With any type of procedure revision surgery is sometimes needed. In the case of breast implants this can sometimes be many years after surgery.
It is estimated that perhaps up to 25% of patients having a breast implants will have further surgery over the next 5 years. This may be an exchange of their original implants for larger or smaller implants, a mastopexy (breast uplift) or removal of the implants if no longer desired. However, perhaps the commonest reason for revision surgery is due to capsule contracture around the implant.
Removal of breast implants and mastopexy (breast uplift)
“I am very happy with how they look now, it took a few months for them to settle into their natural shape.”SN, Age 37, Exeter, Devon, Removal of breast implants & mastopexy (breast uplift)This patient had a previous breast augmentation with 460mls CUI breast implants combined with a mastopexy many years ago. She wished to return to her natural size without the ageing breast implants. Both breast implants were removed and were found to be intact, the capsules were left in place in the sub muscular position and then the breast was lifted. Removal of breast implants and mastopexy (breast uplift)
“I am very pleased with my smaller breasts without my breast implants. My breasts feel a similar size to before I had children.”
DJ, Age 58, Exeter, Devon, Removal of breast implants & mastopexy (breast uplift)
This patient underwent removal of her very old breast implants which have been present for 25 years along with the breast implant capsules. This procedure was combined with a breast uplift or mastopexy.
The implants have been placed on top of the muscle and when they are in this sub-glandular position it is possible to remove more of the capsule and sometimes all of it, as was the case here. This is called an en-block capsulectomy which is not always possible and particularly when the implants are placed under the muscle as in this position it is not possible to completely remove all the implant capsule safely.
In order to remove all of the capsule I generally recommend a breast uplift (mastopexy) and the capsule needs to be quite thick and firm in order to remove it. If the capsule is not thickened then here’s no evidence to suggest that removing all of it is beneficial and it can be damaging to the breast, ribs and chest wall to do so unnecessarily.
Results are shown at six weeks after surgery.
Exchange of breast implants
“I have gone from a 34 DD/E to a 34D cup and I feel much more comfortable now the breast is soft, with a more natural shape.”
TY, Age 46, Exeter, Devon
This patient underwent removal of her ruptured implants as she also had capsule contracture around her existing 470 mls sub-muscular implants.
The operation involved removing the lower anterior capsule and then replacement of her implants with 390CC anatomical mentor sub glandular implants. This allows her natural breast tissue to drape more naturally over the new sub-glandular implant and the anatomical shape helps improve the projection lower in the breast behind the nipple areola complex. The remaining sub muscular implant capsule can remain beneath the muscle and the new implant is placed in a sub glandular position.
These results are shown 8 weeks following surgery. With any type of implant exchange the results can be less predictable than primary surgery, however if implants have ruptured then they need to be removed to reduce the risk of lymph node disease particularly with older implants which may not be manufactured using a cohesive gel.
However most implants that are less than 20 years old should contain cohesive gel which makes removing any silicone from inside the old capsule much easier than older implants. With capsule contracture it is generally better to change the implant position or to completely remove the capsule which is sometimes possible in a sub glandular pocket.
Removal of breast implants and a mastopexy (Breast uplift)
“I am very happy to be back to my natural size, and there is now less weight on my bra straps which I find more comfortable.”
LB, Age 47, Torquay, Devon
The results shown here are 10 weeks following surgery.
This 47-year-old patient decided that she no longer wished to have her 300cc breast implants which she had had for many years. Removing the breast implants followed by a breast uplift or mastopexy can be a very popular operation as implants are often placed in the breast after weight loss or pregnancies to refill the breast skin envelope. Often if they are removed without an uplift then the breast may be quite droopy afterwards although this can vary significantly between different people and some patients are able to remove their implants without causing too much breast droop but this needs to be assessed on an individual basis.
This can also be a good option for patients who experienced recurrent capsule contracture or other problems with their implants. In this situation in the future it is possible to replace the breast implant perhaps with a smaller implant in the sub glandular position whilst the original might have been in the sub muscular position, but when the breast gland has been elevated a sub glandular placement can be possible.
However most patients choose not to have their implants replaced and to be satisfied with their natural breast volume.
Removal of breast implants and a mastopexy (Breast uplift)
“The results are just what I wanted. I feel much more confident now as I prefer my smaller natural size.”
SJ, Age 66, Exeter, Devon
Results are shown at 8 weeks post-surgery
This patient underwent removal of her breast implants and a mastopexy (Breast uplift). 270 ml implants which were still intact in good condition, were removed that had been in place for 25 years. Breast size is now reduced from 34 DD to a more natural 34 C cup
Exchange of breast Implants with en-bloc complete capsulectomy
This patient underwent exchange of her breast implants and complete capsulectomy to remove the implants and the capsule. The implant had been in place for 20 years . She underwent a complete capsulectomy to remove a grade IV capsular contracture . This is possible when the implant has been placed on top of the muscle. 260cc implants were removed and they were replaced with Nagor Impleo High Profile 360 cc implants in the same sub-glandular position (on top of the muscle) after the old implants and capsules had been removed. Results are shown at six weeks.
“The results are beyond my expectation and I didn’t expect such a natural result at my age”
RN, Age 71, Exeter
With this type of revisional surgery I always explained that the results of surgery are less predictable and there is an increased chance of a breast implant capsule recurring, but this is reduced if the implant is placed in a new position and the new implant is not in contact with the old capsule or if the old capsule has been completely removed.
It is not always possible to remove all of the capsule particularly when the implant has been placed under the muscle or if the capsule is very thin and soft. Each patient is unique and there are advantages and disadvantages of each approach too implant replacement which will be discussed at your consultation to help you make the right decision about which procedure will be best for you.
Bilateral capsulectomies for Grade IV Capsular contracture and re-augmentation
This patient underwent complete capsulectomies for a grade IV (severe) capsule contracture in the sub-glandular position. For this patient the replacement implant was anatomical shaped to give a more natural breast shape. The natural shape is an advantage of the teardrop shaped or anatomical implant however there is a risk of implant malposition or rotation with this type of shaped implant which might require additional surgery and further cost in the future.
The risk of rotation probably reflects lifestyle choices such as exercise and movement and it is a risk that needs to be kept in mind when selecting this type of implant .
“The results are better than I expected and I feel so much more comfortable”
ER, Age 57, Torquay
Revision breast implant surgery
The patient result below had been operated on elsewhere some years ago. She had an implant that was sitting too low on the chest wall which is sometimes called a double bubble deformity. Surgical correction is sometimes possible and involves replacing and repositioning the implant. In addition re-positioning the fold under the breast (infra-mammary fold) is sometimes needed and removing some of the capsule around the old implant to maintain and support the new implant in the correct position.
As with all types of surgery the outcome is not completely predictable. Mr Oliver will try to explain the realistic expectation of the post-operative result. This is important with all types of surgery but in particular when a revision is required. Often revision surgery can be more complex and difficult than the initial procedure.
This photograph show the results 6 weeks after surgery which involved implant repositioning with new silicone breast implants and re-enforcing the infra-mammary fold.
Removal of breast implants and immediate Mastopexy (Breast Uplift)
The patient result below had been operated on elsewhere some years ago.
This patient has had 175cc implants removed with a breast uplift. The photographs show the breast implants removed entirely (en-bloc) and then the resultant breast shape after the mastopexy. En-bloc removal of implants is possible when there is a significant degree of capsule formation and can be a very useful technique especially when the implant has ruptured. If you are considering this procedure Mr Oliver would be able to discuss this with you at your consultation.
“The procedure and the staff were excellent all round, the result is perfect for me”
YW, Age 50, Guernsey
Removal of breast implants and Mastopexy (Breast Uplift)
This 61 year old lady had undergone breast augmentation more than 10 years ago.
She wanted the implants removed and rejuvenation of the breast. She had a 270cc implants which were intact and showed no signs of leakage when removed. There was descent of the implant on the chest wall and grade 3 capsule contracture leading to a firm and uncomfortable breast which was too low and now too big for her. She choose to have the implants removed and a mastopexy or breast uplift procedure at the same time. The old capsule has been used to make a pocket to elevate the lower breast tissue up behind the nipple and areolar to maintain and increase the projection of the breast despite reduction in the overall size of the breast, and restore a more aesthetically pleasing breast shape returning the breast to their natural size. These photographs show the results at 6 weeks post-surgery when the scars are still red and visible. The scars can be expected to fade over the next 6 to 12 months.
“I am extremely pleased with the procedure and the results”
TN, Age 61, Torquay, Devon
Removal of breast implants and Mastopexy (Breast Uplift)
Removal of implants and Mastopexy
This patient underwent removal of 295cc Allergan implants and a mastopexy. These photographs are 2 months post op. The scar will continue to fade over the next 12 months or so. Whilst breast augmentation and mastopexy is a difficult operation removing implants and at the same time performing a mastopexy is relatively safe with regard to preserving the nipple blood supply and I feel can be performed safely along with implant removal. In order to avoid a droopy empty breast a mastopexy at the time of implant removal is always a consideration particularly if the implant has been relatively large in comparison to the overall breast volume.
“The hospital was a pleasant experience, I am happy with the size and shape but still have a little discomfort on one side which I am waiting to settling down.”
MR, Age 58, Devon
Removal of 275cc breast implants & Mastopexy (Breast Uplift)
Removal of implants and Mastopexy
This patient underwent removal of breast implants that were 20 years old but still intact. The breast has been lifted and the nipple elevated. The photographs are taken at 3 months and the redness in the scars can be expected to fade further over the next 6 to 9 months. The lower breast tissue has been place inside the pocket where the implant has been removed. The volume removed was 275cc. Sometimes the sensation to the nipple can be reduced with this procedure and it can take about a year for the maximum recover to take place and even then the overall sensation may be reduced compared to before the uplift.
“I am very pleased with the outcome of surgery to remove my old breast implants, but my nipple sensation is a little reduced still.”
NT, Age 61, Torbay, Devon
Removal of breast implants and mastopexy (Breast Uplift)
Removal of implants and Mastopexy
This patient underwent removal of 300 cc breast implants and a breast lift or mastopexy at the same time. The breast tissue is tucked back up behind the nipple to add some projection in the middle of the breast. Recovery usually takes 2-3 weeks. Sometimes the nipple sensation can be affected by this procedure.
“My breasts have returned to my pre-augmentation shape. I had no problems with recovery. I feel like me again and am much more comfortable. I have gone down from a 36C back to a 36B cup bra.”
NC, Age 57, Exeter, Devon
Removal of breast implants and mastopexy (Breast Uplift)
Removal of 350 cc breast implants and Mastopexy
This patient underwent removal of 350 cc implants and a mastopexy. She had gained some weight and breast volume since her breast augmentation and no longer wanted to be so big but didn’t want to be left with breast droop after having her implants removed. These results are at 6 weeks and the scars can be expected to fade further over the next 12 months.
“My upper back and neck feels much better. Everything was very efficient and I took two weeks off work to get back to 100%.”
TD, Age 54, Exeter, Devon
PIP breast implant removal
“Excellent Standard of care.”
IG, Age 38, Removal of PIP implants, under local anaesthetic
PIP breast implant removal & mastopexy
“I am very, very pleased. I have got my confidence back.”
EV, Torquay, Age 48
Capsulectomy & exchange of breast implants
“I am really pleased with the new implants.”
EH, Channel Island, Age 47
Exchange of breast implants following complete capsulectomy
BF, Devon, Age 64
Exchange of breast implants following complete capsulectomy and removal of original Dow Corning breast implants inserted 30 years ago.
This patient had ruptured implants which were made by the very first breast implant manufacturer. She had 175 mls implants, both ruptured which were removed along with the capsules before replacing the implant in the sub-glandular position. Due to the thick, calcified capsule with silicone leakage it was important to remove the capsules. This would have been much more difficult if the implant had been place under the muscle in the sub-muscular position without damaging the pectoral muscle.
At the patients request a further 100 ml was added to the implant volume and Nagor Impleo HR 270 ml implants were used on both sides to add a little breast volume.
The exact lifetime of modern breast implants is difficult to predict but modern implants are manufactured to a much higher specification than the original implants first used and can be expected to last longer and generally contain a cohesive gel which will help contain any silicone should the outer shell rupture in the future. Implants can rupture within the first 10 years but should be expected to last between 10 and 20 years.