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by Dr. Gregory T. Lynam

Implant Replacement

According to the American Society of Plastic Surgeons and
the FDA, There Are Reasons a Follow Up Procedure May
Be Necessary After Receiving Breast Implants.

Will I Need to Replace My Breast Implants?

Per the FDA, below are some things the FDA thinks you should consider before undergoing breast augmentation, reconstruction or revision (replacement) surgery.
• Breast implants are not lifetime devices, the longer you have your implants, the more likely it will be for you to have them removed.
• The longer you have breast implants, the more likely you are to experience local complications and adverse outcomes.
• The most common local complications and advere outcomes are capsular contracture, reoperation and implant removal. Other complications include rupture or deflation, wrinkling, asymmetry, scarring, pain, and infection at the incision site.
• You should assume that you will need to have additional surgeries (reoperations).
• Many of the changes to your breast following implantation may be cosmetically undesirable and irreversible.
• If you have your implants removed but not replaced, you may experience changes to your natural breasts such as dimpling, puckering, wrinkling, breast tissue loss, or other undesirable cosmetic changes.
• If you have breast implants, you will need to monitor your breasts for the rest of your life. If you notice any abnormal changes in your breasts, you will need to see a doctor promptly.
• If you have silicone gel-filled breast implants, you will need to undergo periodic MRI examinations in order to detect ruptures that do not cause symptoms (“silent ruptures”). For early detection of silent rupture, the FDA recommends that women with silicone gel-filled breast implants receive MRI screenings 3 years after they receive a new implant and every 2 years after that. MRI screening for implant rupture is costly and may not be covered by your insurance.
• If you have breast implants, you have a risk of developing a type of cancer called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) in the breast tissue surrounding the implant. BIA-ALCL is not breast cancer. Women diagnosed with BIA-ALCL may need to be treated with surgery, chemotherapy and/or radiation therapy.

According to the American Society of Plastic Surgeons, below are a few of the reasons a follow-up procedure may be necessary after receiving breast implants.

Rupture or deflation: Exceedingly rare in both saline and silicone implants. If it does occur, however, a revision will be necessary.

Development of capsule contracture: If scar tissue forms around your breast, it can harden and change position and/or shape. In these instances, another procedure to replace the implants can alleviate the issue.

Dissatisfaction with initial results, or a desired change in breast size.

The goal of breast implant revision surgery is to replace old breast implants with new implants. Often the goal is also to change or improve the appearance of the breasts while updating the implant material, which could include:
• A concurrent breast lift or reduction
• Reshaping the breast implant pocket to reposition the implant on the chest
• Either increasing or decreasing the size, shape or style of the breast implant

The desire to have breast implant revision surgery can be because of any of the following reasons:
• Desire to change the size of the breasts
• Pain from capsular contracture
• Concern about rupture or migration of implant
• Change from saline to silicone or different style of implant

Over time, breast implants can change shape or size, and the overlying breast tissue can also change, creating an appearance or feel to the breast that is less desirable than the original result. Also, many breast implants have a lifetime warranty on the actual implant device, but after ten years the costs associated with having surgery to replace the implants are no longer covered. Because of this, many women will elect to replace or update their breast implants at or around the 10-year time frame.

Breast implant revision surgery is not a standard or routine procedure and needs to be tailored specifically to the patient’s goals and desires. Therefore, this surgery should be performed by a board-certified plastic surgeon who is well-trained and experienced in all types of breast surgery and who will listen to the patient’s goals and desires and will develop a surgical plan specifically to address all of the issues at the time of surgery.

Who is a good candidate for breast implant replacement/revision?

Breast implant revision surgery is intended for patients who have had a breast augmentation in the past and are now unhappy with their implants or concerned about the condition of their implants. This procedure can address those concerns by replacing the existing implants with new implants.

In general, you may be a good breast implant revision candidate if:
• You are unhappy with size, shape or appearance of your breast implants
• You are concerned about the integrity or condition of your implants
• You are physically healthy and at a stable weight
• You have realistic expectations
• You are a nonsmoker

If you’re considering surgery, spend some time reviewing breast implant revision surgery photos and learning about what to expect during recovery. Preparation ahead of time helps patients have reasonable expectations and a smoother recovery.

What is the cost of breast implant replacement/revision?

A plastic surgeon’s cost for breast implant revision surgery may vary based on his or her experience as well as geographic location. In some instances, health insurance may cover breast implant revision surgery. Also, in some instances, the implant warranty will cover some of the costs associated with this surgery.

Many plastic surgeons offer patient financing plans for breast implant revision surgery in instances where health insurance does not cover it, so be sure to ask.

Breast implant revision costs may include:
• Surgeon’s fee
• Hospital or surgical facility costs
• Implant costs
• Anesthesia fees
• Prescriptions for medication
• Post-surgery garments
• Medical tests and x-rays

When choosing a board-certified plastic surgeon for breast implant revision surgery, remember that the surgeon’s experience and your comfort with him or her are just as important as the final cost of the surgery.

What should I expect during a consultation for breast implant replacement/revision?

During your breast implant revision consultation, be prepared to discuss:
• Your surgical goals
• Medical conditions, drug allergies and medical treatments
• Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use
• Previous surgeries

Your plastic surgeon will also:
• Evaluate your general health status and any pre-existing health conditions or risk factors
• Examine your existing breast implants
• Take photographs
• Discuss your options and recommend a course of treatment
• Discuss likely outcomes of breast implant revision surgery and any risks or potential complications

The success and safety of your breast implant revision procedure depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.

Be sure to ask your plastic surgeon questions. It’s very important to understand all aspects of your breast implant revision surgery. To help, we have prepared a checklist of questions to ask your plastic surgeon that you can take with you to your consultation.

It’s natural to feel some anxiety, whether it’s excitement or a bit of preoperative stress. Don’t be shy about discussing these feelings with your plastic surgeon.

What questions should I ask my plastic surgeon about breast implant replacement/revision?

Use this checklist as a guide during your breast implant revision consultation:
• Are you certified by the American Board of Plastic Surgery?
• Were you trained specifically in the field of plastic surgery?
• What specific training do you have in breast implant revision techniques?
• How many years of plastic surgery training have you had?
• Do you have hospital privileges to perform this procedure? If so, at which hospitals?
• Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
• Am I a good candidate for this procedure?
• What will be expected of me to get the best results?
• Where and how will you perform my procedure?
• What surgical technique is recommended for me?
• How long of a recovery period can I expect, and what kind of help will I need during my recovery?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• How can I expect my breast implant revision to look over time?
• What are my options if I am dissatisfied with the outcome?
• Do you have before-and-after photos I can look at for this procedure and what results are reasonable for me?

Risks and Safety

Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedures you will undergo and any risks or potential complications.

The possible risks of breast implant revision surgery include, but are not limited to:
• Bleeding
• Infection
• Poor healing of incisions
• Hematoma
• Anesthesia risks
• Fluid accumulation (seroma)
• Skin loss
• Numbness or other changes in skin sensation
• Skin discoloration and/or prolonged swelling
• Unfavorable scarring

These risks and others will be fully discussed prior to your consent. It’s important that you address all your questions directly with your plastic surgeon.
• Recurrent looseness of skin
• Fatty tissue found deep in the skin might die (fat necrosis)
• Deep vein thrombosis, cardiac and pulmonary complications
• Asymmetry
• Suboptimal aesthetic result
• Possible need for revision surgery
• Persistent pain

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