Breast augmentation is a great surgery but sometimes breast augmentation will require a breast implant revision or breast augmentation revision. If you are unhappy with your breast implants, Dr. Windle can help.
You may have breast implant problems like:
- Capsule contracture. This is when the scar around your breast implants shrinks and causes your breasts to slowly become firm round balls that can be very uncomfortable.
- Rupture or leaking of your old breast implants. This could be a rupture of your old silicone breast implants or a leak of your saline implants.
- Breast implant animation deformity or pectoralis flexing deformity.
- Excessive rippling of your breast implants. All breast implants will ripple but the older silicone breast implants and saline breast implants can have quite bad rippling problems.
- One or both breast implants is in the wrong position or slide to far down or out.
- Your implants are too close together resulting in a so called unaboob or symmastia.
- Your breast implants are heavy and sagging too much.
- You have stretched the skin out over your implants due to pregnancy or weight gain and now the skin hangs off your implants.
- You do not like the size of breast implant that was placed.
- You have decided that you no longer need or want your breast implants.
- Your want your breast implants bigger or you want your breast implants smaller.
Dr. Windle has seen and dealt with all of these problems and concerns for women who are seeking a breast implant revision or perhaps a seeking a removal of their breast implants with or without a breast lift. In addition, Dr. Windle has a special expertise in using rapid recovery techniques for breast augmentation and breast its potential problems.
Breast augmentation surgery and breast augmentation surgery problems combined make up the most common procedures performed by Dr. Windle totaling over 200 breast implant revisions per year.
Before and after breast augmentation photos showing a 54 year old woman who had saline breast augmentation 15 years prior. These implants were replaced with new saline breast implants 6 years later and they both ruptured. Her implants were below the muscle and she said the she also had the muscle contraction deformity of her breast implants that she did not like when she was at the gym. She chose to have new gummy bear breast implants placed above the muscle for her breast implant revision. This way she hoped to avoid the animation of her breasts as well another saline leak that she would have to have another operation for. There are more similar breast implant revision before and after photos here.
Do You Really Need to Change Your Breast Implants?
Most often, there is no reason to change implants unless there is a significant issue that you can just no live with. Breast augmentation is thought by many patients to be a simple surgery to execute but it is quite complex. Proper surgical technique and attention to the details, big and small, are essential to good results, and too often these are overlooked. Revision breast implant surgery, which is surgery that is done to correct a problem, often takes more skill, precision and artistic ability than the primary breast augmentation surgery. Dr. Windle sees many patients who are dissatisfied with their breast augmentation or who have developed complications. He says, “There is no such thing as a simple breast augmentation, and the attitude of “seen one, seen them all” that some plastic surgeons have is far too simplistic when dealing with the subtle complexities and intricacies of breast augmentation.
Breast Implant Revision Options
Breast implant revision options are many but they include:
- Removal of the scar capsule and replacement of the implants, with the same size, larger or smaller breast implants.
- Breast lift, with or without changing out the breast implants.
- Remove the breast implants all together.
- Repositioning of your implants:
- In a better position on your chest
- Above or below the pectoralis muscle
- With a sling or internal bra called an acellular dermal matrix (ADM)
- The use of new textured gummy bear breast implants that will “Velcro” to your body and have far fewer complications.
- Going to a new size of breast implant.
Each case requires careful study of a patient’s needs and a personalized treatment plan to achieve the best outcome and Dr. Windle, with his 30 years of experience and expertise with breast augmentation and breast augmentation revision surgery will guide you through the various decisions that will customize your new look.
A New Revolution in Breast Augmentation and Breast Augmentation Revision in Seattle
“We just do not have the perfect breast implant yet but with the new gummy bear breast implants we are getting close” says Dr. Windle. Breast augmentation today is a different process than it was. Surgeons used to choose the size of the implant and all we had was smooth breast implants that were either saline filled or silicone filled. The operation was cookie cutter and after the surgeon would tell the patients not to move for days and placed them on narcotic pain medication to keep them comfortable. They hoped that there would be no complications but in fact the reoperation rate over 15 years was quite high.
Should You Get Your Breast Implants Changed Every 10 Years?
It was reported to be over 40% in one study published the Journal of Plastic and Reconstructive Surgery in 2011. Perhaps, this is why so many patients come in to have their breast implants exchanged or revised after about 10 years. There is a myth out there that suggests that you should get your breast implants changed every 10 years. The old silicone gel implants that were placed prior to the FDA silicone breast implant moratorium in in 1992 that lasted 14 years, had a problem and if you have those implants still in then you should see a surgeon and consider having breast implant revision surgery. Insurance will sometimes cover at least the removal of the old implants.
There is a definite change that is occurring in the approach that many surgeons are taking to breast augmentation these days however, and some plastic surgeons are farther behind in their approach than others. As an example, the notion that the surgeon knows best in the selection of the implant size for his or her patients is ridiculously outdated. A surgeon should never presume to know what is best for our patients in this regard. We do need to set limits based on the patient’s physique but the surgeon’s responsibility should be to present the facts to our patients and guide them in making their own decision that is in their best interests. Similarly, no one incision is right for every patient, and one location for implant placement (be it above the muscle, subpectoral, or totally submuscular) does not satisfy every patient’s needs.
Breast Implant Types for Breast Implant Revision
There are just two basic breast implant types used today: saline-filled (saltwater or basic IV fluis) and silicone gel filled breast implants. Both types of breast implants have an outer shell or envelope or bag, made of silicone rubber.
Saline breast implants are filled with saline at the time of surgery. Saline breast implants have been around for a long time and they have been shown to be both safe and effective.
The advantages of saline implants include:
- If a leak does occur, the saltwater which is really IV fluid is safely absorbed.
- Saline implants are filled after insertion and adjustments can be made for breast size differences more easily than if the implants were prefilled.
- Smaller incisions can be used.
- Saline breast implants are less expensive.
The disadvantages of saline implants:
- They can be more firm than silicone breast implants
- They often have rippling and the ripples can act almost like waves as the fluid moves.
- They are prone to leaking. This is a much bigger problem than originally realized since, if a leak occurs, another surgery is required to remove and replace them. While some patients may not see this as a problem, added surgery brings additional risks for bleeding, infection and other potentially grave complications.
Silicone gel filled breast implants were re-approved for use since November of 2006 by the FDA (Food and Drug Administration). However the implants that were approved were 3rd generation implants and they were far superior to the older 2nd generation implants that were removed from the market in 1992.
Silicone breast implants have evolved and improved over the years. We now have the 5th generation breast implants available. These breast implants have a thicker, stronger outer shell and the gel that is used to fill the shell contains a more cohesive or gooier gel that does not run and does not act to break down the shell and cause leaking. The new implants are like a gummy bear candy and when they are cut or disrupted they will not leak or deform. These new breast implants do not feel as soft as their older counterparts when you feel them or pick them up but when they are placed inside your body, they are much softer and tend to stay that way rather than get hard.
The advantages of the new textured gummy bear silicone breast implants are:
- A softer, much more natural feel.
- Far less wrinkled or scalloped edges and therefore, can be installed on top of the muscle, if desired to avoid the animation or muscle contraction breast implant deformity.
- They will “Velco” or scar to your body so they stay in position and do not slide or stretch out your breast skin.
- They have been shown to form far fewer capsule contractures than the older style breast implants and in fact usually have a warrantee against capsule contracture.
- They are available in a tear drop shape which mimics the shape of the natural breast giving more volume at the bottom of the breast and helps to avoid the upper pole fullness or “shelf” that is an obvious tip off that you have breast implants.
The disadvantages of silicone implants are:
- A rupture may occur unknowingly, however, this has not been shown to be detrimental to you or your health.
- Silicone implants are prefilled and, therefore, the size cannot be adjusted.
- Silicone implants are more expensive.
Almost universally, women who have saline-breast implants and change to silicone-breast implants do prefer the silicone more for the natural feel. The breast implant companies now offer a variety of shapes and sizes to customize the fit to your body.
The three most common reasons for breast implant revision surgery are:
- changing implant size.
- improving the natural feel and appearance of the breast
- correcting capsular contracture
Dr. Windle, by strictly following best practices before and during your surgery like using the no touch Keller funnel technique, Sientra breast implants which have lowest capsule contracture rate and using the 24-hour rapid recovery protocol has minimized these revisions in his own practice while improving patient outcomes and satisfaction ratings. He feels very strongly that the real focus in breast augmentation surgery should be the prevention of problems and not in the treatment of breast implant problems.
Breast Implants and Breast Augmentation Are NOT Perfect
Despite our best effort to achieve the perfect breast augmentation, we are just not there yet. Breast implants are not real breast tissue; they are man-made and like any other medical device surgery (such as heart valves and artificial joints) sometimes revision procedures will be necessary for some reason. Dr. Windle, with his vast experience, is fully cognizant of the potential problems that breast augmentation and breast implant revision surgery and he is equipped to properly diagnose and treat patients so that an acceptable outcome is achieved.
If you have a breast implant problem, Dr. Windle, in treating your specific complaint, will do his utmost to properly evaluate your problem and recommend to you one or more ways by which the problem can be corrected. By it nature, breast augmentation revision surgery is a very complex surgery but often Dr. Windle can achieve a correction of your breast augmentation problems that may very well be able to improve your results.
We invite you to visit our office to discuss your problem and the potential solutions to achieve the appearance you desire with the least invasive procedure and the fastest recovery available.
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The Reason for Breast Implant Problems
The first step in correction of breast implant problems is to figure out exactly what is causing the problem or properly diagnosing why the problem exists.
The need for breast augmentation revisions can be the result of a number problems to include:
- Implant asymmetry with one implant higher than the other or located too far medially or laterally with respect to the other implant.
- Unaboob or symastia is when your implants that are too close together.
- Bottoming out (implants being positioned too low or too lateral on the chest wall in relation to the nipple position). This may occur because of creation of the implant pocket below the region of the inframammary crease or may occur naturally especially with large, smooth implants since they will act as a dead weight on your tissue and stretch it out.
- Implants are placed too high and do not drop or settle into the correct position.
- Implants that are too widely spaced, lacking desirable cleavage or falling into the armpits upon lying down.
Your tissue characteristics and tissue problems.
- Snoopy deformity or tuberous breast deformity (prominence of the nipple-areolar complex characterized by herniation of some of the breast tissue into the nipple-areolar complex, named after its similarity to the cartoon character Snoopy) should be addressed during the initial operation but occasionally only becomes apparent post-operatively.
- Large areolas can look too large after augmentation since the implant will stretch them out even more. They do not necessarily need to be addressed surgically but you should be aware of this potential problem. If Dr. Windle feels that this is a concern he will point it out to you during the initial consultation and can make the areolas smaller during the initial operation if need be and it is of concern to you.
- Cords under your breast after a breast augmentation are unusual and they are called Mondor’s Cord because a French surgeon, Henri Mondor, decribed them. They are actually a form of scar contracture that extends from the scar around your breast to your lower chest wall. They usually does not require surgery and are usually best treated with massage and warm compresses until they resolve
- Thin breast tissue as a result of aging, pregnancy, weight gain and then weight loss or breastfeeding. This leads to “coverage” issue in which there is very little breast tissue to cover the implant and your breast implants are more visible and the appearance less natural. In other words you can see ripples
- An elongation of the skin and sagging of the breasts over time as tissue elasticity is lost as a result of aging, sun damage or smoking.
- Pre-existing breast or chest wall asymmetry that is not corrected or accounted for at the first surgery. Most breasts have some asymmetry but sometimes it can be quite significant. Marked breast asymmetry or chest wall asymmetry is rarely perfectly corrected during surgery. However, Dr. Windle will point out obvious asymmetries to you preoperatively and attempt to correct the asymmetry as much as possible during surgery.
- Double bubble occurs when there is a groove along the breast below the nipple giving the appearance of the breast sitting on top of the implant. This may represent a problem with the tissue characteristics as well as a problem with the surgical placement of the implants and may occur on one or both sides.
Implant failure or implant associated problems
- Deflation of saline implants this is usually obvious because the augmentation effect is rapidly lost over the course of a day or two and you have a “flat tire.” Silicone breast implant rupture may be less obvious and may require further testing to confirm, such as an ultrasound or MRI. Breast implants used today have a full replacement warranty that will provide you with replacement implant(s) at no cost to you. Depending on the warrantee it has been since your original operation, you may also be eligible for financial assistance towards the operating room costs as well. One of the many reasons that Dr. Windle uses Sientra is that they have been shown to be the strongest implant available today so the possibility of a breast implant failure is very low
- Capsular contracture of breast Implants occurs when your body forms a thick scar around the implant(s) and that scar contracts. This may occur on one or both sides and may cause a shape change, discomfort, and may cause the breast to feel more firm. It may be more common following infection or hematoma.
There are four grades of breast implant capsular contracture called Baker Grades:
- Baker Grade I – the breast is normally soft and looks natural
- Baker Grade II – the breast is more firm but looks normal
- Baker Grade III – the breast is firm and looks abnormal
- Baker Grade IV – the breast is hard, quite often painful, and looks very abnormal
- Dissatisfaction with the size of your implants is the most common reason women have a breast implant revision surgery; to change the size of their implants. It is almost always to go bigger! This is the reason that Dr. Windle and his staff spend time with you discussing size and your expectations. He then measures your chest dimensions and based in those measurements gives you guidelines on a range of sizes that will work for your breast tissue and chest size. You are then placed in a bra and you try on implants in that size range so that you can decide on a size that works for you. Dissatisfaction with your implant size should be totally preventable by a thorough evaluation and decision-making process.
- Rippling is described as irregularities of the implant surface that can be felt or seen through the skin. This may result from thinning (atrophy) of the tissue covering the implants, a saline implant that is underfilled or leaking, a placement problem such as an implant being placed above the muscle, or some combination of these events.
- Animation or Muscle flexion distortion occurs when the pectoralis muscle sticks to, or scars down to, the capsule surrounding the breast implant. When the chest muscle is flexed, it can lead to a distortion of the breast.
- Implant palpability or being able to feel the implants beneath the ski is not uncommon especially with the new gummy bear implants but it is not usually an issue. Most women say that when they can feel it they know their implants are alright.
Solutions to Breast Augmentation Problems
Dr. Windle has several techniques that are aimed at correcting these various breast implant or breast augmentation problems that are not only tried and true but also scientifically proven. Depending on your specific problem, a specific solution exists. These may include:
- Simple Breast Implant Exchange (replacing your present implants with new implants that may be smaller or larger. If you have saline implants, sometimes the saline can be added or removed. Usually, even with saline implants in place, patients want to switch to the newer gummy bear implants with the textured surface.
- Capsulectomy or removing the entire capsule surrounding the implant and doing an implant exchange to new implants is one of the definitive, state of the art treatments for capsular contracture. This may be combined with moving the implants into a totally submuscular position and/or switching to textured implants to reduce recurrence rates.
- Neopocket formation is the creation of a new, separate pocket either above or below the old pocket and doing an implant exchange to new implants is the other definitive, state of the art treatment for capsular contracture. It is a little less traumatic and has fewer post-operative complications
- Capsulotomy (making an incision in the capsule surrounding the implants) is not a successful method for treating capsular contracture but can be very useful when the implant pocket needs to be adjusted.
- Mastopexy or breast lift surgery. There are many different types of lifts depending on the amount of lifting and reshaping that is required. A crescent mastopexy (using an incision from 10 o’clock to 2 o’clock around the top of the areolar border) can raise the nipple 1-2 centimeters. A Binelli (aka donut or concentric) mastopexy (using an incision around the outer border of the areola can raise the nipple up to 4 centimeters), can raise the nipple 2-4 centimeters. A vertical mastopexy (creating a lollipop-shaped incision around the outer border of the areola and extending downwards towards the inframammary crease) can lift the nipple up to 6 centimeters. A full traditional mastopexy (creating an anchor-shaped or inverted-T shaped incision around the outer border of the areola and extending downwards to the inframammary crease and then medially and laterally along the inframammary crease) can lift the nipple 8 centimeters or more. Please read more about mastopexy on this website if you think you might be a candidate for this procedure in combination with one of these other breast implant revision surgeries.
- The Internal Bra procedure is used for patients with bottoming out of one or both implants. This means that the pocket, or capsule, surrounding the implant has enlarged or stretched under the effects of gravity and have become too low on the chest wall or rests too far laterally when lying down. This may cause the appearance to be unattractive and even uncomfortable when wearing no bra. The implants may hang too low, preventing you from being comfortable when braless. Usually an internal bra of mesh or a sling called an an acellular dermis is placed to support the your breast implant and hold it in place
Some Breast Augmentation Revision Surgery Details
Breast augmentation revisions are performed as an outpatient procedure. After surgery, we start you on our Rapid Recovery protocol and you should be back to doing most things the next day without any narcotic medication.
Unlike many surgeons, Dr. Windle does use any specific regimen of straps, massaging, etc., following your augmentation because this is not advised with the type of implants he mostly uses; Sientra textured gummy bear breast implants.
The Results You Can Expect
While we cannot give you any guarantees you should notice an improvement in your breast shape and size immediately.
Please call (425) 366-8222 or contact D. Windle for further information or to schedule your breast revision consultation. We are located in Kirkland, close to Seattle, Bellevue, Renton, Mercer Island, Issaquah, Redmond, Bothell and beyond.
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