San Francisco Breast Augmentation Revision

Despite all the controversy, breast augmentation remains one of the most popular cosmetic plastic surgery procedures. With hundreds of thousands of American women receiving breast implants every year, the need for breast augmentation revision surgery is also increasing.

Breast implants, like hip replacements or pacemakers, are not considered a lifetime device. Many patients have the idea that breast implants need to be changed at ten years. As a general rule during the first ten years after surgery 25% of women receiving breast implants have implant revision surgery, and this is the focus of ongoing research.

Sometimes breast augmentation revision surgery is volitional. Examples include exchanging implants to change their size. One of the most common revisions performed is to replace the breast implants with larger breast implants. Breasts continue to change as we age, with or without breast implants, so sometimes an adjustment is necessary. Less frequently implants are changed to reduce size, and this may also require a breast lift.

Sometimes breast augmentation revision surgery is not so volitional. Examples include implant deflation and capsular contraction. If an implant deflates, it needs to be replaced with a new implant. The two major American breast implant manufacturers (Allergan® and Mentor®) back up their products with a lifetime warranty. That is, if the implant deflates a new implant is supplied at no cost. If the implant deflates during the first ten years, they also supply funds to defray the costs of the required surgery. Both companies offer enhanced warranties with additional features for an additional fee.

Capsular contracture means that the normally soft scar that secures the implant becomes tight and firm. This can lead to a firm breast or a displaced implant. Revision surgery removes or modifies the scar and repositions the implant. Research is ongoing as to the exact mechanisms responsible for capsular contracture, which it is hoped, will lead to non-operative therapies.

Breast implant revisions are more common with breast reconstruction (after mastectomy or radiation) than with primary augmentation. It is important to know the facts prior to having breast augmentation surgery, and equally important to know what treatment is available. In most cases breast implant revision surgery is less invasive than the original surgery.

If you are undergoing breast augmentation surgery, you can help decrease the need for breast augmentation revision by participating in ongoing clinical research. The requirements are minimal, and consist of filling out an online form once a year. The current studies are designed to give us ten years of follow-up information. Since breast implants continue to advance, most of the number we now quote are based on older breast implant models. The current implants are manufactured under tighter quality control and with advanced techniques.

I ask all my breast augmentation patients if they would like to volunteer to participate in the breast implant follow-up studies. I feel it is my responsibility as a physician and Board Certified Plastic Surgeon to do everything I can to assure the safety of my patients and the predictability of the procedures I perform. Breast augmentation revision patients are eligible to participate if new implants are needed. If you are considering breast augmentation for the first time, ask your doctor if they are participating in the ongoing effort to improve breast augmentation. As the techniques improve, as smaller percentage of patients should require breast augmentation revision.

By: Joseph Mele MD, FACS