Breast Implant Revision New Jersey – Procedure Information
Parker Center in Paramus, New Jersey
- What are the potential benefits of breast implant revision?
- Breast Implant Revision & Replacement with Dr. Parker
- What are the most common reasons for breast implant revision and how does Dr. Parker address each of these reasons?
- What does the surgery for breast implant removal and replacement entail?
- What does the recovery for breast implant removal and replacement entail?
- Additional Resources
Over two million women have breast implants, the vast majority for cosmetic reasons. Although the overall satisfaction rate among augmentation patients is high, complications can occur. Scientific studies have shown no correlation between implants and breast cancer, autoimmune disorders or systemic illness; however, due to a number of factors, results of breast augmentation vary and a percentage of women are unsatisfied with their initial outcome.
Other doctors and patients frequently refer breast implant revision patients to New Jersey Plastic Surgeon, Dr. Parker, as he has extensive experience in surgery of the breast. In addition, the Parker Center is the only provider in our region trained and licensed to use the revolutionary non-surgical Aspen System for the treatment of capsular contracture of breast implants.
- Improved cosmetic appearance and feel of the breasts
- Correction of any physical symptoms the patient may be suffering from, such as pain from capsular contracture
- Enhanced self esteem and improved body image (see Emotional Considerations) when the distorted appearance of the breast is corrected
In Dr. Parker’s experience, once women become accustomed to having breast implants, they are usually reluctant to have them permanently removed. They may, however, decide to have them removed and replaced with new implants because they are dissatisfied with the results of their augmentation or have suffered a complication with their implants. The exact procedure Dr. Parker uses for breast implant removal and replacement varies depending on the reason that a patient needs or wants to have their breast implants revised.
What are the most common reasons for breast implant revision and how does Dr. Parker address each of these?
Below are the most common reasons women seek breast implant revision and replacement. Click on a link to see details about treatment for a particular reason for breast implant revision:
- Desire for size change, either larger or smaller size
- Correction of capsular contracture: surgical or non-surgical
- Treatment of implant rippling and palpability, more common with saline implants
- Correction of implant deflation or leakage
- Treatment of a “double bubble” deformity and asymmetry of the infra mammary fold
- Correction of implant malposition
- Prior breast augmentation with French PIP breast implants
- Request to remove breast implants permanently
Following breast augmentation, patients will sometimes decide to change their implants to a larger or smaller size. We have reduced the incidence of this with our own patients, here at the Parker Center, by using our sizing and shaping program over the past few years. When patients decide to undergo a size change, Dr. Parker will most often be able to use their prior incision for implant removal and replacement.
In patients desiring larger implants, Dr. Parker surgically enlarges the “pocket,” or space in the breast, surrounding their existing implant to accommodate the larger implant, as in the patient shown below.
39 year old who had 350 cc saline implants inserted initially by Dr. Parker. Though happy with her result, the patient returned sometime later requesting larger implants. After undergoing additional Sizing and Shaping Sessions, the patient selected 550 cc silicone implants. Dr. Parker removed her existing implants and replaced them with the larger ones through her existing incisions.
In patients wishing to have smaller implants, Dr. Parker will surgically reduce the size of the pocket with sutures to properly fit the smaller size implants. During your consultation with Dr. Parker, he will discuss options with you regarding treatment of your breast soft tissue envelope. In many cases, nothing additional will be done to the skin of your breast. In others, depending on the amount of decrease in implant size, the nature of the patient’s skin, and her personal desires, a breast lift procedure may be performed at the same time. An example of this is shown below.
29 year old who had 400 cc saline implants inserted by another plastic surgeon previously. She felt they were too large and heavy and caused her breasts to sag. Dr. Parker replaced these implants with 325 cc silicone implants and at the same time, performed a vertical mastopexy, or “lollipop lift,” to treat her sagging tissues, giving the patient a more youthful look.
Breast implants, once inserted into the body, stimulate the formation of a lining around the implants that is referred to as a “breast capsule.” In a relatively small percentage of patients, the capsule hardens, often distorting the shape of the breast; this is called “capsular contracture.”
Traditionally, the treatment of capsular contracture has involved surgical removal of these capsules and implants, followed by their replacement with new implants. Patients currently seen in consultation at the Parker Center for capsular contracture may also wish to undergo surgical treatment for a variety of reasons: insertion of a different type of implant, larger or smaller implant, or different pocket location of the implant. Typically, Dr. Parker uses the same incision used to insert the original implants to remove the hardened capsule and implant. He will then insert a new implant. This traditional treatment by Dr. Parker is illustrated below.
28 year old who developed left breast capsular contracture 2 years after the insertion of 375 cc silicone implants located in partial submuscular pockets. She underwent removal of her capsules and implants on both sides along with insertion of 475 cc silicone implants.
Today, patients who present to the Parker Center with capsular contracture are offered non-surgical correction of this condition with the Aspen Ultrasound System. This modality, employing a series of ultrasound energy treatments along with targeted massage, has been shown to help close to 80% of patients resolve the pain, breast firmness, and distortion of the shape and position of their breast implants due to capsular contracture. Click to learn more!
Following are results from the Aspen System Treatment; the patient’s left breast was affected with capsular contracture.
The edges of breast implants can be visible and palpable (able to be seen and felt). This is more likely in thin patients with little breast tissue and/ or subcutaneous tissue who have saline implants placed in a subglandular location. This does not pose a health risk to these patients, but they are often bothered by what they, and/ or their partner, see and feel.
To treat this, Dr. Parker will employ the same incision to remove the implants as was used to originally insert them. He will then most often insert silicone implants into a partial submuscular breast pocket. Silicone implants in a partial submuscular location are less palpable and demonstrate less rippling than saline filled implants. This is shown in the patient below.
41 year old who complained of visible and palpable rippling after the insertion of subglandular saline implants by another plastic surgeon. Dr. Parker removed her saline implants, 360 and 390 cc from the right and left breasts respectively, then replaced them with 400 cc silicone implants in a partial submuscular location. He also reduced the size of the patient’s areolas, in accordance with her wishes.
There is a great deal of confusion about how long breast implants will last. Some plastic surgeons recommend replacement of breast implants after 10-15 years. Dr. Parker tells his patients that if their implants are soft, normal looking, and do not cause problems, then these implants do not need to be replaced.
If a saline filled implants leaks, it will be very apparent to the patient, as shown in the example below. When a saline implant leaks, the saline solution is quickly absorbed by the body and the “deflated” side immediately looks smaller than the intact side.
Silicone gel implants are filled with a silicone gel material which is inert and is not absorbed by the body following rupture of the implant’s outer shell. Therefore, the appearance and feel of a silicone gel implant typically does not change with rupture. In order to detect silicone gel implant rupture, radiologic studies, such as an ultrasound, mammogram and/ or MRI, are necessary. When the FDA returned silicone gel implants to the market in 2006, they did so after determining that silicone gel itself is not medically harmful to the body. However, they recommended MRI scans, at intervals following augmentation, to minimize the chance of undetected leakage. If leakage is found, it is recommended that the leaking implant be replaced with a new one.
The latest generation of silicone implants, made of a cohesive type of silicone gel, are impressive with regard to their lower likelihood of leakage. Long term studies are in progress to quantify their leak rate compared to the older silicone implants.
Dr. Parker and his team will discuss these issues about potential implant leakage with you during your consultation. The patient below demonstrates the presentation and treatment of a leaking saline filled breast implant.
35 year old who presented to Dr. Parker with a recent spontaneous deflation of her right breast implant, 15 years after her initial surgery. The patient requested that Dr. Parker replace her existing 325 cc saline implants with 375 cc silicone implants.
In performing breast augmentation, a “pocket” to house the breast implant is created by the surgeon using an inframammary or peri areolar incision. The dissection is performed above the crease at the lower aspect of the breast called the inframammary fold. If the dissection is carried too low and/ or the fold is weak, the implant can migrate downward below the fold, causing what is known as a “double bubble” appearance. This creates an asymmetry of the inframammary folds.
To treat a “double bubble” deformity, Dr. Parker will temporarily remove implant through the same incision used to insert it, reconstruct the inframammary fold with several layers of sutures, and then reinsert the implant into its proper position. This is shown below.
26 year old, after breast augmentation by another plastic surgeon, asked Dr. Parker to correct the loss of her inframammary fold and implant displacement downward. Using her existing peri areolar scars, Dr. Parker inserted internal sutures to reconstruct her inframammary fold and reposition the implant in a better location. As requested by the patient, he also reduced the size of her areolas.
Malpositioned implants result when the two implant pockets are created either too far medially or laterally, so that the implants appear either too close together or too far apart on the chest. Treatment involves surgical adjustment of the pockets, as appropriate. Under direct vision, using the prior incision, Dr. Parker removes the appropriate amount of scar tissue from the capsule surrounding the implant and expands the pocket in the correct direction. He then inserts sutures into the remaining capsule to close down the over-dissected part of the pocket, as seen in the example below.
44 year old patient, 6 years after 330 cc saline breast augmentation by another plastic surgeon, complained to Dr. Parker that her implants were too far laterally displaced and “looked fake”. Using the patient’s healed inframammary incisions, Dr. Parker removed her existing implants and scar tissue. He corrected the malpositioned implants by dissecting the implant pockets more medially to allow cleavage, sutured the lateral aspect of the pockets to keep the implants from drifting laterally, and inserted 300 cc silicone implants, as requested by the patient.
Breast implants made by a French company called Poly Implant Prosthesis (PIP) were found to be defective in 2011. An investigation determined the company used industrial grade silicone, not medical grade silicone, as the gel in their implants. In addition, the company covered the gel with substandard implant shells, found considerably more likely to leak. It has been estimated that over 30,000 European women have discovered they have these defective implants. If a patient believes they have PIP implants in place, it is recommended they be removed.
Dr. Parker removes these implants through the original incision, and during the same operation inserts new implants. PIP implants were never approved by our FDA, so their use in this country was very uncommon. A patient with PIP implants is demonstrated below.
35 year old patient who had breast augmentation performed in South America 5 years ago. She recently heard about the controversy over French PIP implants and their likelihood of leakage. Though she was asymptomatic, the patient had an ultrasound and MRI of her breasts performed. These demonstrated leakage of her right breast implant. At surgery, Dr. Parker removed her 385 cc PIP implants through her healed peri areolar incisions. He found the right implant to be completely disintegrated. The left implant was intact. Dr. Parker replaced these implants with 475 cc silicone implants.
From time to time, women will decide they no longer wish to keep their breast implants because they are dissatisfied with the results of their augmentation or have suffered a complication with their implants. These implants are surgically removed, a procedure called “explantation.” The reasons usually include: leakage, capsular contracture, displacement, implant palpability and rippling, or asymmetry. Such a patient is shown below.
During your consultation, New Jersey plastic surgeon Dr. Parker will discuss options involving implant removal with you. If your implants are large and your skin has stretched, a breast lift may be recommended. If not, removal of the implants alone may suffice. The procedure is usually performed under general anesthesia or intravenous sedation, monitored by one of our board-certified anesthesiologists. The original incision used to insert the implant is almost always the same one used to remove it. The lining around the implant, or “capsule,” is often surgically removed at the same time to facilitate more rapid healing. All incisions are closed with dissolving sutures. Surgery times range from 45 minutes to 2 hours depending on the thickness of the capsule surrounding the implant and whether or not a breast lift procedure is necessary.
During your consultation, Dr. Parker will discuss options involving implant removal and replacement with you. These include the type of implant to be used, implant location above or below the pectoralis major muscle, the size of the implants, and whether any type of breast lift is necessary. These procedures are usually performed under general anesthesia or intravenous sedation, monitored by one of our board-certified anesthesiologists. The original incision used to insert the implant is almost always the same one used to remove it. All incisions are closed with dissolving sutures. Surgery times range from 45 minutes to 2 hours depending on the amount of scar tissue surrounding the implant and whether or not a breast lift procedure is necessary.
New Jersey breast implant revision patients are usually discharged after one hour of observation. Postoperative pain is usually not significant because of our Rapid Recovery pain management protocol. Patients may shower the day after surgery and resume the activities of daily living within several days, including a return to most jobs. Aerobic exercise that does not involve the chest can be started 10 days after surgery. All other activities can usually begin 3 weeks after surgery.
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Watch stories from real New Jersey breast augmentation patients
"Just want to let you know how very pleased I am with the results... I wish to thank you and your staff for making me feel so comfortable before, during and after the procedure. You have helped to increase my self esteem and I wish you continued success in helping others." -Breast Augmentation Patient