March 2023

Time For An Upgrade?
3 Signs You Need New Breast Implants

3 Signs You Need New Breast Implants

Breast augmentation is one of the most commonly performed plastic surgery procedures in the US. According to ASPS, breast implant surgery continues to carry one of the highest satisfaction rates in all plastic surgery procedures at > 94%.

It's no question that the intangible benefits of having breast implants go well beyond having larger, shapelier breasts. For primary breast augmentation and mommy makeover patients in particular, the impact on body confidence and self-esteem is truly unmatched.

In my plastic surgery consults, I always advise my patients to consider the future, and a time when their first set/older pair of breast implants will need to be replaced. It's important for women to have appropriate expectations about breast implants and to be able to plan their rejuvenation roadmap in the future.

Breast implant replacement or breast implant revision provides the perfect opportunity to change your overall breast aesthetic and adjust your breastscape in keeping with your age and lifestyle changes. That said, here are 3 signs you might be ready for a breast implant removal and replacement.

Reason #1:  You've Got Aging Implants

Many surgeons neglect to tell their patients that implants are not permanent medical devices and will need to be replaced at some point in their life. The timing for this is a matter of debate and should be discussed with your board-certified plastic surgeon. The average life of a breast implant is about 10 years. However, this does not mean that at 10 years you have to have your implants replaced.

Aging Saline Breast Implants

Saline implants have a "fill value" and are filled with sterile IV saline solution. At some point, saline-filled breast implants will either leak or go flat, releasing some (or all) of the saline back into the body. This is not harmful but the visible effects of a deflated breast implant can leave a woman with uneven breasts, feeling insecure about their chest appearance.

Should this happen, it is helpful to schedule a breast revision consultation as soon as possible and create a plan to replace both implants sooner rather than later. The reason being, the body will try and close up the implant pocket making it more challenging to achieve symmetry with revision surgery.

Aging Silicone Breast Implants

Newer generation silicone implants won’t go flat like their saline counterparts. If there is a leak, it is more insidious and difficult to detect. Most plastic surgeons recommend a high-definition ultrasound or MRI periodically to detect possible silent ruptures that can occur with trauma (like impact from a car accident) or aging implants in general.

It's important to know that breast implant silicone shells slowly degrade over time which is the primary reason for the manufacturer's warranty. The internal silicone gel permeates through the gel coat in a process known as a “gel bleed.” For this reason, these implants should be closely monitored past the 10-year warranty, and women should be prepared to replace them at some point thereafter.

Implant ruptures do not impose a life-threatening emergency, but should be attended to in order to prevent the accumulation of scar tissue.

For More On Implant Warranties

In my practice, I use Natrelle, Sientra, and IDEAL® Implants. Follow the links below for more information about their specific implant warranties.

Natrelle Breast Implants

Sientra Breast Implants

IDEAL® Structured Saline Breast Implants

Breast Revision Galleries

Reason #2:
You're Noticing Changes

As women mature, their preferences about their breast aesthetic can change. Younger women in their 20s have particular desires for larger breast shape, and well-defined cleavage, and some don't mind an augmented look. Augmented breasts created in a woman's twenties might not serve her figure the same way in her late 30s and 40s. Goals change, as does a woman's body after pregnancy, breastfeeding, and weight loss. 

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Wanting Smaller Breast Implants

30-year-old+ women in my practice schedule their revision consults to make aesthetic changes that create a more subtle and graceful outcome, appropriate with their new/current season of life. In some cases, these patients will also decrease in implant size or combine their breast implant revision with procedures like a breast lift to maintain and raise breast perkiness.

Wanting Larger Breast Implants

Pregnancy, childbirth, and breastfeeding can have dramatic changes on breast appearance after augmentation. The breast tissue covering the implant may warrant a larger implant to restore volume loss and correct saggy skin that appears both droopy and deflated. Replacing the implant with a larger size can fill out deflated skin and give the breast a perkier appearance without having to have a breast lift.

Other times, a patient may just feel that they picked the wrong size volume at the time of their primary breast augmentation. For these patients, replacing the implant with a size closer to their goals is the right choice.

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All About Breast Lifts

Breast Lift

Reason #3: Correcting A Problem With Your Implants

If you are considering replacing your implants it is a good time to evaluate the appearance of your entire breast. Simply removing and replacing the implant might not be enough. And there are those primary augmentation patients who had a complication during their healing, selected implants that were too large for their body or went to a doctor who was not board-certified and received a less-than-desirable result. For these types of breast implant patients, it's important to know that you have options to correct the outcome that was not hoped for. Let's review a few of those concerns.

Before and After Bottomed-Out Breast Implant Repair by Dr. Burns

Bottomed-Out Breast Implants

One problem that commonly occurs is that implants can migrate downward over time in a process called “bottoming out.” Essentially the implant stretches the skin of the lower breast pole and also pushes the breast fold downward. The distance from the nipple to the breast crease can increase causing the implant to sit at the bottom of the breast while the nipples appear abnormally elevated. If this occurs, the pocket can be repaired with sutures to reposition the breast crease and the implant can be supported with a mesh product or “internal bra.” I use Galaflex or Dubasorb in these cases.

Before and After Lateral Displacement repair after breast augmentation

Lateral Displacement- Implant Migration

A similar problem can occur over time as the implant can migrate laterally causing the breasts to fall toward the armpits when lying down. Most women who consult notice that their once well-defined cleavage and the appearance of upper pole fullness have changed. Again, sutures can be placed to close off the space holding the implants closer to the middle of the chest.

Oftentimes, it makes sense to make changes to the implant by upgrading the profile and making changes to the volume (ccs). 

before and after image of a woman's chest with asymmetric breasts after breast augmentation

Breast Asymmetry

In cases of breast augmentation asymmetry, breast implants can migrate over time into different orientations, causing asymmetry. This might result in one implant appearing “higher” than the other. By adjusting the implant pocket using suture or mesh for support, the implant position can be altered to produce better symmetry, desired fullness, and a more natural-looking outcome.

Before & After Capsular Contracture Repair Breast Augmentation

Capsular Contracture

Finally, breast implants elicit a response by the body where a thin layer of scar tissue is produced around the implant called a capsule. In almost all cases, the scar capsule is thin, pliable, and not detectable. However, in rare cases, the capsule can become thick and hardened. This is called capsular contracture. Patients who are experiencing capsular contracture present with other common signs classified as breast tightness and transient breast pain. The scar tissue or capsule can be removed at the time of implant in exchange for a softer and more beautiful breast.

The Takeaway

Regardless, it is important to remember that breast implants are NOT permanent medical devices and were never intended as such. Like everything we value, implants should be cared for and monitored.

At the appropriate time, implants can be changed for a new pair, and any desired changes made at the same time. As a patient, you deserve to have all of the information you need so that you can make informed decisions around your short-term and long-term plan for your breasts and that communication is clear with your plastic surgeon.

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