When do breast implants need revision. How to recognize signs of implant complications. What are the risks of ignoring breast implant issues. Is breast implant pain normal. How often should breast implants be replaced.

Understanding Breast Implant Complications: When Revision Surgery Becomes Necessary

Breast augmentation is a popular cosmetic procedure, but like any surgery, it’s not without potential complications. While breast implants typically last 10-20 years, various factors may necessitate earlier replacement or revision. Recognizing the signs that indicate a need for breast implant revision is crucial for maintaining both aesthetics and health.

Painful Implants: A Red Flag for Potential Issues

Persistent discomfort or pain associated with breast implants is a significant concern that should not be ignored. This sensation can be indicative of several underlying problems:

• Capsular contracture
• Damaged lymph nodes
• Developing seroma
• Pinched nerves
• Poor implant placement
• Implant rupture (particularly in silicone implants)

Even if no serious medical issue is present, some patients find their implants uncomfortable enough to interfere with daily activities. This discomfort often stems from implants that are too large or improperly positioned. It’s important to note that ongoing pain or irritation is not a normal outcome of breast augmentation surgery. If you’re experiencing these symptoms, it’s crucial to consult with your surgeon promptly.

Implant Rupture: Immediate Action Required

Implant rupture can occur due to sudden physical trauma, such as a car accident, or through gradual weakening of the implant shell over time. The signs and detection methods differ between saline and silicone implants:

Saline Implant Rupture

A ruptured saline implant typically results in rapid deflation of the affected breast, making it easily noticeable. The saline solution inside these implants is similar to IV fluid and is safely absorbed by the body. However, prompt removal of the damaged implant is still necessary to prevent potential complications.

Silicone Implant Rupture

Detecting a silicone implant rupture is more challenging, as the gel inside leaks slowly and may not cause immediate visible changes. Diagnostic imaging such as ultrasound or MRI is often required to confirm a rupture. While not a life-threatening emergency, addressing a ruptured silicone implant is crucial to prevent infection or excessive internal scarring.

Implant Bottoming Out: When Support Fails

Implant bottoming out occurs when the breast tissue and skin can no longer adequately support the implant, causing it to descend below the breast crease. This issue is more common with larger or heavier implants but can also result from pregnancies post-surgery or age-related skin laxity.

Unlike natural breast drooping where nipples descend with the breast tissue, bottomed-out implants cause an upward shift of the nipples as the implants fall lower. Patients may also notice the outline of the implant becoming visible or palpable.

Implant Displacement and Rotation: Unintended Movement

While some settling of breast implants is normal, significant movement or rotation is cause for concern. Implant displacement can manifest in several ways:

• Lateral displacement: Implants moving too far from the chest midline
• Symmastia: Implants merging at the center of the chest
• Rotation: More noticeable in teardrop-shaped implants, resulting in an unnatural breast appearance

These issues often stem from an implant pocket that’s too large or improper tissue removal during the initial surgery. Addressing displacement is crucial for both aesthetic and comfort reasons.

Changes in Implant Shape: Asymmetry and Distortion

Alterations in implant shape can result from various factors, including rupture, displacement, rotation, or bottoming out. These changes typically occur asymmetrically, affecting one breast more than the other. Even if both implants change shape, the alterations may not be uniform.

While not necessarily a medical risk, shape changes can cause significant emotional distress and practical challenges, such as difficulty finding properly fitting bras and clothing. Revision surgery can help restore symmetry and the desired breast shape.

Capsular Contracture: When Scar Tissue Becomes Problematic

The formation of a capsule of scar tissue around breast implants is a normal part of the healing process. However, in some cases, the body produces excessive scar tissue, leading to a condition known as capsular contracture. This overproduction of dense, hard tissue around the implant can compromise the success of the augmentation procedure.

Capsular contracture is classified into four grades:

1. Grade 1: Asymptomatic, no interference with implant results
2. Grade 2: Minor cosmetic symptoms, breast feels slightly firm
3. Grade 3: Noticeable firmness and distortion of breast shape
4. Grade 4: Severe hardening, pain, and significant breast distortion

Grades 3 and 4 typically require surgical intervention to address the issue and restore a natural appearance and feel to the breasts.

The Importance of Regular Check-ups and Self-examination

Regular monitoring of breast implants is crucial for early detection of potential issues. Self-examination can help identify changes in breast shape, symmetry, or texture. However, professional check-ups are equally important, especially for detecting silent complications like silicone implant ruptures.

How often should you have your breast implants checked? It’s generally recommended to have a professional examination annually, with imaging studies such as MRI or ultrasound performed every few years, particularly for silicone implants. Your surgeon can provide personalized recommendations based on your specific case and implant type.

Self-Examination Tips

• Regularly inspect your breasts in a mirror for any changes in shape or symmetry
• Gently feel for any unusual lumps, hardness, or changes in texture
• Be aware of any new or persistent pain or discomfort
• Note any changes in nipple position or breast crease location

If you notice any concerning changes during self-examination, don’t hesitate to consult your plastic surgeon for a professional evaluation.

The Revision Surgery Process: What to Expect

Breast implant revision surgery is a customized procedure tailored to address specific issues and patient goals. The process typically involves the following steps:

1. Consultation and evaluation
2. Preoperative planning
3. Removal of old implants
4. Addressing any complications (e.g., removing excess scar tissue)
5. Placement of new implants (if desired)
6. Reshaping breast tissue as needed
7. Recovery and follow-up care

The specifics of the surgery will depend on the reasons for revision and the patient’s desired outcome. In some cases, additional procedures like a breast lift may be recommended to achieve optimal results.

Recovery and Results

Recovery from breast implant revision surgery is often similar to the initial augmentation procedure. Patients typically experience some swelling, bruising, and discomfort for the first few weeks. Most individuals can return to light activities within 1-2 weeks, with full recovery taking 4-6 weeks.

Results from revision surgery are usually long-lasting, especially when addressing specific complications. However, it’s important to remember that breast implants are not lifetime devices, and future revisions may be necessary as the body continues to change over time.

Preventing Complications: Tips for Long-term Implant Health

While not all complications can be prevented, there are steps you can take to maintain the health and longevity of your breast implants:

• Follow all post-operative instructions carefully after initial surgery
• Wear supportive bras, especially during physical activities
• Maintain a stable weight to prevent significant changes in breast tissue
• Avoid smoking, which can impair healing and increase complication risks
• Protect your chest from direct trauma
• Attend regular check-ups with your plastic surgeon

By staying vigilant and proactive about your breast implant health, you can often identify potential issues early, potentially avoiding more complex revisions in the future.

Choosing a Surgeon for Breast Implant Revision

Selecting the right surgeon for breast implant revision is crucial for achieving optimal results. When choosing a surgeon, consider the following factors:

• Board certification in plastic surgery
• Extensive experience with breast implant revisions
• Before and after photos of previous revision surgeries
• Patient reviews and testimonials
• Clear communication and understanding of your goals
• Comfort level with the surgeon and their staff

Don’t hesitate to schedule consultations with multiple surgeons to find the best fit for your needs. A skilled and experienced revision surgeon can address complex issues and help you achieve the results you desire.

Understanding the Costs of Breast Implant Revision

The cost of breast implant revision surgery can vary widely depending on several factors:

• Complexity of the revision procedure
• Surgeon’s experience and expertise
• Geographic location
• Type of new implants used (if applicable)
• Facility and anesthesia fees
• Additional procedures performed (e.g., breast lift)

While cost is an important consideration, it should not be the primary factor in choosing a surgeon or deciding whether to proceed with revision surgery. Many plastic surgeons offer financing options to help make the procedure more affordable.

Insurance Coverage for Breast Implant Revision

In most cases, breast implant revision is considered a cosmetic procedure and is not covered by health insurance. However, there are exceptions:

• Revision due to implant rupture (in some cases)
• Correction of severe capsular contracture
• Removal of implants due to health concerns

If you believe your revision may be medically necessary, consult with your plastic surgeon and insurance provider to determine potential coverage options.

Emotional Aspects of Breast Implant Revision

Undergoing breast implant revision can be an emotionally challenging experience. Many patients feel a mix of emotions, including:

• Disappointment with initial results
• Anxiety about undergoing another surgery
• Excitement about potential improvements
• Concern about recovery and downtime

It’s important to address these emotional aspects alongside the physical considerations of revision surgery. Many plastic surgeons work with mental health professionals or can provide referrals to help patients navigate the emotional journey of breast implant revision.

Managing Expectations

Having realistic expectations is crucial for satisfaction with revision surgery results. While significant improvements are often possible, it’s important to understand the limitations of what can be achieved. Open communication with your surgeon about your goals and concerns can help ensure you’re on the same page regarding expected outcomes.

Alternatives to Breast Implant Revision

In some cases, alternatives to full revision surgery may be appropriate for addressing minor issues or concerns:

• Fat grafting to improve contour or address minor asymmetry
• Non-surgical skin tightening treatments for mild sagging
• Adjusting implant size through minimally invasive techniques (for some saline implants)
• Breast lift without implant replacement for addressing ptosis (sagging)

Discuss these options with your plastic surgeon to determine if they might be suitable alternatives to full revision surgery in your case.

The Future of Breast Implants: Innovations and Advancements

The field of breast augmentation continues to evolve, with ongoing research and development aimed at improving implant safety, longevity, and natural appearance. Some areas of innovation include:

• New implant materials and designs
• Improved surgical techniques for more natural results
• Advanced imaging technologies for better preoperative planning
• Enhanced methods for detecting silent ruptures in silicone implants
• Bioengineered alternatives to traditional implants

These advancements may lead to reduced complication rates and longer-lasting results in the future, potentially decreasing the need for revision surgeries.

Staying Informed

As a breast implant recipient, it’s important to stay informed about developments in implant technology and safety. Regularly check reputable sources, such as the FDA website or professional plastic surgery organizations, for updates on implant safety and recommendations.

By staying informed and maintaining open communication with your plastic surgeon, you can make well-informed decisions about your breast implant health and any necessary revisions in the future.

Seven signs you need a breast implant revision

While it is expected for patients to replace their breast implants after 10-20 years, there are several reasons they may need to be replaced sooner.

If your breast augmentation does not deliver the natural-looking results you were hoping for, you experience complications with your implants or you have noticed your natural breast skin aging and sagging, a breast implant revision can help.

Here are seven common signs you need revisionary surgery.

Your breast implants are causing pain or discomfort

Painful or uncomfortable implants can indicate a number of issues that require a breast implant revision, including capsular contracture, damaged lymph nodes, a developing seroma, pinched nerves or poor implant placement. If you have silicone implants, pain may be a sign your implant has ruptured or is leaking.

Even if there is no serious issue causing pain, some patients find implants are uncomfortable enough to disrupt their daily lives, especially if the implant used was too large or poorly placed.

Regardless of the cause, persistent pain or irritation is not a normal result of breast augmentation surgery. Patients who are experiencing either should schedule an appointment with their surgeon.

Your breast implant has ruptured

Implant rupture can be caused by abrupt or intense physical pressure (like in a car accident) or through the aging and weakening of the implant shell.

A rupture in a saline implant causes a nearly immediate deflation of the affected breast, making it easy to diagnose. The saline solution inside the implant is the same as IV solution and is easily absorbed by the body.

By contrast, ruptures in silicone implants cannot be diagnosed without an ultrasound or an MRI because the viscous silicone gel inside the implant leaks out slowly.

While the rupture of a breast implant is not a life-threatening emergency, it is important to have the damaged implant removed to prevent infection or the development of excessive internal scar tissue.

Your breast implant has bottomed out

If the skin and tissue cannot adequately support the breast implant, it is possible for the implant to gradually fall below the breast crease, or “bottom out.” This condition is more common with large or heavy implants, but post-surgery pregnancies or skin laxity due to age can also cause an implant to bottom out.

Drooping breasts are not uncommon. But unlike breasts that naturally fall over time, where nipples fall with the breast tissue, bottomed-out implants cause nipples to move upward as the implants fall lower. It is also common for patients to be able to feel and see the outline of a bottomed-out implant.

Your breast implant is moving or rotating

It is normal for breast implants to settle into a slightly different position over time. It is not normal for implants to move to a dramatically different location on the chest wall. This is called implant displacement, and there are several ways an implant can shift.

Lateral displacement of implants (implants moving too far away from the midline of the chest) can occur when the implant pocket is too large. Symmastia, or implants merging in the middle of the chest, is a rare complication caused when too much tissue is removed near the breastbone, which in turn causes the muscle between the breasts to detach.

An overly large implant pocket can also result in implant rotation. Patients may not be able to tell if a round implant has rotated, but a rotation of teardrop implants yields a top-heavy, unnatural appearance of the breast.

Your breast implant has changed shape

Implant shape can change if the implant ruptures, shifts, rotates, bottoms out or becomes otherwise displaced.

Changes in implant shape usually occur asymmetrically, meaning in one breast or the other. Even if both implants change shape, they may not change in the same way. This asymmetry is not medically risky, but it can cause patients significant emotional distress and make it very difficult to find bras and clothing that fit properly.

Your breast implant is causing capsular contracture

The formation of scar tissue is a normal part of the healing process after placing any kind of medical or plastic surgery implant. Usually, this process is a good thing because the capsule of scar tissue helps support the implant, keeping it from slipping.

In some cases, however, the body mistakes the implant for a dangerous foreign object and creates excessive amounts of scar tissue to isolate it. Known as capsular contracture, this overproduction of dense, hard tissue around the breast implant can affect the success of the augmentation procedure.

There are four grades of capsular contracture, ranging from normal to severe. Grade one is asymptomatic and doesn’t interfere with the results of the implant. Grade two capsular contracture has only minor cosmetic symptoms, leaving the breast normal in shape but firmer to the touch.

Capsular contracture of grades three and four causes hard, misshapen and overly round breasts that look and feel unnatural. Grade four contracture also often results in breast pain. Patients with either grade three or four capsular contracture usually require a breast implant revision.

You are unhappy with your breast size

While most patients are happy with the results of their breast augmentation, some patients find they wish they had gotten a different size of implant – larger or smaller.

If you want to change the size of your implants, most doctors will recommend waiting about a year after your initial surgery before proceeding. Not only will this waiting period allow your body to fully heal, but it will also give your implants time to settle into their final position before you make this major decision.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

How do I know if my breast implants are in trouble?

There are symptoms and signs that may indicate problems associated with breast implants. However, one must always remember that majority of implant ruptures are picked up incidentally on ultrasounds and mammograms. On the other hand, some of the symptoms and signs mentioned below may not be due to the breast implant, but rather possible disease within the breast tissue itself.

Breast pain, breast discomfort, nipple sensitivity and soreness are not uncommon presenting complaints from patients with breast implants. Many attribute it directly to the implants but one must remember, idiopathic (unknown medical cause) breast and nipple pain is actually a very common phenomenon in women in general. If the discomfort is not associated with hardening, shifting or changes in the implant shape, a simple ultrasound or MRI can provide reassurance that the implant is intact, and may also allow detection of any abnormal breast tissue overlying the implant.

Breast lumps are often a concerning feature in patients with or without breast implants. In patients with old liquid silicone implants, pockets of silicones which has seeped into the breast tissue can form hard lumps. These can be detected and differentiated from breast cancer lumps via imaging techniques such as ultrasound, mammogram and MRI.

Change in breast shape or progressive asymmetry between the two breasts. Breast implants can move on the chest wall, or capsular contracture can push an implant upwards. This often occurs slowly overtime, thus can be difficult for some to notice. However, if you find that your bra sits crooked because your breasts are not at the same level, or if it doesn’t fit because one is sitting a little further into the armpit, then it may be time to see your doctor or a plastic surgeon. Don’t forget, sometimes pre-existing natural breast asymmetry can become more obvious after weight changes or even hormonal fluctuations such as pregnancies or menopause. This means, you may need a change in the size of your implants to correct the difference between the two sides.

Breast swelling is very rarely associated with breast implants. This can be associated with trauma to the chest wall (you may have bled around the implant), or it may be spontaneously with no precipitating event. The former requires urgent surgery, the latter requires further investigations into the cause of the swelling. Swelling can be due to fluid around the implant or infection. Swelling can sometimes be associated with abnormality in the breast tissue and need to be thoroughly assessed.

Breast skin or nipple discharge need to be taken seriously. If there are any discharge from an open sore on the breast or the nipple, please see your doctor. This could be implant-related or associated with diseases of the breast tissue or nipple, which may not necessarily be cancer.

Please contact your doctor or seek a referral to an accredited plastic surgeon if your breasts exhibit any of the abovementioned symptoms.

Our next blog will discuss the management of ruptured implants.

To read more about breast implant surgery, please click here.

Author:Dr Lily Vrtik

About: Dr Lily Vrtik is a fully-qualified and accredited aesthetic, plastic & reconstructive surgeon practising in Brisbane, Queensland (QLD), Australia.

Pain after mammoplasty – what to do?

Written on 18 Jun 2020

Pain after mammoplasty – what to do?

Contents

1. What hurts after mammoplasty

2. When does the pain go away after breast augmentation

3. The implant is placed under the muscle

4. Ribs hurt after mammoplasty and

5.What to do with unbearable pain

There are exceptions for everything in medicine, and normally, the severity of pain symptoms after breast augmentation surgery is assessed by patients as acceptable, tolerable. But for everyone who has a low pain threshold, it can be difficult to survive the first days after surgery and the stages of healing. One thing remains unchanged: it is impossible to completely eliminate the manifestation of pain after mammoplasty – this is a natural reaction of the body to surgical intervention and the installation of implants.

What hurts after mammoplasty

Anesthesia is still effective immediately after breast augmentation surgery, and patients will not have to experience pain of a high degree. In addition, with the appearance of obsessive, disturbing pain, while in a hospital, medical staff can offer painkillers.

Localization of pain: chest area, patients feel them like pain in the ribs. Less often – reflected in the back and upper abdomen (epigastrium), burning and discomfort can also be felt directly in the sutures themselves.

Such pain symptoms are normal, because during a surgical operation, at the stage of implant installation, soft tissues are moderately injured, the integrity of nerve fibers is reversibly disturbed.

Popular topics and articles:

When will the pain after breast augmentation go away? How does the residual effect of anesthesia pass? Further, during the day, pain sensations are experienced in different ways:

• Patients with a low pain threshold may find it difficult to tolerate the symptom and require pain medication;
• The widest group of operated patients feels pain as neutral, as one that can be tolerated without experiencing any obvious discomfort. Analgesics are prescribed only under special circumstances;
• Less common – patients with a high pain threshold – do not notice disturbing sensations, taking painkillers is not required.

How patients perceive pain in everyday life will determine how much they experience this symptom after breast augmentation surgery.

Pain, burning, reflected sensations subside during the first day, then, during the first week after mammoplasty, any degree of pain severity disappears completely.

If symptoms persist for more than a week or cause unacceptable discomfort, accompanied by severe swelling, it is necessary to visit the surgeon for an unscheduled examination.

Implant placed under the muscle

This is the general name for two types of augmentation (breast augmentation with implants) – total submuscular arthroplasty, or placement of the implant partially under the muscle and mammary gland. In both cases, it is not possible to avoid the occurrence of pain, but the soft tissues injured during the operation are restored as standard, within the first week after mammoplasty.

In most cases, patients notice a reduction in this period to 2-3 days, then the pain is either not felt, or felt as a background that does not interfere with everyday life. There is no prohibition on taking painkillers if there is no individual reaction to painkillers. Special formulations, most often, are not required, standard NSAIDs are enough, non-steroidal anti-inflammatory drugs – those that are often taken for colds.

Ribs hurt after mammoplasty

It would be more correct to say that it is the soft tissues that are close to the ribs that hurt, and not the costal bones themselves, the pain of which belongs to rare diseases. Such manifestations are a good example of reflected pain: those that arise in one part of the body, but are given to those located nearby.

Mandatory examinations before mammoplasty, tests allow to exclude any risks of surgery in patients with chronic degenerative diseases of bone tissue. If any pathology is found that is an obstacle to breast augmentation with the help of implants, such a surgical operation is not performed.

How to deal with unbearable pain

Contacting your plastic surgeon is the only correct way to find a solution in such a situation.

Under no circumstances is it allowed to perform exercises that in everyday life would help restore the mobility of muscle tissue. It is also forbidden to take baths (steaming), swimming, increasing physical activity or returning to the previous level of stress (running, fitness, etc.). It is strongly not recommended to remove compression garments, even if wearing them causes more discomfort than muscle recovery.

For more information on rehabilitation and recovery after breast augmentation surgery, see Consequences of Breast Augmentation. Rehabilitation and recovery

The main rule in the event of acute pain is not to take any of the actions that are described in large numbers on patient communication forums, and also not to use folk methods.

In the history of plastic surgery there is also no description of the positive experience of using warming compositions, which in everyday life, without surgical operations, help to cope with muscle strain. Apply such creams, gels, ointments is prohibited.

If there is a sudden onset of acute pain in the chest muscles, take a relaxed half-sitting position and observe the further nature and severity of pain for 15-20 minutes. If the symptom has resolved after the resting position has been taken, the daily activities should be reviewed and more time should be spent at rest. In the absence of positive changes, you should consult a doctor: you may need to consult a cardiologist, osteopath or other highly specialized specialists.

The main rule in the event of acute pain is not to take any of the actions that are described in large numbers on patient communication forums, and also not to use folk methods.

Popular topics and articles:

Postoperative recovery, Breast augmentation

What to do if the chest hurts after mammoplasty?

Mammoplasty is an operation to change the shape and size of the breast. Through plastic surgery, you can both enlarge the breast with the implantation of endoprostheses, tighten the sagging mammary gland, and reduce it by removing excess adipose tissue and skin.

Why there is pain after mammoplasty

When a woman experiences discomfort due to imperfection in shape, breast size or asymmetry, she turns to surgeons with a question about the possibility of mammoplasty.

During augmentation mammoplasty, implants are placed that are foreign to the woman’s body. It takes time for them to engraft in soft tissues, for the woman’s body to adapt to changes. Therefore, in the postoperative period, you should be patient and follow all the doctor’s prescriptions regarding not only taking medications, but also the regimen of physical activity, as well as self-care.

Pain after breast augmentation is associated with traumatization of tissues during the operation, their stretching due to the installation of implants. The severity of pain depends on the surgical approach, the volume and technique of the operation, and the sensitivity of the patient. The placement of the implant also affects the intensity of pain sensation: if it is installed under the breast, the pain will be less pronounced than in cases of installation under the pectoral muscle.

In the first weeks after the operation, discomfort will also be associated with breast swelling. Sometimes swelling extends to the abdomen, which is considered normal in this period. Perhaps the presence of hematomas, which quickly resolve.

There may be back pain, which usually disappears on average 2 weeks after the plastic surgery.

How long will you have to endure?

In the first week after the operation, the pain is the most intense. Each patient is different, but usually the pain decreases and gradually disappears already 2 weeks after the operation.

If the feeling of pain does not go away or, on the contrary, its intensity increases, you should notify the attending physician, tell about your feelings, and, if necessary, come for an examination. Pain accompanies the healing process, but can be an important signal of the onset of the inflammatory process.

An important point that requires special attention is the proper hygiene of the suturing area after surgery. Failure to follow the rules for caring for the seams can cause discomfort, burning sensation, pulling pain, and cause complications.

Unpleasant sensations during active movements may accompany you for several months after the operation.

The whole process of rehabilitation after mammoplasty with a return to a full, normal lifestyle usually takes about 1 year.

How to relieve pain after mammoplasty?

To relieve pain and prevent inflammation in the postoperative period, painkillers, anti-inflammatory and antibacterial drugs are prescribed. The surgeon will recommend the scheme and duration of the reception.

Prohibited after surgery:

• drinking alcohol – within 2 weeks;
• physical activity, sports – 4-6 months;
• visiting saunas and baths – 2 months;
• sunburn, sunbathing – 4-6 months;

Recommendations on the regimen:

• sleep on the back for the first 2 weeks after the intervention, then it is allowed to sleep on the side. You can sleep on your stomach no earlier than a month later, if there are no discomfort;
• physical activity, even minor, should be limited for 2 months. In the first week, active hand movements should also be excluded so as not to provoke displacement of the implants;
• Compression underwear around the clock for 1 month. A few days after the aesthetic surgery, the doctor will allow you to take a shower and remove the compression underwear for 1-2 hours. Wearing special underwear not only fixes the implants, but also reduces postoperative swelling. After a month, the doctor will recommend wearing compression underwear at night for another 1 month.

The final result of the operation will depend not only on the actions of the surgeon, but also on the implementation of all recommendations in the postoperative period by the patient herself. Physical calmness and psychological comfort are essential attributes of a painless and quick rehabilitation period.

If you want to consult on mammoplasty in our clinic, write to Dr.