With breast augmentation being the most popular cosmetic surgery procedure there are a large number of patients who eventually require an exchange of their implants after many years, typically 15-25 years. There are also a group of patients who may have had breast augmentation elsewhere who are unsatisfied with their result and request revision.
What is an implant exchange?
Although breast implant technology is improving all the time, and their lifespan is increasing, most breast implants will eventually require exchange due to the development of capsular contracture as the scar tissue laid down around the implant eventually tightens, starts to harden and the breast shape changes. In a smaller number of cases, this may also be accompanied by some discomfort and/or occur at an earlier stage.
Once the capsular contracture has progressed to a significant degree implant exchange is usually recommended.
How is an implant exchange performed?
Implant exchange normally involves reusing the small incisions in the creases under the breast, used for the original augmentation, to access the old implant and removing it. Normally the tightened scar tissue will either be released or removed depending on its extent. A new implant is reinserted and the incisions closed. The old scar is excised and restitched to ensure a neat scar. Small drains may be inserted for short periods in some cases to allow any fluids to drain post-operatively.
What is pocket adjustment and change of plane?
In some cases the implant pocket may require adjustment if the original surgery has not been optimal, to ensure the best cosmetic result. This may involve improving the pocket shape eg in the cleavage area if there is an excessive gap between the implants, it may also involve closing the outer pocket in a few cases if the old implant had been placed in too lateral a position.
Often the plane of the implant may be changed eg from sub-glandular to sub-muscular/dual-plane. I will often move the new implant to the dual-plane if the original was in the sub-glandular plane to ensure a more natural result, particularly in the upper pole.
Will the new implant be the same size and shape as the old implant or different?
An implant of similar volume is often used but frequently of a slightly larger volume to allow for any volume lost by removing scar tissue. Some patients may prefer to increase their implant size with their new implants and use a larger implant.
In some cases, a change of implant shape is recommended to produce the most natural result. This may involve moving to a moderate from a higher profile round implant or to an anatomical/tear drop implant in some cases.
How is the new implant volume and shape selected for implant exchange?
A detailed assessment is made in clinic including discussion of the old implant and surgery that has been performed including implant size, shape, profile, plane of the implant pocket and incisions used. This is best discussed by bringing the information from the previous surgery to the consultation eg the implant cards or a copy of the medical/operation notes. In some cases, these may not be available and an estimate has to be made.
A number of measurements of the breast base and assessment of chest wall shape and body weight are made. Following discussion with the patient, a number of options are recommended, which may be a change to an implant of similar size and shape to previous. Alternatively changes to the volume, profile and/or shape of the implant and implant plane will be recommended to produce a more natural look, particularly in the upper pole.
Where an increase in implant size is desired, small volume sizers together with a trial bra are used to give an indication of how the new breast volume will look in front of a mirror.
Will a breast lift (Mastopexy) be required?
In many cases, the breast tissues around the implant remain in a good position and breast shape is good, such that just an implant exchange is required. However, in other patients the breast shape may have changed over time eg with breastfeeding or weight change. In some of these cases, a breast lift or mastopexy is recommended with the implant exchange to make sure the breast shape is optimal and pert after the surgery.
For milder cases of ptosis (droop), a peri-areolar mastopexy may be suitable – this involves excising a small amount of skin from above the areola to lift the nipple and the lower pole of the breast. A small crescentic inclusion is made on the border of the upper half of the areola which is well hidden.
For more significant cases of breast droop (ptosis) a vertical scar mastopexy is often used, involving an incision around the areola, vertically down the lower half of the breast and a short incision hidden underneath in the breast crease. In a small number of cases, a full mastopexy may be required involving incisions around the areola, vertically down the lower half of the breast and a longer incision hidden underneath in the breast crease.
If a peri-areolar mastopexy is used there is some flexibility with the new implant volume. Where a vertical scar mastopexy is needed with an implant exchange the implant volume is limited to a smaller size if a one-stage operation is desired to prevent recurrent droop (ptosis). If a larger implant volume is desired a 2 – stage approach is required with implant removal and mastopexy (uplift) performed initially, and an augmentation with a larger volume implant performed at a second stage.
How long does recovery take after an implant exchange?
Implant exchange is carried out under a short general anaesthetic either as a day case, or some patients may prefer to stay in hospital overnight.
If drains have been used these are kept in place until later in the day or the following morning. Post-operatively the implants are strapped with elasticated support strapping for a week to keep them in the correct position.
These dressings are removed after a week, after which a plain Lycra bra is worn to 6 weeks. You will need 1-2 weeks off work depending on the type of work you do. Sports and gym exercise will need to be avoided for around six weeks except for the use of an exercise bike at 3-4 weeks
Which types of implants are used?
The implants are predominantly silicon, as a silicon gel (like a firm jelly). The implants have a silicone shell which has light texturing eg micro-textured as for Nagor Impleo or Mentor Siltex implants, or nano-textured eg Motiva or Sebbin implants. Nano-textured implants are almost completely smooth and have the lowest risks of ALCL (a rare form of lymphoma associated with some more roughly textured implants).
The implant types will be discussed at your consultation in terms of volume, profile, shape, brand and degree of texturing as discussed above.
Anaesthetic: GA 1-2 hours
Hospital stay: Day-case/1 night
Dressings: 1 week
Recovery period: 1-2 weeks off work, 6 weeks away from most exercise
ASSOCIATED BREAST PROCEDURES:
For more information on the breast implant exchange procedure, book a consultation with Mr Tulley.