Breast Implant Revisions
Breast implant revision, also referred to as breast augmentation revision, is a surgical procedure involving the removal and/or replacement of breast implants to correct complications that have occurred after breast augmentation or implant-based breast reconstruction surgery. Breast implant revision can also be performed to correct an unsatisfactory result from either of the aforementioned surgeries.
Removal of Implants
For some patients, unrelated health problems can arise that require the removal of implants. An example is the diagnosis of breast cancer - although breast cancer is not linked to breast implants, treatment of the disease may be more effective after breast implant removal. Implants may also require removal due to implant complications, such as rupture, severe capsular contracture (hardening of the implants) or shifting of the implant.
Lifestyle changes are another motivating factor behind breast implant revision, replacement, or removal. A woman may simply decide she no longer desires implants, or that the specific size she opted for no longer meets her cosmetic goals. Whatever the reason, any patient dissatisfied with her breast implants is a potential candidate for implant revision.
Is it right for you?
Some women experience unwanted complications after breast augmentation or implant reconstruction, such as asymmetry, breast pain, implant deflation, and other side effects. Some women want their implant removed for breast screening purposes, as presence of implants can decrease the effectiveness of mammograms. Others have implant rupture and calcified silicone leak which can obscure breast cancer on mammography. These ladies often require not just removal of the implants but also excision of calcified lumps of leaked silicone (also known as ‘silicomas’).
Patients who are simply dissatisfied with the results of their breast augmentation may be candidates for a revision. The cause of dissatisfaction will need to be established (size, shape or position). Expectation will also need to be re-established and confirmed - whether it is realistic and whether removal and replacement will achieve this. Speaking frankly with your surgeon during your consultation is essential for him/her to fully determine if a breast implant revision is practical and applicable in your circumstance.
Options in Implant Revision Surgery
Implant Removal without Replacement
Implant Revision is performed under General Anaesthesia. Regardless of previous incisions used for implant insertion, implants are often removed via an inframammary incision to allow visibility and access. The incision is made in the inconspicuous crease at the base of the breast to minimize visible scarring.
If your implants are being removed due to capsular contracture, concurrent removal of the capsule (capsulectomy) with the implant is essential to prevent recurrence.
If your implants are being removed due to rupture and silicone leak, often breast tissue affected by the silicone or calcified silicone deposits may require removal to allow adequate breast screening on mammogram.
If no replacement or other concurrent surgery is being done, drains are inserted to close the redundant space left by absence of the implants. The incision is then sutured closed. Often the stretched breast tissue will become floppy and droopy once the implants are removed.
Removal & Replacement
Implants can be replaced after removal. The implant size and shape, as well as the pocket in which the implants are re-inserted are determined by the reason for removal in the first place. For example, for implants which are removed due to capsular contracture, the implants are often replaced in a different pocket (usually under the muscle) to prevent recurrence of the contracture.
Sometimes, if the implants are new and just removed and replaced due to wrong positioning, the implants do not have to be changed, and can just be washed and re-inserted once the correct position and pocket has been created.
Replacement of breast implants may not be suitable for everyone. For example, if implants are being removed to maximise mammography screening, replacement with new implants are not recommended as the presence of implants can decrease efficacy of mammography. In some instances, replacement of the implants may need to be done as a delayed secondary procedure. For example, where implants are being removed in the setting of an infection.
Several factors will need to be considered when replacing an implant:
- Type of implant
- Size of implant (smaller, bigger or the same size)
- Plane of placement (using the same pocket or a different pocket)
- The position (does the pocket need adjustment or adjuncts such as prosthetic slings/mesh will need to be used to anchor the implant in place)
During your consultation and physical assessment, your surgeon will discuss all the above component of implant replacement surgery with you to individualise your surgical plan according to your cosmetic needs.
Removal & Breast Lift
When implants have been removed, the breast tissue and skin are often stretched and can appear very droopy. Most of the breast tissue will hang low with the nipple sitting at the bottom half of the breast and pointing downwards. A breast lift can significantly improve the shape and cosmetic outcome. Often, with shortening and tailoring of the stretched breast skin, the breast tissue can be centralise and tightened to re-create the volume of a normal-looking breast mound. This procedure will also not affect any future breast imaging. The trade-off of a breast lift is the extensive incision (and thus scarring) involved as part of the breast lift.
Breast lifts may be done at the time of breast implant removal or as a secondary procedure. This is dependent on several factors (e.g. the implant pocket, the amount of breast tissue, integrity of the skin etc). After your assessment, your surgeon will discuss the recommended option with you.
Not all breasts after implant removal are suitable for breast lift surgery. To achieve an aesthetic result with a breast lift, there must be adequate natural breast volume to lift. To find out more about Breast Lift, please click here.
Specific Risks of Implant Revision
The decision to have implant revision surgery is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable.
Your surgeon will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure your have chosen and accepting of possible risks or potential complications.
The risks of implant revision surgery include:
- Unfavourable scarring
- Bleeding (hematoma)
- Poor healing of incisions
- Changes in nipple or breast sensation, may be temporary or permanent
- Capsular contracture, which is the formation of firm scar tissue around the implant
- Implant leakage or rupture
- Wrinkling of the skin over the implant
- Anaesthesia risks
- Seromas (Fluid accumulation under skin or around implant)
- Blood clots
- Pain, which may persist
- Deep vein thrombosis, cardiac and pulmonary complications
Most of the risks are very uncommon, and some people (with particular health problems or specific breast features), may be at higher risk for specific complications. Your surgeon will discuss this with you during your consultation if any of these risks are specifically pertinent to you.
Although this surgery can be an effective procedure where the benefits significantly outweigh the risks, like everything in the practice of medicine and surgery, it is not an exact science. The degree of surgical success can be altered by how each individual’s body responds to surgery and healing. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure; revision surgery may be necessary.
Be sure to ask questions: It’s very important to ask questions about your procedure. 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 and any specific concerns with your surgeon or any of our staff members.
How do I arrange a consultation?
It is required by the current cosmetic surgery regulations for you to have a referral from your GP if you would like to have a consultation for breast implant revision. This would ensure that before your consultation, your GP has considered and assessed your general health status and that you have had the appropriate scans required.
To make an appointment, you or your GP must send or email us the referral with your medical history first. Once received, a file will be created for you on our system awaiting you to contact us. This process takes approximately 1-2 working days. You can then organise an appointment by calling our reception staff on 3353 6165. We do not offer appointment via email, social media or text message.
For patient who choose to have breast implant replacement for cosmetic purposes (not reconstructive), it is a requirement from the Regulations for Cosmetic Surgery, for you to have two consultations prior to surgery. Your first consultation will involve a general discussion of your health and your expectations to see if you are suitable for surgery. If surgery is appropriate, there will be a discussion on the surgical option(s) recommended, postoperative recovery, possible outcomes and expectations, as well as potential risks. At the end of your first consultation, you will receive an estimate of fees and costs.
A psychological assessment is part of the regulation requirement, and this is done through a number of questions that your surgeon will ask you. Testing may occur either during your first or second consultation. If there are any major concerns with the testing result, you may not qualify for surgery and may be referred to a psychologist for further assessment.
The second consultation will be a re-discussion of the procedure, outcomes, risks and possible complications. It will also involve signing of consent forms, measuring for the postoperative bra, and addressing any questions or concerns you may have. After your second consultation, we will provide you with a list of potential available dates for surgery.
According to the regulation, you will not be allowed to book your procedure date until 7 days after your second consultation (known as the 'cooling-off period', at which time you will be able to contact us via phone or email to book in your procedure. A booking fee will apply to secure your surgery date.
Further consultation can be made if you have more questions or concerns prior to your surgery. Similarly, if you require reassessment due to any recent health issues or body changes (e.g. newly diagnosed medical conditions, new medications, change in weight, recent hospitalisation), your surgeon may require you to attend additional appointments.
For patients who are not having implant replacement or having replacement for reconstructive purposes, two consultations may still be required but there will be no psychological assessment or cooling-off period applied.
Please also note that your surgery consent is only valid for 6 months, if you book in for surgery more than 6 months after your last consultation, you will need another consultation prior to booking your procedure.
After the operation, your breast is covered in gauze and elastic foamy bandage to give your breasts support. You will have thin tubes (drains) from each breast. Hospital stay can range from 1-5 days dependent on drain output. Once the drains are removed, you will be able to go home. A special garment may need to be worn for 2-8 weeks depending on the type of surgery. If implants were replaced, no underwire bra should be worn for a minimum of 3 months.
You will have a minimum of two postoperative appointments with our nurses in the dressing clinic within the first 4 weeks, and a review with your surgeon at 8-12 weeks depending on the procedure performed. More appointments can be made if required. It is advised that if you have any concerns during your recovery period, you contact our nurses in the office via phone.
Although the breast skin and tissue are already accustomed to the presence of implants, recovering from implant revision is very similar to the recovery experienced after the initial implant surgery. Symptoms such as swelling, soreness, and stiffness are to be expected for the first week or two. If the implants have not been replaced, the recovery is often quicker and you can return to usual activities sooner.
Exercise and normal activity can resume at your surgeon's advice and as mentioned above, is dependent on the extent of your surgery. Over time, post-surgical swelling will decrease, and incision lines will fade. The breasts will settle into its final shape at around 4-6 months.
For more information, please browse our Postoperative Instructions page under Patient Resources.
Results and Expectations
It may take up to 6 months after your breast revision surgery to see the final result. Over the first few months, post-surgical swelling will resolve and incision lines will fade. If you have had implants replaced, these will take time to settle and 'drop' into their position to create your breasts' new shape. If you did not have replacement, the stretched skin and contour irregularities will take time to retract. The scarring inside will also soften over the course of 6-9 months and the pulling or tethering on the skin will improve.
If any possible revision or planned secondary surgery is required, this will be assessed at your 3-month postoperative consultation with your surgeon.
Costs associated with Implant Revision Surgery
Implant revision surgery may be covered by private health insurance. However, this would depend on several factors:
- The type of insurance policy you have
- The reasons for your initial implant surgery (e.g. cosmetic or reconstructive)
- Whether you are having your implants replaced or not replaced
Implant removal with no replacement, whether it is performed for implant complications or not, can be covered under private health insurance if you have the right level of cover. Implant replacement is only covered by private health insurance if the implants were inserted for reconstructive purposes previously. However, some policies may exclude reconstructive breast surgery. Each insurance policy varies greatly. Carefully review your policy to determine coverage prior to surgery. If a mastopexy (breast lift) is required, it is almost always considered cosmetic and not rebatable.
Some implants may be under a life-time warranty. So if you are having your implants replaced due to rupture and/or capsular contracture, and you still have the records of your old implants, it may be worth contacting the implant company and ask about any possible reimbursement in regard to removal and replacement of the implants concerned.
If your surgery is not covered by private health insurance, there will be the following costs associated with your surgery:
- Hospital Fee +/- any tests required before, during or after the procedure
- Anaesthetic Fee
- Surgeon's Fees
Our quote for ‘Surgeon’s Fees’ will include your surgery, the surgical assistant fee, your breast implants, your post-surgical garment, and your routine postoperative visits. It will not cover any subsequent surgery or revision surgery.
A booking fee is required to secure your surgery date. This will be subtracted from the total of your surgeon's fee. This booking fee is not refundable as it will cover the cost of administrative work, as well as the delivery of implant orders. It is important that you do not book in for surgery until you have made a definitive decision to proceed.
The quote given to you with your financial consent will also have the contact details of a selection of hospitals where you can have your procedure, and the specialist rooms of your anaesthetist. It is your responsibility to contact them to check their fees before booking your surgery.
It is standard practice that all fees are paid 10-14 days prior to surgery. You will receive notification for payment prior to your surgery. If this is not received within the specified timeframe, your surgery will be cancelled. In these instances, it is our practice policy that the booking fee will not be refunded and rebooking will not be considered.
Vocabulary to know
- Areola: Pigmented skin surrounding the nipple.
- Augmentation mammaplasty: Breast enlargement by surgery.
- Breast Augmentation: Also known as augmentation mammaplasty; breast enlargement by surgery.
- Breast Implants: Medical devices placed in your body to enhance an existing breast size or to reconstruct your breast. Breast implants can be filled with either salt water (saline) or silicone (elastic gel).
- Capsular contracture: When scar tissue that normally forms around the implant tightens and squeezes the implant and becomes firm.
- General anaesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.
- Haematoma: Blood pooling beneath the skin.
- Inframammary incision: An incision made in the fold under the breast.
- Mammogram: An x-ray image of the breast.
- Mastectomy: The removal of breast tissue, typically for cancer or cancer risk.
- MRI: Magnetic Resonance Imaging; imaging of the body produced by using a magnetic field.
- Saline implants: Breast implants filled with salt water.
- Silicone implants: Breast implants filled with an elastic gel.
- Submammary or subglandular placement: Breast implants placed directly behind the breast tissue, over the pectoral muscle.
- Submuscular or subpectoral placement: Breast implants placed under the pectoral muscle, which is located between the breast tissue and chest wall.
- Sutures: Stitches used by surgeons to hold skin and tissue together.
- Ultrasound: A diagnostic procedure that projects high frequency sound waves into the body and records the echoes as pictures.
(Some Information & Illustrations are courtesy of the American Society of Plastic Surgeons).