Breast Implants
Pregnancy may cause breast enlargement, cause breast tissue to stretch and a degree of ‘drooping’ of the breast tissue. This may require the breast to be surgically lifted however some poor skin integrity may have a tendency to stretch and continue to ‘drop’.
Capsular Contracture (less than 1%) occurs when the scar surrounding the implant thickens and tightens around the implant. This can make it feel hard, look unnatural, feel uncomfortable and may occur months to years later. Should this occur, a capsulectomy and a remove and replacement of implant/s may be required in the future.
Implant Rupture can occur after injury or years of repetitive action in the same part of the implant. MRI is the gold standard to assess this as Ultrasound shows a false positive reporting for rupture in approximately 30% of cases. A ruptured or leaking implant will require surgery of removal and replacement of the implant.
Implant ‘Wrinkles’ and Palpability can also be noticed. All implants ripple to a degree. If there is reasonable tissue coverage this will not be noticeable. If there is little overlying breast tissue and fat this is more likely.
Anaplastic Large Cell Lymphoma (ALCL) is a rare tumour of lymphoid cells in the breast which has recently been found to have an increased incidence in patients with textured breast implants. ALCL relates to a patients genetics, a textured implant and bacteria being present. This may present as a unilateral swelling of a breast due to fluid accumulation. When detected early, this is treated by removing the fluid and the implant. Dr Layt has and continues to perform this procedure utilising the 14 point plan to minimise the risks of ALCL, capsular contracture and other complications relating to using an implant.
In summary, the risks of bleeding, haematomas, capsular contracture, ALCL, infection, asymmetry, scarring, seroma, pain, palpable implant, loss of cleavage, sensation, implant malposition, implant rupture/leakage and breast feeding are discussed through the ASPS and The Layt Clinic information on Breast Augmentation. Implants may be removed and replaced over time and they are not lifetime devices. Implants used are registered with the Therapeutic Goods of Australia (TGA) and patients will be sent Patient Information Leaflet (PIL) regarding the implants chosen.
All surgery carries risks and it is important to understand these. Revision surgery is also often complex and more involved than initial surgery.