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Breast Implant Revision - Capsulectomy

Breast implant revision is a surgical procedure designed to replace older silicone implants with new saline-filled implants, or in certain patients with newer silicone-filled implants.

This procedure may also be necessary to remove a fibrous capsule forming around the implant with possible displacement or discomfort.

Women have been taking advantage of breast implant surgery since the 1960s, and many are still opting for the procedure. However, some women experienced problems with their silicone gel implants in the 1990s, leading to questions about the safety of these implants.

The life of the average silicone gel implant is about ten years. Therefore, women who had silicone gel implant surgery several years ago may want to consider having them replaced with saline-filled implants. In recent years, serious questions have been raised about the connection between silicone leakage and chronic ailments from mild fatigue to lupus. While there is no medical evidence to support these claims, there is still a great deal of controversy surrounding silicone gel implants.

Recently, the US Food and Drug Administration ruled that saline-filled implants (made by Mentor and McGhan) were safe to use in breast augmentation surgeries. Unlike liquid silicone, saline is a salt-water solution that can be safely absorbed by the body without side effects. So, if one of these implants breaks, the leaking fluid will not present the same kinds of risks.

If you're considering breast surgery revision, the following information will provide you with a good introduction to the procedure. For more detailed information about how this procedure may help you, we recommend that you schedule a consultation with Dr. Kremer / Dr. Zettl.

What are some of the most common benefits of breast surgery revision?

Breast implant revision allows a woman to keep the fuller, larger breasts that she desires while minimizing risk. The two makers of saline implants offer a lifetime warranty on their products.

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What will happen at the initial consultation?

During the consultation, you and Dr. Kremer / Dr. Zettl will discuss the changes that you would like to make in your appearance. Because this is a highly personal decision, you’ll want to take time to discuss all of your concerns and desires, including the size and shape of the implants.

Dr. Kremer / Dr. Zettl will explain the different options available to you, the procedure itself, and its risks and limitations as well as the kind of anesthesia required. You should tell him about any medications you currently are taking, and any health conditions you have.

Be sure to ask all the questions you have about the surgery. Learning everything you can about your options, risks and benefits is the key to making an informed decision.

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How is breast surgery revision done?

During the procedure, Dr. Kremer / Dr. Zettl will open the former incision to remove the existing implants and place new implants in the same area. Next, an existing scar capsule is scored or sometimes even completely removed, depending on your condition.

Depending on your tissue quality the new implants can be placed either in the same or in a different location. This decision is based on the shape of your breasts, the thickness of your subcutaneous tissue as well as the severity of a present fibrous capsule.

A general anesthetic will be typically used.

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How long does the surgery take?

Breast surgery revision usually takes about one to three hours to complete. The length of the procedure varies according to the technique used and your anatomy, as well as any existing capsular contracture, asymmetry or other factors related to the previous implants.

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Do I have to stay in the hospital?

Probably not. Most breast surgery is performed in a day surgery center as an outpatient procedure; you’ll be able to return home within a few hours of the surgery. However, if you have an infection or hardening of the breast, you may have to stay overnight in a hospital.

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How much pain is there?

Exchanging a breast implant stretches the tissues and can be painful. This may be true for breast surgery revision as well, especially when the implants are placed under the muscle or the pocket location is different. The pain is greatest within the first 48 hours, but improves with each day and is somewhat relieved by pain medications.

When you wake up you will feel tired, sore, and stiff. It is important to take the medication prescribed to you by Dr. Kremer / Dr. Zettl.

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What can I expect after surgery?

Your breasts will be wrapped with gauze bandage as well as a tighter bandage for protection and support. You also may have drainage tubes coming out of the incision for several days, to help drain some of the excess fluid.

Dr. Kremer / Dr. Zettl may prescribe an antibiotic and an anti-inflammatory medication to be taken after the surgery. It is a good idea to have these prescriptions filled beforehand.

Someone will need to drive you home, and you may need assistance at home over the next couple of days as well.

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What is the recovery period like?

Your scars will be pink for several weeks. After several months they will begin to fade. It is critical that you review post-procedure care with Dr. Kremer / Dr. Zettl. Following his instructions carefully will help promote a speedy, healthy recovery. Also keep in mind that:

Rest is important to the healing process, so get as much as possible following your procedure! Drink plenty of fluids, and be sure to take Dr. Kremer / Dr. Zettl's prescribed medications.
For at least 3-5 days, you should try to keep arm extension to a minimum. Elbows should not be raised higher than the armpit. The tissues will heal more quickly if you avoid stretching and separating the muscles and tissue surrounding the breast implants.
After several days, the gauze dressing will be removed. You may be required to wear a support bra to help your breasts form and maintain a pleasing, balanced shape. You may or may not be able to shower, depending on where your stitches are.
The stitches will come out after about ten days, but swelling may continue, gradually subsiding over several weeks. With the swelling, your breasts may seem hard and unnatural, but eventually they should soften to a more natural feel.
Because revision surgery can range from minor surgery performed on soft breasts to a major procedure on hardened breasts, you should check with Dr. Kremer / Dr. Zettl to find out when you’ll be able to return to your normal activities. Recovery varies from patient to patient and depends upon the technique, type of implant, and site of placement that Dr. Kremer / Dr. Zettl uses, as well as the level of activities in your daily routine.

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How long do the results last?

There is no one answer for how long implants last. It may be between 6-8 years or as long as 15 years, but predictions in individual cases are nearly impossible.

Keep in mind that larger breasts sag faster than smaller breasts, and augmented breasts do this as well. Gravity, unfortunately has no exceptions. Ten or twenty years after surgery, successful augmentation patients will still look far improved over those who haven’t had surgery.

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Ideal candidate:

In general, the best candidates for breast surgery revision are:

18 years of age or older
Not currently pregnant or nursing
In good physical health
Psychologically stable
Wanting to improve their appearance
Realistic in their expectations
Having this surgery for the first time

The above is only a partial list of the criteria that Dr. Kremer / Dr. Zettl will consider in determining whether or not this procedure is appropriate for you.

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Possible complications:

Some of the more common possible complications include postoperative infection, hematoma (a blood clot in the breast tissue requiring evacuation of the blood clot during a subsequent surgical procedure); implant rupture, deflation or leakage; capsular contracture, changes in nipple or breast sensation, interference with mammogram readings, shifting of the implant.

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Risks:

There are several concerns regarding any breast surgery: the surgery itself, the implants, breast cancer, and the risk of anesthesia. All surgeries carry some risk and the possibility of complications can include (but are not limited to) infection, unsatisfactory results, excessive bleeding, adverse reaction to anesthesia, and the need for second or sometimes third procedures.

There is no known association of breast implants with breast cancer in human beings, and in fact several large studies have shown a lower incidence of breast cancer in women with breast implants. Breast implant type devices have been shown to cause a rare form of cancer in rats that are prone to cancer, but this cancer has not been reported in humans with breast implants.

Read more about breast implants and health on the Food and Drug Administration (FDA) website.

Other side effects specific to breast surgery revision include:

capsular contracture: occurs when the scar or area around the implant begins to tighten, causing the breast to feel hard.
nipple sensitivity or loss in sensitivity: usually disappears after several weeks, but for some this is permanent.
rippling: indentations on the breast, often caused when the implant moves. This tends to be more common with textured implants than smooth implants.
rupture: when the breast implants tear and/or leak. If your implant ruptures, it will require a second operation to replace the implant. Rupture of a saline implant is generally not an urgent matter, and will almost certainly have fewer problems than rupture of a silicone implant. Silicone gel has the consistency of glue, and may irritate the body.
symptoms of immune system disorders: some women have reported having symptoms such as joint pain swelling, fever, fatigue, or breast pain. Although research has not found conclusive evidence correlating breast implants with these symptoms, further studies have been requested by the US Food and Drug Administration (FDA).

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Be sure to:

Tell Dr. Kremer / Dr. Zettl about any allergies you have (to foods, drugs, environmental elements)
Tell Dr. Kremer / Dr. Zettl if you have a history of bad scarring, such as keloids.
Tell Dr. Kremer / Dr. Zettl about all medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription)
Carefully follow any instructions Dr. Kremer / Dr. Zettl gives you regarding eating and drinking and smoking.
Avoid aspirin and aspirin-containing medicines for two weeks prior to surgery.
Arrange for someone to drive you home after surgery or after discharge from the day surgery center or the hospital.
Please inform Dr. Kremer / Dr. Zettl immediately in case you should experience fever or symptoms of an infection after surgery.
Try to schedule surgery at a time other than your menstrual period.

The information on this web site is only intended as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result.

The best method of determining your personal options is to schedule a personal consultation with Dr. Kremer / Dr. Zettl. He will be able to answer specific questions related to your situation.

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