Factors Leading To Implant Replacement

1. Capsular Contracture The most common cause for breast implant replacement is capsular contracture or hardening of scar tissue around breast implants. When a breast implant is placed in the breast, the body's first reaction is to form scar tissue around the implant. The scar tissue around the breast implant can become progressively tighter, leading to hardening of the breast implant. As the capsular tightening or contracture advances, the breast implant deforms and becomes painful. The rate of capsular contracture around breast implants is anywhere from 10 to 20% over the first 10 years with over 90% of these occurring in the first year after breast augmentation. Another important trend is the longer the implants are in place, the greater the chance of developing capsular contracture. So after several decades, the rate might increase up to 30%. A number of factors influence the development of capsular contracture. Breast implants used in breast reconstruction have a greater chance for developing capsular contracture than cosmetic breast augmentation. Breast implants placed under the pectoralis muscle have a lower chance for developing capsular contracture than implants placed on top of the muscle. Lastly, implants with a rough sand paper or “textured" shell have a lower chance for developing capsular contracture than smooth shelled implants. Once the capsular contracture progresses, the breast implant hardens leading to breast deformity and pain. After conservative measures have failed, surgery becomes the only option. During capsulectomy surgery, the scar tissue around the breast implant is removed and the breast implant is replaced with another implant. The frequent (10 to 30%) occurrence of capsular contracure makes it the most common cause for breast implant replacement. 2. Dissatisfaction With Breast Size As women age, their breast size can change due to pregnancy, weight change or aging alone. Breasts augmented in the past with implants may no longer be proportional to their figure. Breast implant replacement with a larger or smaller implant can address these concerns. Aging breasts also droop particularly after breastfeeding. Implant replacement with a larger breast implant can produce the extra volume necessary in to lift the breasts to a more youthful position. Another group of women simply wish they had larger breasts after breast augmentation surgery, while very few desire smaller breasts. Breast implant replacement yields more desired sizes in this group of patients. 3. Rupture Breast implant replacement is necessary in cases of breast implant rupture. Ruptured saline implants result in immediate change in breast size over a period of a few days. In such cases, implant replacement as soon as possible is necessary to keep the implant pocket from shrinking around the now deflated saline breast implant. Breast implant replacement is more difficult in cases where the implant pocket has contracted around the ruptured implant as the pocket now has to be expanded surgically before inserting the new implant. Ruptured silicone implants are more difficult to diagnose particularly with the new cohesive or “gummy bear" silicone implants. The first sign of a ruptured silicone implant is likely a change in breast shape or hardening of the implant. As soon as a ruptured silicone implant is suspected, a physical examination by an experienced plastic and reconstructive surgeon is imperative. Diagnostic tests such as ultrasound or MRI can be performed to confirm a suspicion for a ruptured implant. Breast implant replacement is indicated if a ruptured silicone implant is highly suspected or confirmed. 4. Rippling Rippling of a breast implant is visible wrinkling of the implant shell. Rippling typically occurs in women with thin breast tissue covering a breast implant. Rippling most commonly occurs at the bottom of the augmented breasts since there is the least amount of tissue and muscle covering the breast implant at that region. Surgical treatment of rippling is breast implant replacement with possible grafting inside the pocket to thicken the tissue covering the implant. Plastic and reconstructive surgeons typically recommend downsizing the breast implants during a breast implant replacement procedure for treatment of rippling. 5. Infection Breast implant replacement is typically necessary for infections of breast implants. As breast implants do not have circulation, it is difficult to treat infections effectively with antibiotics. Though mild infections can be treated with a trial course of antibiotics, more severe infections require removal of the breast implant. Severity of the infection is determined both by the extent of the infection or the infecting organisms. Implant replacement occurs once the infection has resolved. 6. Extrusion Breast implant extrusion occurs when a breast implant becomes exposed (extruded) through a wound at the breast. Breast implant extrusion is extremely rare and typically occurs in women with thin tissue covering their breast implant. One such circumstance is large implants placed in thin women with very small breasts. Implant replacement with a smaller implant is the treatment of choice in such cases. Implant replacement with a smaller implant places less tension on the wound thereby improving the chances of proper wound healing. 7. Personal Preference For Another Implant Material Personal preference to change breast implant material is another reason for implant replacement. Many women the 1990's chose to replace their silicone breast implants with saline implants due to a scare involving silicone implants. Silicone implants were pulled off the market by the FDA until November 2006 when the FDA re-approved them. During the period when silicone implants were unavailable to the general public, all women received saline breast implants. Since the approval of silicone implants in 2006, many women are returning to plastic and reconstructive surgeons to have saline implant replacement with silicone breast implants. The most common reason to have implant replacement among this group of women is the more natural feel of silicone implants versus saline. Despite this trend, certain women continue to desire silicone implant replacement with saline implants due to concerns for silicone leaking in their breasts. 8. Implant Age Many patients continue to go to their plastic and reconstructive surgeon with concerns of breast implants that are simply too old. Most of these women will have some degree of silicone rupture or bleed when their implants are removed. Implant replacement can be performed with either saline or silicone implants in this group of women. Though there is no age limit to breast implants, it is widely accepted that breast implants do not last forever. Anyone undergoing a breast augmentation surgery should be open to having at least one breast implant replacement surgery in their long lifetime. 9. Dissatisfaction With Implant Shape Not all breast implants are shaped the same. Some implants are tear-drop shaped while others are round. Each type of implant has its strengths and weaknesses, but most surgeons in the United States are currently using round implants. Women with strong preferences for one type of implant versus another can undergo breast implant replacement to receive the implant of their choice. 10. Animation Deformity Deformity of the breast implant with contraction of the pectoralis muscle is called “Animation Deformity." To treat the animation deformity, the breast implant is removed and the pectoralis muscle fibers divided to a greater extent. Implant replacement is next performed to complete the surgery. Some surgeons advocate replacing the breast implant in a different pocket above the pectoralis muscle. In this manner, contraction of the pectoralis will not impact the positioning of the breast implant.

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