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Breast Implant Revision 01
BREAST IMPLANT REVISIONBreast Implant Revision
Breast enhancement surgery with implants is usually a life changing event and dramatically improves not only a woman’s breast size but improves shape. It also makes it easier to shop for clothing that is form fitting and breast implants brings out the designer’s vision for what a garment is supposed to look like on you. Though implants are designed to last a life time, there may come a time where a woman who has breast implants may want to make a change in the size, appearance or both.
As we age, our body can change. This is no more true for woman than when they go through their child bearing years and breast feeding which can change both the size of the breasts and their shape and drooping can even occur. And so it would be no wonder that women who have had breast implants when they were younger might require a “tune-up” to improve what the childbearing years have done to change a woman’s physique. The basic aging process itself can have effects on the breast and there is generally a loss of breast size with the hormonal changes that occur in our lifetime. This loss of volume can lead to a general loosening of the skin and this can change the way the breast tissue relates to the implant.
Breast Implant Technology
As technology marches its way into the future, there have been many changes and improvements in the design and make up of breast implants themselves. New implants can feel more soft and natural and there are more choices for women, not only just the alternatives of saline versus silicone gel breast implants, often referred to as simply “gel implants”. We now have different degrees of firmness of the gel implants. The most common implant chosen by women remains the basic gel implant that has been available for longer than fifty years! Newer alternatives have the same shell as the basic gel implant but the fill of shell has been modified. These implants have firmer gel that can feel more youthful and the firmest of these choices is referred to by patients as the “gummy bear” implant but they are officially known as “highly cohesive implants”. Patients may opt to change to another style of these implants to improve on shape, feel, and appearance and even to change the size of their breasts.
Your Body Changes!
As we age, the width of the chest, from side to side itself can widen. And since the implants don’t change, they can appear to be not as close to each other in the center. This results in a loss of cleavage with a larger space between the breasts. There are other effects on implant positioning as the breast widens including the breast not coming far enough to the side and a loss of projection (sticking out) of the breast because the implant is not large enough for a woman’s new shape. Going with a larger implant can be a simple solution for these issues. And at that time a different implant can be chosen if so desired. Exchanging implants is a revision in the strictest sense because the shape is being revised at the same time.
Breast Lift Surgery and Breast Implants with Lift
Another common issue that can develop as patients get older that may require breast implant revision surgery is drooping (ptosis) of the breast. Drooping of the female breast naturally occurs without breast implants and so it is no wonder that it could also occur in patients who have had breast augmentation. When patients don’t have breast implants and develop drooping, repair may be simpler in that only a breast lift may be required or even simply an implant may be all that is needed to remedy the issue. Nowadays, plastic surgeons are very focused on filling the upper part of the breast in patients with drooping to restore the breast’s “upper pole” because that is the part of the breast that sticks out from the top of the bra and what everyone can see. Some patients who develop significant drooping without implants may require both a breast lift and an implant to get the very best results. Of course, it always depends on how much drooping there exists in each patient and a careful evaluation with an experienced breast implant doctor who is well versed in breast implant with lift surgery can help you best determine what is best for you, your body, and your needs. A patient may have minimal drooping and a plan can be crafted to place an implant without a lift or provide an alternative method to hide the drooping.
Breast Implant Drooping
For patients who already have breast implants and thereafter develop drooping, there are a host of options to repair both drooping and even possible the loss of fullness of the upper pole that has come from descent of the breast tissue. It’s important to understand what is happening during the drooping process in order to devise a successful plan for breast implant revision when drooping occurs with implants. The drooping breast is simply saying that it cannot handle the weight of the breast and the implant. The volume of implant and breast are bearing down on the skin and underlying support tissues and when the weight is too much for the support, the breast descends to a lower position. That’s why patients who have large implants placed at their first surgery have a higher chance of needing breast implant revision surgery. The larger implant simply has more weight. For these patients, going with a smaller implant may be of terrific benefit as a smaller implant may better match their frame and life style. And when these patients opt for smaller implants, the breast itself and pocket around the implant may require pocket modification surgery (see below) to make this space smaller. Pocket modification surgery may be needed to prevent the implant from moving around during activities and when lying down but even more importantly can reshape the whole breast to give a more youthful look and bring a vibrant appearance to the breast.
“My Breast Implants Go All Over the Place”
Over time, some patients who had large breast implants initially, look in the mirror and see themselves as “all boobs”. It’s not only that the implant itself is too large but rather that the implant has worked on the surrounding support tissues over time to expand and stretch them and therefore enlarge the pocket around the implant. Patients then report that their implants “are going all over the place”. Because the space around the implant becomes too large, it also gives the impression that the implants are too big and are taking over the chest! But the breast implants have remained the same size but are working to affect the very shape of the breast. There are two general ways that this can happen.
The Waterfall Effect
Breast implant doctors generally see two kinds of patients who come with issues of drooping when they have breast implants. Each type of drooping requires a different approach and there are many techniques so that each patient can have a totally unique treatment plan crafted for them by a breast implant doctor and plastic surgeon.
Some patient who have had breast enhancement with implants had their original surgery in such a way as to retain good support of the implant or for other reasons have certain attributes that keep the implant well supported to prevent the implant from descending on the chest. In these patients, the implant can remain in good position but the breast tissue itself can fall away from the implant because although the implant is well supported, the breast tissue is being pulled down by gravity. The Waterfall effect is the term that aptly describes the breast shape as the tissue seems to flow down and away from the breast mound. Patients who have this change usually say that “their breast is coming away from the implant”. Breast implant revision surgery in these women may only require the tightening of the skin envelope should the patient not want to change the implants. Should the patient wish a different size of implant or if pocket modification surgery is necessary to change the shape or breast implant position, that can also be done with skin tightening. Some patients can even develop more breast tissue as they move through the aging process. In these patients, some breast tissue can be removed as an additional treatment to get to the size they wish and to decrease the need for more revision surgery.
Bottoming Out and the Bra
The second way patients can develop drooping with implants is termed bottoming out. This is a shape issue that can develop as the result of the technique from the initial surgery or more commonly over time as the tissues holding the implant up become weak and the implant along with the breast falls. Think of this as the weight of the implant being free to damage the lower part of the breast, to push the breast downward. This downward push also stretches out the lower part of the breast skin between the nipple and the fold under the breast. The stretching of this lower breast skin give what patients refer to as the “banana appearance” to the breast that is associated with the aging process.
The bottoming out kind of drooping results in not only the breast falling as with the Waterfall effect but rather both breast and breast implant fall together. This leaves an empty space in the upper breast and is often referred to as a loss of upper pole fullness. So not only is the breast lower but there is loss of upper pole fullness and the breast takes on a more aged appearance.
A quick fix is that patients come to rely on the support of a good bra to push the implant back up to its original position on the chest in a way such as to regain a youthful look for the breast. But without a bra the breast comes to rest at a lower position. Bottoming out can be mild, moderate or severe and so a decision to have breast implant revision to correct the drooping is made, in consultation with a plastic surgeon. The process of deciding to proceed with revision is based on the severity of the shape problem and other factors such as any discomfort the patient may have as a result of the pocket being too large and the implant rubbing against the chest or even pressure on the tummy as the result of looseness and drooping of the breast. Patients who have bottoming out can also have lateral falling that may make a patient become more inclined to fix the bottoming out.
Lateral Falling of Breast Implants
Some patients who have had implants for many years may notice that when they lie down, their implants fall to the side. This can be the result of large implant placement at initial surgery but can also happen by itself over time. Breast implant revision surgery can be performed to treat this issue by closing down the space, or pocket around the implant so the implant no longer falls to the side. As with bottoming out, safe revision surgical techniques can be used to improve shape and return a youthful appearance to the breast. When bottoming out occurs, there is little support and the breast implant falls and the most significant part of the shape problem is loss of the fullness that everyone can see in the top of the breast as that part of the breast is exposed even when clothes are worn.
Breast Implant, Do your Job!
This loss of upper pole fullness comes from a loss of support for the implant. And so because the height of the implant cannot reach up any higher, there is a collapse of the skin in the upper part of the breast. A larger implant has a larger height but because a larger implant is also heavier, it will pull the breast down even more and not fix the loss of upper pole fullness. One can also think of bottoming out as the implant not being able to do its job because it can only reach so high, the height of the implant as it sits on the chest.
Internal Pocket Modification
What if there was a way to raise the breast without doing a breast lift which results in scars on the outside of the breast?
And besides, skin tightening won’t repair bottoming out because the same stretching forces are being applied after the lift and so drooping will recur.
Breast implant revision surgery techniques can be used to treat bottoming out by working to improve drooping from the inside and these techniques that I term “internal pocket modifications” because they are all done inside the breast. And despite the fact that repairs are hidden and done on the inside, very significant change can be afforded to shape the breast to look better and to have a youthful appearance. Internal pocket modifications involve changing the implant space to raise the breast using the body’s natural tissues to stabilize the position of the implant.
Combining Techniques in Revision Surgery
Internal pocket modification techniques can be combined with different types of breast lift surgery in an endless array of different possible combinations to suit both revision goals and wishes and the particular anatomy of the patient. And during both internal (pocket) and external (breast lift) combination surgeries, the implant can be changed to suit the patient and solve other issues to improve the patient’s appearance. The patient may want to change to a different size for personal reasons, either larger or smaller. But also the size of the implant can have effects on the shape of the new breast that can make the breast look different and better. Some patients may have an exchange to a smaller implant to lessen their chance for more drooping or in the prevention of its recurrence. As with all issues patients face, it’s a great idea to fully discuss all the different alternatives for breast implant revision with a Plastic Surgeon who has a great deal of experience with both breast lift surgery as well as internal pocket modification techniques.
* Individual results may vary.