There are several reasons, and a number of studies, why implant exchange or removal needs to be carried out.
These can be classified as cosmetic issues, capsule formation, implant failure and rare clinical problems such as infection and inflammatory reactions to silicone.
The most common reason for implant exchange or removal is related to dissatisfaction with the cosmetic result of the breast augmentation. This can be due to technical per-operative factors.
Even minor surgical misjudgment in the position or extent of the sub-glandular or sub-muscular pockets can lead to differences in appearance. Sometimes pre-existing breast asymmetry is enhanced or is first noticed by the patients after surgery. Therefore the preoperative assessment is critical. Essentially there is no guarantee that the size and shape of the breasts after breast augmentation will be satisfactory because it is dependent on so many factors, from the size and shape of the existing breasts to the type, size and anatomical placement of the implants. When there are many variables involved there will naturally be variance in outcome.
However, with experience (and with this comes judgment and increasing expertise of technique) and a very clear consultation with the patient, it is more likely that an informed consent and a satisfactory outcome can be achieved. This includes a clear explanation of the different effects low profile, high profile, round and teardrop-shaped implants have on outcome along with whether they are put above or below the muscle. Despite this, dissatisfaction with size can occur. Sometime the patient feels disappointed that their breasts are still too small or, more uncommonly, too large. It is true that there are really no agreed benchmarks regarding the ideal breast size and shape, the physique of the patient and the volume of the pre-existing breast will govern the initial size and type of implant that it is technically possible to insert. It has to made clear that if a very large breast volume is desired, it may not be possible to achieve in one stage. With careful preoperative planning and discussion an unwanted exchange to “size up” maybe avoided or at least planned electively.
In my practice a common cosmetic reason for implant exchange is a change in psychology or circumstances. Occasionally a patient will want the implants removed altogether. The cosmetic appearance following this cannot be determined until some months have elapsed. It is not unusual for the breast to shrink and revert to a shape that is reasonable and satisfactory to the patient. The desire to further enlarge or adjust the shape and size of the breasts after some period of time has elapsed is also not unusual. This can be due to pregnancies, weight changes or simply a shift of the patient’s feelings about the body image. Breast ptosis (droopiness) that develops after augmentation can sometimes be carried out by mastopexy or by exchange with a bigger of implant alone.
When a breast implant is inserted this process will occur naturally and capsule formation is a normal healing response. For the majority of patients the capsule stays healthy, soft and pliable and you will not even notice it is there. However, sometimes the response is too aggressive or abnormal and the capsule can become hard and palpable and, in some patients, the capsule distorts the breast. Click here to read more about capsulectomy.
Implant failure and rare clinical problems
Implant failure can be defined as rupture or changes in volume and shape of the implant due to tears in the outer shell and leakage of the silicone inside. The true rate of implant failure is really not known because it is not always possible to detect the implant failure clinically. The largest data source is the reported failures from the main implant manufacturers. This has been estimated to be between 9-12%. There is some evidence that the most common cause for implant failure is the surgeon, although this cannot be proved for certain. It is true that damage can result from instrumentation of the implants as they are inserted, however intrinsic failures are also known to occur. The PIP implant fiasco has been widely reported and recognized. In one study, the rate of PIP failure increased after 2003 when non-approved, industrial silicone was used to manufacture the implants. There is also circumstantial evidence that intrinsic failure can occur with any implant.
The treatment of implant exchange is exchange with a new implant. Sometimes this is not advisable especially if the implant has caused a local or regional inflammatory reaction. This was not an uncommon finding with patients with ruptured PIP implants. The surrounding capsule was inflamed and in some cases silicone escaped in to the local lymph nodes causing pain and discomfort. Rarely this can occur with other implant types. In these unfortunate patients immediate implant exchange is not advisable after removal until all the inflammation and discomfort has settled.
Infection post operatively is rare in breast augmentation surgery and even more uncommon in the long term, although unfortunately it can occur. The treatment is removal of the implants, thorough wash out of the space from where the implant came from and a long course of antibiotics. A new implant can only be inserted when the infection has been eradicated.
I have been researching breast implants and currently have Allergan, but my friend has Polytech and her breasts look more natural and round. Can I change my implants?
The simple answer is yes. You can safely have your implants exchanged or removed.
Before this procedure we would have a consultation and discuss the reasons you are requesting the implant exchange or removal.
I have been using the Nagor implants for many years and am very happy with the results achieved. They are soft but tough, and very dependable. And because of the time I've worked with them I have an extensive evidence base regarding the outcomes that can be achieved with the Nagor breast implants.
But ultimately, the decision is yours and I will work with you to achieve your desired outcome.
What type of bra do you recommend after breast surgery?
The breasts need to be well supported following any breast surgery (exchange of implants, removal of implants, breast augmentation, breast reduction, even nipple correction surgery). I recommend a comfortable sports-style bra, the one made by Dunlop has been recommended by many of my patients as it is made of soft mesh yet tight enough to provide support.
In placing the implants under the muscle, does this damage the muscle in any way? What happens to the muscle if the implants need to removed for any reason?
This is a good question. The reasons for any muscle changing in function if it is not used for any reason, injured, the nerves been damaged or the muscle length and therefore its tension has changed. Initially the muscle is damaged because we have to incise it partially to get the implant under it. This is why sub-muscular implants are more painful postoperatively than implants placed directly under the breast. Also initially because it is stretched the muscle will function slightly differently, but nature is forgiving because the muscle will learn to behave as normal after a period of recovery.
I have not detected any long term functional problems with the muscle (called the pectoralis major muscle). However, if you were a professional swimmer, tennis player, athlete (such as a javelin thrower, gymnast) I would not recommend any sub muscular implants to be inserted. For “normal people” in the long term, I do not think that there should be any impediment to sporting activities and every day life. Long term the muscle, I believe, fully recovers.
If the implant is removed the muscle will function as before but I suspect that there will be a relatively short period of full functionally recovery as the muscle gets used to the decreased length and tension after the implants have been removed.
MRI scans – should I do this every few years to check for any ruptures?
This is a complex and important question. There is no indication for regular MRIs in my opinion to check the state of the implants. An MRI should be carried out only if there is clinical suspicion that there is something wrong with the implant. For example a volume change, a change in shape or the presence of pain, may indicate rupture (implant failure) or capsule formation. I also believe if the patient is anxious , or feels she is experiencing odd symptoms or the implants has been in a very long time; then a scan should be done. A simple ultrasound is probably as good as an MRI in the right hands for detecting implant rupture. If an implant is damaged then they should be removed with the option to replace them with a different implant, perhaps consider fat filling.
What is a long time? This is not really known but after 10 years it maybe prudent to have an ultrasound. This is an arbitrary figure based upon the fact that nothing man-made lasts for ever and the cause of implant failure is multifactorial. Unfortunately, sometimes I am sure that an implant maybe damaged and ruptured but not detected clinically. This is because the natural capsule that forms around the implant keeps the implant in shape and in position. This logically begs the question of whether it is dangerous to have a ruptured implant in your body with internal extrusion of silicone. The opinion of the majority of medical practitioners and available research of statistical data (known as meta analysis), indicates that it is not dangerous. There is no evidence that silicone is harmful to the human body although of course, if the silicone used in implants is of low-industrial grade (such as in the PIP implants), then I believe that they can cause side effects and abnormal internal inflammatory responses. In my practice with Nagor, Allergan and Mentor implants I have not seen ruptured implants causing serious systemic problems. For some PIP cases, I have seen bad abnormal capsule formation and lymph node involvement and also historically in patients who have had implants that ruptured many years ago with old generation implants.The patient has to listened to and examined carefully should there be some change in.
The other reason for scans and investigations would be for diseases that may affect your breast in the future. This is a separate issue and must be treated on their own clinical merits. The implants would not affect the efficacy or the way diseases of the breast itself can be investigated. There is no evidence that you are more at risk or there is less chance of diagnosing breast disease because of silicone implants. There is certainly no evidence that they cause cancer.
What would be the likely costs of re-operation or replacement?
Any emergencies will be covered free of charge.
But long term surgery is not free. For example, if a hard capsule forms around the implant after several years, the cost of the implant will be covered (as this is under warranty) but not the cost of the surgery. The rate of capsule formation is about 10%.
If the patient wants bigger implants or the implants removed then there will be a cost in the region of £2900 to £4900 dependant upon the surgery required/requested.