Breast augmentation is the second most popular plastic surgery procedure. According to the American Society of Aesthetic Plastic Surgeons, over 360,000 are performed annually. Much of this popularity is due to the high satisfaction women have with the results. Surveys find the satisfaction among women with breast implants to exceed 90%. Some women, while pleased with their augmentation elect, for various reasons, to exchange their implants.
Size is among the most common reasons women choose to have a breast implant exchange. Over the course of a woman's life, her breasts change and there are times when she may wish for fuller, or smaller, implants. While most women elect to have larger implants, there are also women who choose smaller implants as well (though less frequent). In most cases, the surgery to change the size of the breast implants is more straight forward and easier to recover from than the initial surgery. The reason for this is that the pocket (the space around the breast implant) is already created. For exchanges to larger implants, the pocket may be expanded. It is unusual, but for exchanges to smaller breast implants, the pocket may need to be partially closed. In either case, it is usually less painful and easier to recover from than the initial breast augmentation.
Saline breast implants can leak. When this occurs, the saline slowly leaks out and the implant deflates. Because saline is the body's natural fluid, this does not pose a health risk. However, the affected breast will get smaller as the fluid is absorbed. The treatment for this is to replace the implant. It is quite helpful for this reason for women to keep records regarding their breast augmentation. Specifically, they should receive a card at the time of surgery which states the manufacturer, model, and size of the implants. Treatment involves removing the ruptured implant and replacing it with a new one. The opposite breast does not require treatment unless the implants have been in for a considerable amount of time, in which case it may be prudent to exchange that implant as well, or if the patient wishes to change size. Another reason why patients decide to exchange breast implants is because they wish to switch from saline breast implants to silicone gel or vice versa.
Silicone implants differ from saline in that if they leak or rupture, the body does not absorb all of the silicone the way saline is absorbed. Generally, it remains in place. Some feel that the rupture can contribute to problems local to the breast such as capsular contracture. The general view is that when there is a known, or suspected, gel implant rupture, the treatment of choice is to remove the ruptured gel breast implant and replace it. The new implants can be either silicone or saline.
Capsular contracture leads to a hardening of the breast after augmentation. There is always a scar tissue capsule that forms around an implant. It is the body's response to a foreign object. While this capsule typically remains soft, it can contract causing the breast to feel firm. When this occurs, it may result in one or both breasts becoming only slightly hard. Alternatively, it can cause the breast to become very hard and visibly distorted. If there is only a slight hardening of the breast, treatment may be observation. When the breast is very hard, re-operation is considered. Capsular contracture is a frustrating condition for both patient and surgeon. There is no definitive understanding of why this occurs nor can it be predicted to whom this will occur. It occurs less often in the submuscular position. For this reason, when it occurs in a patient with subglandular implants, Dr. Shuster will often recommend treating the scar tissue and moving the implants to a submuscular pocket. When a patient with submuscular implants develops capsular contracture, Dr. Shuster will usually treat this by releasing the scar tissue (a procedure called capsulotomy) and/or removing scar tissue (a procedure called capsulectomy). These revisions will also involve a breast implant exchange.
Over the course of time a woman's breast will change. The position of the breast implants may change with time as well. This may occur to an extent that the implants do not appear in proper relation to the breast, termed malposition. They may appear too far to the side or too low, termed "bottoming out". When breast implants bottom out, the treatment is surgical. It involves manipulating the tissue to create an internal brassiere to support the breast implants in a proper position. A similar type of secondary breast implant revision can be performed for implants that have moved too far to the side.
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