Breast Implant Revision
Caroline A. Glicksman, M.D., F.A.C.S.

Revision Surgery for Problem Breast Implants
Revision Saline to Gel Breast Implants
Revision Surgery for Old Silicone Gel Breast Implants

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Revision Surgery for Problem Breast Implants

Breast augmentation surgery is a process that begins with patient education. Many surgeons skip this part of the process and make decisions concerning the size, fill and location of the device, without educating the patient as to the long-term consequences of their decisions. The most frequent breast implant problems are caused by improper implant selection, as well as old-fashioned surgical techniques. Oversized implants can produce local problems, including stretch deformities, wrinkling, asymmetries, and even pain.

Any surgical procedure should be considered carefully. Revision surgery should only be performed when the long-term benefits and risks associated with revision surgery have been fully discussed.

Patients interested in revision surgery should obtain their previous surgical records, if possible, including the size, style, and manufacturer of the implant. Any patient over 35 may require an up-to-date mammography.

The final surgical procedure will depend on the complexity of the problem. Multiple problems may require the use of various surgical techniques to restore a more natural appearing breast. I spend a great deal of time with my revision patients, many of whom may never have had the opportunity to learn about the full range of implant choices, as well as the long-term effects of their decisions. The revision procedure may include changing the device, the location of the implant, (subglandular or partial submuscular) and addressing the stretched skin, if necessary. My goal is to restore a woman’s soft, natural appearing breasts, as well as to give her stable, long-term results.

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Revision Saline to Gel Breast Implants

Many patients come to me, unhappy with their saline implants. Saline implants are firmer than gel devices and also have higher failure rates than the newer gel devices. Deflation of the saline implant or thinning of overlying skin and breast tissue may produce visible wrinkling. In addition, many surgeons routinely either oversize or overfill saline implants. This may lead to other local complications, such as stretched skin, asymmetry or malposition.

Any surgical procedure should be considered carefully. Replacement of saline implants to gels should only be performed when the long-term benefits and risks associated with revision surgery have been fully discussed.

Patients interested in replacement surgery should obtain their previous surgical records if possible, including the size, style, and manufacturer of the implant. Any patient over 35 may require an up-to-date mammography.

The final surgical procedure will depend on the complexity of the problem. Multiple problems may require the use of various surgical techniques to restore a more natural appearing breast. I spend a great deal of time with my revision patients, many of whom may never have had the opportunity to learn about the full range of implant choices, as well as the long-term consequences of their decisions. The goal of revision breast surgery should be soft, natural appearing breasts and long-term results.

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Revision Surgery for Old Silicone Gel Breast Implants

Approximately four million American women have undergone breast augmentation in the last 40 years. Many women were either discharged shortly after surgery, or have lost contact with their primary surgeon. Other women with older generation breast implants (Evolution of Breast Implants) were never informed that their breast implants would not last a lifetime, and may have lived for years with hard, aging devices.

Although the safety and efficacy of silicone gel implants has now been well established (Institute of Medicine Report: Safety of Silicone Breast Implants and "In the News", Safety of Silicone.) local breast complications can occur when older generation breast implants have been neglected, especially beyond 10 years. These local complications can include capsular contracture (a hardening of the scar tissue around the breast implant), rupture of the gel implant, either within this capsule or beyond into the local breast tissue, or the inability to obtain clear and accurate mammograms due to a thick calcified capsule, and the firmness that this can produce.

Any surgical procedure should be considered carefully. Replacement of older generation silicone gel implants should only be performed when the long-term benefits and risks associated with revision surgery have been fully discussed. Options should include complete removal without replacement, as well as replacement with newer state–of-the-art devices.

Patients interested in replacement surgery should obtain their previous surgical records, if possible, including the size, style, and manufacturer of the implant. Often, medical records older than 10 years are no longer available, but patients should make every effort to track down their own records prior to their consultation. Any patient over 35 will require an up-to-date mammography. Other radiological studies may be indicated to determine if the implant has ruptured, and if the gel has traveled beyond the capsule. An MRI is presently the best test to evaluate an aging breast implant, but newer ultrasound procedures are on the horizon.

The final surgical procedure will depend on the complexity of the problem. Multiple problems may require the use of various surgical techniques to restore a more natural appearing breast. I spend a great deal of time with my revision patients, many of whom may never have had the opportunity to learn about the full range of implant choices, as well as the long-term consequences of their decisions. The revision procedure may include replacement of the device or removal without replacement, changing the location of the implant, (subglandular or partial submuscular) and addressing the stretched skin, if necessary. My goal is to restore a woman’s soft, natural appearing breasts, as well as to give her stable, long-term results. In addition, the removal of aging silicone breast implants may help provide better future breast imaging in screening for breast cancer.