The most common breast implant revision surgeries in the United States are done to correct problems from the initial breast augmentation surgery that may have been a result of improper implant selection or poor surgical technique. Revision procedures may also be necessary to remove or replace aging, older generation gel and saline devices.

Local problems may include capsular contracture, stretch deformities, wrinkling, implant palpability, incorrect sizing, visibility, asymmetries, and even pain. Often, patients have had problems with their breast implants for many years. Many women were either discharged by their plastic surgeon without any follow-up care, or are uncomfortable with the idea of returning to their original plastic surgeon.

Preoperative patient education is extremely important.

  • Patients undergoing a breast implant revision procedure need to understand and accept the risks associated with implant revision surgery or opt for implant removal alone.
  • Revision goals must be realistic: obtaining a soft, comfortable implant, improved breast screening for cancer, and long lasting results.
  • Patient desires must be converted into realistic surgical choices. Some severe or long-term problems may be uncorrectable.

Any surgical procedure should be considered carefully. Revision or removal of aging breast implants or revision surgery for local implant problems should only be performed when the long-term benefits and risks associated with the revision procedure have been fully discussed.

Patients should attempt to obtain any information about their previous breast implant surgery. Important information can be gained from old operative reports, and any information on the size, style, or manufacturer of their breast implants may be useful when selecting a replacement implant. Patients over 35 should also have an up-to-date mammography. Additional radiological studies, such as a breast MRI, may be necessary to evaluate the integrity of older gel implants.

The final surgical procedure will depend on the complexity of the problem. Multiple problems may require the use of various surgical techniques to restore a more natural appearing breast.

Form stable implants remain at this time investigational devices and are not yet approved by the FDA. Patients will need to enroll and meet the eligibility criteria for the study.

The Form stable breast implants are currently being evaluated to determine if the following characteristics have any advantage over round implants:

  • variable height, width and projection which may offer a wider range of size options for the surgeon.
  • possible decrease in visibility and palpability of the implant due to the more cohesive gel fill.
  • to determine the longevity of the implant as well as its rupture rates.
  • to determine the capsular contracture rates.

The use of a form stable cohesive gel implant may require:

  • the surgeon create a carefully developed and precise pocket for the new implant.
  • the possibility that with any shaped implant there is the risk of rotation.
  • enrollment in a long-term follow-up study (ten years)
  • the cost- form stable gels may be a few hundred dollars more expensive than round gels.

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