Breast augmentation surgery with breast implants has been one of the most popular cosmetic plastic surgery procedures performed over the last 30 years. Breast implants don’t last forever though recent advances in breast implant technology with highly cohesive silicone gel (gummy bear breast implants) may help to reduce long term complications.
- As the saline breast implants placed in the 1990s age there will likely be more and more secondary breast augmentation for breast implant deflation.
- Secondary breast surgery for scarring and complications related to silicone gel leakage has decreased with cohesive gel breast implants, which contain little to no liquid silicone.
Breast implant size changes are still the most common indication for secondary breast augmentation.
- Patients are frequently choosing a decreased volume in breast implant size (smaller breast implant) with a breast lift or mastopexy to help rejuvenate the aging breast which has sagged overtime either from the weight of the breast implant, weakening of breast tissue or through pregnancy. This can deliver a very natural look.
- Increasing breast implant size is common for simple volume issues and after implant deflations.
Changing Breast Implant from Saline to Silicone is a common request and choice. Both saline and silicone breast implants look the same when placed correctly, but the feel of silicone breast implants is definitely more natural.
Breast Implant Deflation and Rupture are going to be more common because the risk of rupture of a breast implant is 1% per year and with all of the saline breast implants placed during the silicone scare these have about a 20% risk of rupture at this point.
Capsular Contracture can be caused by a multitude of factors including silicone rupture. This can be seen in older implants or in breast implants placed with a pocket expansion technique rather than the use of electrocautery for precise thermal pocket creation.
Implant malposition is a common reason for implant revision initially, either lowering the implant or raising the breast fold in the first three months after the initial breast augmentation, but over time the breast implants may descend and the breast pockets could be reinforced with acellular dermal matrix (ADM) for internal breast support. A hard high breast implant is a sign of a capsular contracture.
Animation Deformity or deformity caused by the flexion of the pectoral muscle is a less frequent indication for secondary breast surgery, but can be corrected easily with a subglandualr plane change or with muscle repair with ADM.
Breast Lift (mastopexy) can be performed at the time of the secondary breast augmentation to help tighten, shape and lift the breast over new breast implants.
Removing the Breast Implants altogether is always an option with a simple mastopexy or a mastopexy coupled with an auto-augmentation to help provide some shape and volume to the breast after the implant has been removed.
In general, secondary breast surgery is usually easier to recover from than the initial procedure, because the majority of the stretch and muscle work has been performed.
- Secondary breast surgery is typically performed through a lower breast fold incision, but may be possible through a peri-areolar incision which may depend on pre-existing scars and need for a breast lift.
- Sometimes with silicone ruptures and capsular contractures small drains are used temporarily.
- Patient satisfaction is high after these sometime challenging procedures.
- Goals and expectations need to be discussed thoroughly during the initial consultation.
- Implant and surgical records are helpful in deciding on implant volume.
- Imaging and implant fitting is difficult in these cases because the native breast implants are in place.
The first step in the process of secondary breast augmentation is a consultation with Dr. Trussler in his plastic surgery office in Austin Texas.