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Secondary breast implant surgery refers to any surgery to address issues that have occurred some time after the placement of the original implants. There are many reasons why people may seek secondary breast implant surgery, including changes to the breast that happen with pregnancy or ageing, issues with the implants or surrounding scar tissue, or possibly a disappointing outcome from the original surgery (sometimes referred to as “implants gone wrong”).

As a result of the wide variety of reasons for requiring secondary breast implant surgery it follows that there is a wide variety of procedures that might be necessary for correction. These can range from the simple (implant exchange and scar tissue removal – capsulectomy), through to the more complex (the addition of breast lifts, and changes to the implant pocket). The key is to have a bespoke plan made for you after careful review by Mr Pacifico.

WHAT CAN HAPPEN?

The following is a list of the most common issues women seeking secondary breast implant surgery present with, although the list is not exhaustive:

Capsular contracture – this refers to the hardening and tightening of the naturally occurring scar tissue around the implant. This can result in the change in shape of the breast, and can sometimes be uncomfortable. Ideal treatment – capsulectomy (removal of the hard scar tissue) and implant replacement or removal of the implant

Implant rupture – this refers to damage to the integrity of the shell of the silicone breast implant. Most of the time, the silicone (which is normally a thick gel) is kept within the capsule of scar tissue the body has produced around the implant. It may give rise to a change in shape of the implant, the development of capsular contracture (see above) or be discovered by chance during a scan. If there is a suspicion of implant rupture then an ultrasound scan or MRI can be performed. Whilst these are helpful, there is a cost to have them done, and they do not pick up all ruptures. Therefore, if you have decided to proceed with surgery anyway, Mr Pacifico does not always recommend a pre-operative scan (as it will not change the surgical or management plan). Ideal treatment – implant removal and replacement, often with a capsulectomy

High riding implants – this refers to implants that sit unnaturally high in the breast, having a negative effect on the breast aesthetics and proportions. The nipples may appear to be too low in the breast, when in actual fact the issue is that the implant is too high. This occurs more commonly in textured implants placed under the muscle, but can occur with any type of implant. Ideal treatment – revision surgery to lower implant, possibly tailor the implant pocket with internal stitches and consider changing implant plane

Visibility of implant – if there is a thinning of soft tissue cover over the breast implant then the implants can sometimes become visible through the skin. This may be as a result of weight loss, post-breast feeding or the ageing process. Ideal treatment – removal and replacement of the implants, creating a new pocket under the muscle. In addition fat grafting (lipofilling) may help add soft tissue cover to the breast.

Waterfall effect – when implants are sitting too high, or have been in for some time, the soft breast tissue can sometimes appear to hang off the end of the implant, hence the term waterfall effect. There is a dissociation of the breast tissue with the implant which creates an un-aesthetic appearance and can occasionally be uncomfortable. Ideal Treatment – sometimes an implant exchange, capsulectomy and use of a slightly larger implant can be helpful in this scenario. However, more commonly, some form of breast lift (mastopexy) is required, with the replacement of the implant.

Double bubble – this describes the appearance of a breast when there is a “take off” of the implant from the chest wall (at the breast crease) with another separate take off of the breast itself. This is due to a residual “memory” of the original breast crease, when the position of the implant has dropped below this level. Therefore the breast appears to sit unnaturally higher upon the implant than it should, where in fact the underlying position of the implant is the key issue. Ideal Treatment – secondary surgery is required in this situation, with the precise nature of the surgery determined by the individual situation. The implant would need to be removed, the inframammary crease repositioned in its original location and consideration of a further augmentation with, or without a breast lift.


 

 

 

 

 

 

The patient above demonstrates a degree of waterfall effect on her left breast, with associated capsular contracture (right more than left). Mr Pacifico performed a total capsulectomy on both sides, and replaced the implants under the muscle in this case

 

WHY DOES IT HAPPEN?

There are many reasons why the above issues may occur. These can be summed up as follows:

Capsular contracture – from what is understood about the causation of capsular contracture, it appears that the thickening and hardening of capsule is due to a subclinical infection developing – most likely due to bacteria that originate on the skin.

Implant rupture – whilst modern breast implants are very durable, they are not expected to last your whole lifetime. Rupture of the shell may be due to wear and tear or a specific episode of trauma (such as a car crash). As described above, as the ruptured implant is composed of medical grade silicone and is kept within the capsule, it is not medically harmful.

Complications of surgery – sometimes the sub-optimal surgical result is due to complications at the time of the original surgery. This may be due to bleeding; creating a haematoma, or collection of blood, that causes increased scarring. Infection of the breast or of the implant itself can also have significant consequences on the outcome.

“Patient factors”  – pregnancy, breast feeding, weight change and ageing will all have an impact on the result of a breast augmentation. These may result in the recommendation of secondary surgery

Poor surgical planning – it is important to recognise that if sub-optimal decision making or surgical technique has been executed previously, this can result in a poor result, requiring secondary surgery.

WHAT ARE THE DIFFERENT APPROACHES?

There are a variety of surgical approaches, or combination of approaches that may be required to improve a breast augmentation. These range from the more straightforward, such as removing and replacing the implants with different implants; through to the more complex, involving breast lifts, tailoring of the implant pocket, fat grafting and more.

HOW COMPLEX IS THE SURGERY?

The complexity of the surgery is widely variable and relates to the extent of the problem and the combination of surgical techniques required to put things right. This may come at the expense of further scarring, more complex surgery and the acceptance of further revisions needed. In addition, an acceptance of a philosophy of  “better, not perfect” is paramount in proceeding with secondary breast surgery.

WHAT WILL MY BREASTS LOOK LIKE AFTER SECONDARY BREAST SURGERY?

This is one of the most frequently asked questions, but unfortunately one of the hardest questions to answer. Because of the large number of variables, and the pre-existence of an implant, it can be difficult to predict the future shape of the breast, which is different from the situation in primary breast augmentation. Crisalix 3D imaging software does not have the same role in this situation too.

The only way to get a realistic idea of the outcome of your surgery is to have an in-person consultation with Mr Pacifico who will then discuss with you the issues, your goals and what realistic expectations you can have. He will then illustrate the outcomes you might achieve by showing you before and after photographs of patients in a similar position to you.