Women who have had breast augmentation in the past often ask about exchanging their older implants for newer ones. The first question many ask is, "Is it necessary to change out my implants?" or "When is it necessary to exchange older breast implants for newer ones?"
The answer to these questions depends on whether or not there is something bothering the patient with their current implants. Also, if something has been documented to be wrong with the implant such as a rupture or poor position of the implant, then there would be a greater indication to exchange the implants. However, if the implants have been stable and the patient has been pleased with her result then the answer is often to leave the breast implants alone and simply monitor them over time.
Is Breast Implant Exchange Right For Me?
Indications for implant exchange could include the obvious – implant rupture, poor position of the implant, worsening cosmetic result over time, and painful implants. Less obvious indications for implant exchange could include – capsular contracture (aggressive scar tissue which forms a capsule around and implant and deforms the breast over time), desire to change saline implants to more natural-feeling silicone implants, desire to change older silicone implants to saline implants, desire to correct less severe but still bothersome cosmetic aspects of the breasts such as implant rippling, thinning breast skin, palpable implants, or a desire for a bigger or smaller implant.
Breast Implant Exchange Options
A breast implant exchange can be as simple as removing the old implant and replacing it with a new implant of similar size. It can also be much more complicated depending on what needs to be corrected. Recovery is usually quick since the patient has already had a prior implant. Each patient is different, so an appointment with our surgeons is required to get a full understanding of each patient's needs and post-operative recovery.
Women now have a choice in their type of breast implant. Breast implants have a silicone shell that is filled with either silicone gel or salt-water solutions known as saline. The FDA approved silicone gel implants that are available today and are constructed of a "cohesive" elastic-type of semi-solid gel that feels, looks and moves much like normal breast tissue. Unlike older silicone implants, these "new" silicone implants do not leak throughout the body or deflate if ruptured.
Currently, silicone implants are FDA approved for women over age 22. Silicone gel implants have been extensively studied, making them one of the most researched medical devices in history. The overwhelming body of medical literature has demonstrated the safety and efficacy of silicone implants. Both saline and silicone implants can provide natural and long-lasting results. Our doctors will discuss these options with you in more detail and help you select the implant that is right for you.
Our doctors, Christopher Williams, M.D. or Jeremy Williams, M.D. will discuss these options with you in more detail and help you select the implant that is right for you.
Types of Anesthesia
At Park Meadows Cosmetic Surgery, you will have your surgical procedure performed in one of the only dedicated cosmetic surgery centers in Colorado that is both fully state licensed and The Joint Commission Accredited. We are proud to care for your anesthesia needs with one of our board certified anesthesiologists from South Denver Anesthesia. Our board certified anesthesiologists will be with you from beginning to end insuring your comfort during the surgical procedure.
Anesthesia choices include intravenous sedation and general anesthesia. Your doctor and anesthesiologist will recommend the best choice for you.
Choice of Incision
Incisions are made in inconspicuous area to minimize visible scarring. Incisions can be placed around the areola (the dark portion surrounding the nipple), within the crease between the breast and the chest or in the armpit. You and your plastic surgeon will discuss which option is appropriate for your anatomy and desired result.
Positioning of the Breast Implant
Implants can be placed beneath the pectoral muscle of the chest wall or directly behind the breast tissue. Most patients will have their implants placed behind the chest muscle unless there are anatomic considerations that warrant the implants being placed directly behind the breast tissue. Some studies have suggested that implants placed behind your chest muscle have a lower risk of forming capsular contracture (scar tissue that hardens around the implant) and interfere less with breast examination by mammogram than if the implant is placed directly behind the breast tissue. Placement behind the muscle does lead to more muscular discomfort in the initial days after surgery than placement directly under the breast.
Drainage tubes are almost never necessary during breast augmentation. All incisions are closed with dissolvable stitches and a water tight dressing is placed over the incision, enabling you to shower the next day. The total surgery time is approximately 1 hour.
All Surgery Carries Some Uncertainty & Risk.
Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure.
The most common problem, implant failure, is actually not that common. Most studies suggest that the implant failure rate is approximately 1% per year. When saline implants fail the saline leaks out and is absorbed by the body and the breast deflates. When silicone implants fail, the silicone typically does not migrate beyond the implant pocket. Silicone implants do not "deflate" and because they do not cause many symptoms, often the only way a failure is detected is by MRI or other imaging study. For this reason, it is recommended that patients with silicone gel implants have regular MRI follow-up of their implants.
Capsular contracture, or scarring around the implant pocket, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways and sometimes requires either removal or "scoring" of the scar tissue or perhaps removal or replacement of the implant.
As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood. A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within 1 week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.
Some women report that their nipples become oversensitive, under sensitive or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients. There is no evidence that breast implants will affect fertility, pregnancy or your ability to nurse. If however, you have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery. This may cause some discomfort, but can be treated with medication prescribed by your doctor.
A few women with breast implants have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. These symptoms may include joint pain or swelling, fever, fatigue or breast pain. Research has found no clear link between silicone breast implants and the symptoms of what doctors refer to as "connective-tissue disorders".
While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable X-ray of a breast with an implant. Additional views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.
While the majority of women do not experience these complications, you should discuss each of them with one of our doctors to make sure you understand the risks and consequences of Breast Augmentation.
Preparing for Surgery
Planning your cosmetic procedure will be an effort that our staff will carefully guide you through. It is important to recognize that each individual will recover at a different rate so be sure you set aside adequate recovery time from work and strenuous activity to allow your body to heal. This will ensure a smooth recovery and a more rapid return to normal activities. It is also important to have a supportive care group around you especially during the initial 24-72 hours after surgery. Many patients find it beneficial to have additional help with daily activities for the first 4-5 days after Breast Augmentation.
At least 1 month prior to surgery
Stop smoking at least 1 month prior to your procedure. Smoking reduces circulation to the skin, impedes healing, and can lead to major postoperative complications.
2 weeks prior to surgery
Stop all medications that can thin the blood 1-2 weeks prior to surgery. These include drugs such as Aspirin, Coumadin, Lovenox, Ibuprofen, Vitamin E, and multiple herbal preparations. These medications may cause bleeding during and after surgery. Please see the warning about blood thinning medications on our website for a list of drugs that must be stopped.
1 week prior to surgery
Report any sign of a cold or infection that appear the week prior to your surgery. You may need to postpone your procedure to avoid unnecessary complications. Make sure you fill all of your prescriptions provided to you by our doctors prior to your surgery day; this will make the transition from the surgery center to your home as smooth as possible.
The day before surgery
Do not eat or drink anything after midnight before your surgery. This includes water, ice, or hard candy. The only exception is that you may take your blood pressure or heart medication with a sip of water the morning of surgery.
The day of surgery
Plan to wear loose fitting clothes to the procedure, preferrable with a zipper in the front. Do not wear jewelry or bring valuables with you, except for your ID and insurance card. You may wash your surgical site with regular soap the day before and morning of surgery. You must arrange to have a responsible adult drive you home after your procedure.
What to Expect on the Day of Surgery
When you arrive, you will be escorted to a preoperative evaluation area where you will be asked to change into a gown and will be given foot covers. Your surgeon and the anesthesiologist will meet with you before you enter the operating room suite. During this time, the surgical consent form will be reviewed with you in detail and special markings may be made on your skin at the surgical site. You will have the opportunity to ask any last minute questions.
Once in the operating room, you will be transferred to our padded operating room table. A nurse will start an intravenous drip in your arm and connect you to monitoring devices. The anesthesiologist will give you medication through your intravenous drip to make you feel drowsy.
When your surgery is completed and your dressings are in place, you will be moved to the recovery room. During this period a recovery room nurse will assure your comfort and continue to monitor you closely.
Your stay in the recovery room will last approximately 1 to 1 1/2 hours. Most patients are fully awake within 30 to 60 minutes after their surgery, but may not remember much about their time in the recovery room due to some of the anesthesia medication. Once you are ready for discharge, a postoperative appointment will be scheduled and your discharge instructions will be reviewed.
You must have a responsible adult drive you home from the surgery center. This individual should have your prescription filled at the pharmacy prior to taking you home. A responsible adult must stay with you the first night after your surgery because you have been sedated.
Diet: Start with clear liquids and toast or crackers. If those are well tolerated, progress to a regular diet.
Driving: No driving for 48 hours after your procedure or while taking pain medicine.
Activity: You may walk and climb stairs immediately following surgery. After 2 weeks you may resume moderate activity such as brisk walking. During the first 6 weeks, do not lift anything heavier than a gallon of milk. After 6 weeks you may resume more strenuous aerobic work and lifting activities.
Work: Depending on your career and your rate of healing, you should be able to return to work within 1 to 2 weeks of surgery. Your surgeon will be able to give you a better estimate depending on you physical and professional profile.
Wound Care: Your surgeon will take down your dressing at your first post-operative visit. Do not remove your dressing at home. Your dressing may get wet in the shower. Try to direct the shower to your back, but it is fine if the dressing gets wet. Pat dry after your shower.
Bathing: You may shower and wash your hair 48 hours after surgery. Shower only for the first 30 days post-operative. Try to keep the shower directed at your back and not at your incision or dressing. It is okay if the dressing gets wet in the shower. Pat it dry after your shower. For the first 4-6 weeks after surgery, do not submerge in a bathtub, pool, or hot tub.
Medications: Ask your surgeon when you may resume your blood thinning medications. All other prescription medications may be resumed immediately, as usual. While you are taking pain medicine, you are encouraged to follow a high fiber diet or take a stool softener such as Colace (available over the counter), as pain medications tend to cause constipation. Take your full course of antibiotics as prescribed by your surgeon.
Smoking and Alcohol: Do not smoke for the first several weeks after surgery as it impedes wound healing and can lead to serious wound complications. Alcohol consumption is dangerous while taking pain medicine. It has a tendency to worsen bleeding.
Post-operative Appointment: Your first follow-up visit will be 1 week after surgery. Your surgeon will then see you at appropriate intervals after this to monitor your progress.
Special Considerations: Call your surgeon immediately if you experience any of the following: excessive pain, bleeding, redness at the incision site, or fever over 101° F.
What Are the Major Risks of Implant Exchange?
All surgical procedures involve some possible risks, such as the effects of anesthesia, infection, swelling, redness, bleeding, and pain. There are also potential complications specific to breast implants. These complications occur in a very small percent of women, but you need to be aware of the possible risks. After reading the discussion below, please contact your surgeon if you have questions.
Deflation and Rupture: You should be aware that breast implants may wear out over time and deflate or rupture. When breast implants deflate the saline solution leaks out of the silicone implant shell. It can occur rapidly over hours or slowly over a period of days. Deflation or rupture is recognized by loss of size or change in shape of your breast. Implants may deflate or rupture within the first few months or several years after surgery. Today's silicone implants do not deflate and the gel is usually retained within the capsule or implant pocket. Causes include: damage by surgical instruments, overfilling or underfi1ling of the implant with saline solution, capsular contracture, trauma, intense physical manipulation, excessive compression during mammographic imaging, and other unknown reasons. Deflated implants require additional surgery to remove and to possibly replace the implant.
Capsular Contracture: Capsular contracture occurs when scar tissue (the capsule), that normally forms around the implant, tightens and squeezes the implant. At present, it is unclear whether capsular contracture is caused by infection or hypertrophic scar formation. Symptoms of capsular contraction range from mild firmness and discomfort to severe pain. Capsular contracture may cause pain because of nerve entrapment or interference with muscle motion. Breast distortion, palpability of the implant, and or movement of the implant may also be noted. To correct capsular contraction, surgical options range from removal of the capsule tissue to removal and possible replacement of the implant itself. Capsular contracture may reoccur in one or both breasts.
Pain: If you experience severe pain not relieved by pain medicine, notify your surgeon immediately. Some discomfort is expected after surgery and you will receive a prescription for pain medication. The intensity and duration of pain after Breast Augmentation will vary among women. Prolonged or intense pain can be due to implant size, placement, surgical technique, or capsular contracture.
Dissatisfaction with Cosmetic Results: We strive to attain the aesthetic results you desire. Some women are not entirely satisfied with their results due to mild wrinkling, asymmetry, implant displacement (shifting), incorrect size, unanticipated shape, implant palpability, scar deformity, hypertrophic (irregular, raised scar) scarring, or "sloshing". Careful surgical planning and technique can minimize but not always prevent such results.
Infection: A small number of women develop an infection. This typically can occur several days to several weeks after the procedure. With implants present infection can be more difficult to treat than infection in normal body tissues If an infection does not respond to antibiotics, the implant may have to be removed, and another implant may be placed after the infection has resolved. In rare instances, toxic shock syndrome has been reported in women after Breast Implant Surgery. This life-threatening condition is characterized by symptoms such as sudden fever, vomiting, diarrhea, fainting, dizziness, and/or sunburn-like rash. A doctor should be seen immediately for diagnosis and treatment for this condition.
Hematoma and Seroma: A hematoma is a collection of blood under the skin, and a seroma is a collection of the watery portion of the blood under the skin. Hematomas or seromas typically develop within the first few days after surgery. However, they may occur at any time after injury to the breast. The body can reabsorb small hematomas or seromas and often patients will be unaware or asymptomatic of these smaller fluid collections. Larger ones require the placement of surgical drains for proper healing. A small scar can develop at the surgical drain site. Implant deflation or rupture can occur if the implant shell is punctured when the drain is placed.
Nipple and Breast Sensation: Feelings in the nipple and breast can increase or decrease after implant surgery. People report a range of feelings, from intense sensitivity to complete numbness in the nipple or breast. These changes are usually temporary, but can be permanent and may affect your sexual response or your ability to nurse a baby.
Delayed Wound Healing or Wound Dehiscence: In some instances, the incision site takes longer to heal than normal. Cigarette smoking, poor nutritional status and a compromised immune system can all cause delayed wound healing or wound separation.
Implant Extrusion: Extrusion is when the breast implant comes through the skin. If blood supply to the overlying tissue is compromised or if wound healing is interrupted extrusion may occur.
Possible Connective Tissue Disease: Concern has recently been raised over the association between breast implants and the development of autoimmune diseases, such as lupus, scleroderma, or rheumatoid arthritis. A review of several large epidemiological studies on women with and without implants indicates that these diseases are no more common in women with implants than those in women without implants.
Breast Cancer: Published studies indicate that breast cancer is no more common in women with implants than those without implants. It is important that women continue to obtain regular mammograms as directed by your physician. Make sure the radiologist is aware that you have implants. Calcium deposits may form in the tissue around the implant. On mammograms these calcium deposits can be mistaken for cancer or precancerous lesions. Additional surgery for biopsy of the lesion, or removal of the implant may be required to rule out cancer.
Additional Surgeries: You should understand that you may require additional surgery in the future to replace or remove your implants. Situations such as deflation, capsular contracture, infection, shifting, and calcium deposits can require removal of the implants.
Learn more about breast implant exchange by contacting Park Meadows Cosmetic Surgery online or by phone at (720) 457-4471.