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Breast Implant Revision

Breast Implant Revision

Breast Implant Revision San Antonio TX | Breast Implant Revision

For all breast implant patients, there comes a time when a touch-up or perhaps even a major revision is needed to rejuvenate the look and feel of the breasts. The question is always when, not if.  Just as we expect the breast tissue itself to change with age, augmented breasts will also “age”.  This process can lead to a variety of distressing functional and cosmetic issues which may or may not require surgery to correct.  Although many women have anxiety about revision breast augmentation surgery, Dr. Albright is here to help!  He will give an honest assessment of the underlying problems and possible solutions to achieve an improved and more rejuvenated breast.

The first step to approaching breast implant revision is to identify the problem.  The common functional problems with implants are capsular contracture and implant rupture. These issues require surgery to fix and may need to be fixed sooner rather than later.

Even without a functional problem with the implants, plastic surgery patients may be dissatisfied with the appearance of their augmented breasts.  The cosmetic issues involved are more complex than many realize, as the problem may relate to the implant, the overlying breast/soft tissue, or, most frequently, a combination of both.  Dr. Albright is an expert in identifying these issues and utilizes the most up-to-date surgical procedures to address these concerns.  

Great, so how do we fix the implants?!?

Dr. Albright utilizes the most up-to-date techniques to improve outcomes in revision breast implant surgery. Although no augmentation revision surgery is “permanent”, Dr. Albright will try to obtain lasting results by addressing the underlying problem with the most appropriate solutions.  Often multiple techniques are used during the surgery, and they include:

  1. Changing the implant (dimensions / volume / fill-type / implant shell surface)
  2. Changing the implant pocket
  3. Capsule adjustments including capsulorrhaphy (suture adjustment), capsulotomy (incision adjustment) and capsulectomy (capsule removal)
  4. Soft tissue reinforcement with mesh for implant support
  5. Removal of damaged excess skin
  6. Repositioning of the nipple

Breast implant revision FAQ’s

What are the common functional problems with breast implants?

Capsular contracture:  Although rates have steadily declined over the years, capsular contracture remains one of the most common functional problems with implants.  Capsular contracture is a progressive abnormal thickening of the scar tissue around the implant (the capsule).  Capsular contracture causes the implant to feel more firm, develop a more rounded shape, and may cause pain.  As with any breast pain, breast cancer should be excluded first.  The pain from a contracture can begin as intermittent feeling of tightness in the breast especially with certain arm movements, and can progress to chronic discomfort.   Although contracture occurs more frequently with implants above the muscle, any breast implant can develop it.  It can develop in one breast or both, with saline or silicone gel implants, and either smooth or textured surface implants.  The most frustrating issue with contracture is that a contracture can reoccur even after surgery to correct it. Dr. Albright will formulate an individualized surgical plan for you to help lower this risk and get your softer, more natural breast back.

Implant Rupture:  Although there are many different types of breast implants, all implants are man-made and will not last forever.  A common rule of thumb is that the annual risk of implant rupture is about 1% per year per implant.  Patients may have had blunt force trauma to the implant, or no trauma at all.  For saline implant rupture, patients may experience a gradual reduction in volume or present with a more sudden decrease in breast size.  For silicone implants, particularly the newer generation of cohesive gel implants, patients (and surgeons!) may not be able to identify a ruptured implant as it may not look or feel different.  For this reason an MRI may be necessary to help identify a ruptured silicone implant (although this too is not 100% accurate!).  With a ruptured implant, you have surgical options depending on your preferences and desires.  Whether it is to remove the implants without replacement or a more advanced revision surgery, Dr. Albright will help you make an informed decision.

What are the common cosmetic issues with breast implants?

Waterfall Deformity is seen in the seated or standing position where the implant stays high up on the chest, and the breast tissue starts “sliding off the mound” as it is pulled downward by gravity.  This is also called the ‘snoopy deformity’, as the hanging breast tissue resembles snoopy’s face in profile.  Typically this involves an implant that is completely under the muscle, whereby the muscle has continued to support the implant high up on the chest while the native breast has begun to droop. It tends to occur in women who are prone to droopy breasts (multiple pregnancies with breastfeeding, and large native breasts).  Often, some form of breast lift surgery will be needed to fix this issue.

Implant Displacement can occur due to gravity pulling on the implant (all implants), or by active displacement due to muscle contraction (below muscle implants).  There are a variety of breast deformities that are due to implant displacement.  The stretch deformity is most characteristic of implants placed above the muscle or partially under the muscle, and have  inadequate soft tissue support.  With stretch deformity, the implant migrates downward and begins to stretch the skin of the lower pole of the breast, and the nipple may remain high. This is different than a Double Bubble deformity, where the implant has actually moved downward and below the native lower breast fold (IMF).   This creates a step-off from native breast tissue to a lowered bottom edge of the implant, and typically occurs with partial submuscular implants in which the muscle has forced the implant past this natural barrier.  Finally, another commonly encountered issue is implants that have moved toward the armpits.  Not only does this bother patients as their arms can bump into the displaced implant during exercise, but also the patient will develop a breast implant "gap" between the breast mounds.  

Visible rippling or implant folds can be particularly distressing to patients and are typically a result of implant characteristics, implant pocket, and patient soft tissue coverage. Whether saline-filled or silicone breast implants, every implant currently in the US has rippling of the shell but they differ in how pronounced the rippling is.  The other critical factor is how well this inherent rippling is disguised or camouflaged by the patient’s own soft tissue (how thick is the skin, fat, breast and/or muscle). Thinner patients are at a higher risk for being able to see the ripples and feel the implant edges or folds. Fat transfer to the breast is one possible solution to correct (camouflage) implant rippling.

Is revision implant surgery more complicated than initial breast augmentation?

Patients’ fear of revision implant surgery is not completely unfounded, as there is an inherently higher complication rate with revision breast surgery when compared to the first augmentation procedure. There are many reasons for this.  But broadly, the tissues themselves have changed due to: scar tissue from previous surgery, the weight of the implant on the soft tissue, and from the natural aging of the breast. As the skin around the implant begins to sag, longer incisions are often needed which increases risk of wound healing problems, operative time and creates less well-hidden scars.  Patients may also be less medically healthy than they were when they had the implants placed. To minimize your risks for complications, it is important to find a surgeon who will take these factors into account when formulating an individualized surgical plan, such as Dr. Albright, a board-certified plastic surgeon in San Antonio.

Can my health insurance cover my cosmetic breast implant revision surgery and what about my breast implant warranty?

Patients often wonder why their personal health insurance will not cover the cost of their revision surgery especially if they are experiencing a functional problem like capsular contracture. Whereas in the past insurers may have been less restrictive and covered claims made for complications from cosmetic surgery, nowadays insurers almost always deny these claims.  Even if the surgery is performed and a claim is submitted, once it is rejected by your insurer, you will be on the hook for the full insurance rate charges from the surgeon, anesthesiologist and surgical facility; typically a much higher bill than full cosmetic rates. For this reason, Dr. Albright will not submit insurance claims for cosmetic surgery.

All current implant manufacturers in the US provide a basic limited warranty for implant rupture by providing replacement implants at no cost. However the cost of the implants themselves is a relatively small part of overall surgery cost.  Manufacturers in the past, offered an additional warranty that patients had to pay extra money for at the time of the implant placement. Typically, within ten years, if the implant were to fail, the manufacturer would write a check to offset some of the out-of-pocket expenses from revision surgery.  However, even this is not typically enough to cover all expenses.  Today, implant warranties offer more inclusive coverage, but still fall short of covering expenses. Dr. Albright and his staff will help assist you with taking advantage of any available implant warranty you may have.

Why is revision breast surgery more expensive than my first augmentation surgery?

One of the most frequently cited issues for patients seeking revision of their cosmetic breast surgery is cost. There is no denying that it is expensive.  Implant warranties are variable and rarely contribute enough to cover surgery expenses. Health insurance plans will not cover complications from cosmetic surgery.  Therefore patients usually will have to pay for the care out-of-pocket. The costs for revision surgery are higher than initial augmentation surgery because the surgery is more complex and time-consuming.  There may be more supply costs for new implants, surgical mesh and postoperative garments. Surgeon, anesthesia, and facility fees are usually based on the complexity of the procedure and operation time.  There are also additional miscellaneous fees such as cosmetic insurance and financing fees which may be different than previous arrangements. All together, revision surgery can be expensive.  Dr. Albright is sensitive to this issue and offers financing plans, as well as competitive pricing to get you the best results possible.

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Breast Implant Revision
“ Dr. Albright and his staff were all very friendly and helpful. He replaced my old breast implants that I had had since my mastectomy about 15 years ago, I would recommend him.”
Breast Revision
“ Dr. Albright has really helped me through such a rough patch of my life. I struggled with a breast deformity and through this uncomfortable process, Dr. Abright handled my case with such grace and made me feel comfortable under the circumstances. Great care, and great nurses on staff. If you do happen to get surgery for whatever reason, you are in GREAT hands. I really can't thank him & his staff enough for what they've done for me. I finally feel comfortable in my own skin.
Thank you. ”
Tummy Tuck
" I traveled to have Dr. Albright as my plastic surgeon and it was well worth the time and miles. I was referred to Dr. Albright by my oncologist for a second opinion to have my implants corrected as there had been some movement with the one. My first appointment with the doctor was very detailed and informative. He was very kind and patient answering all my questions and telling me the pros and cons to both surgeries I was considering. After that appointment I knew which surgery was best for me and felt very confident that I had found the best doctor for me as well. I truly believe his goal was to make me feel and look great again, which he did. Should I have a need again in the future for a plastic surgeon, he will be the only doctor I see. "
Breast Augmentation
“ Dr. Albright spent a great deal of time to explain pros and cons and the best options that would benefit me the most regarding my breast augmentation. The best place to go for honest and open discussions, reality vs misconceptions and the confidence of feeling better about oneself. Highly recommend!”
Diane
Alamo Plastic Surgery San Antonio TX | Team - Dr. Albright, Franchesca Espinosa, Juli Albright
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