The longer I have been in practice (over 17 years now), I see more and more women seeking revision of breast augmentation surgery. Both for myself and as supported by national trends, redo surgery is more common than first time surgery. There is no truth to the urban legend that implants need to be changed out every 10 years – more often the issue is the aging breast on top of the implant. Looking at my experience, I have drawn the following lessons:
- Breast augmentation patients should be counseled that they should expect to need revision surgery sometime in the future.
- Breast augmentation revision is usually more complicated than first time surgery and therefore takes longer and costs more.
- Patients who had augmentation years ago should not be surprised that price inflation applies to everything, including surgery.
- Despite the above, patients are overwhelmingly happy with their decision to have augmentation and would not consider removing the implants.
- A small minority of women, however, are unhappy with their implants and want them removed. Beast implants are supposed to make the patient happy. If they do not, remove them.
- Implant removal patients must accept that most often, their breasts will be less attractive due to volume, loss, fullness, and normal aging. That’s okay, they want them out and are overwhelmingly are happier without them.
- As patients age, the implant often stays where it was originally placed and the breast droops off the implant – not an aesthetic look. With a capsulectomy, larger implant, and redistribution of breast tissue, the chest looks much better.
- Often, the implants were too high on the chest to begin with due to inadequate tissue release. This is not a true contracture.
- Implants in the below muscle position placed with an incision in the fold of the breast do much better over time than above muscle via an areolar or arm pit incision.
- If I redo these patients, I place the implants below muscle (new plane) via the fold incision. The muscle gets tacked to the deep surface of the breast gland to hold the new space.
- The concept of the bra as a cast and the bandeau (elastic band worn initially over the superior pole of the implant) acts like braces.
- Upgrading from saline or old silicone to the new silicone implants helps a lot. With a firmer implant, the breast shape is better controlled.
Mark D. Wigod, MD, FACS, providing Cosmetic and Reconstructive Plastic Surgery to Boise, Meridian, Treasure Valley and Southeastern Idaho.
