Breast implant exchange

Overview

Breast Implant Exchange is sought when the existing breast implants are causing problems. Often this is just an undesireable change in the shape of the breast due to tightening of the scar (capsule) around one or both implants.

This can happen even years after breast augmentation. Sometimes the implants have ruptured and often this leads to problems like change in shape, swelling, pain and swollen glands. Recently there was a scandal about PIP implants which led to many women seeking implant exhchange. This was not the first implant scandal.

If your breast implants are not causing any signs of problems they are probably OK and don’t need removing or changing, but if you are not sure do seek medical advice.

Click here for Implant exchange FAQs

This lady came to me, unhappy with the results from previous surgery done elsewhere. Here the right breast has tightened up and rounded. The lady’s right nipple had been pulled up and remained a little high after the surgery. In this case it was possible to correct the previous surgery by operating on the one breast.

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Often times, there may be no visible defect, but the problem may be that a breast is hard and painful.

In this case the lady went for larger implants

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Here the right lady’s right breast has tightened up and rounded. There is a visible kink on her right breast due to the formation of tight scar tissue around the implant, following surgery.

A larger implant was used to replace the ones removed.

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Tight scar tissue can develop months and often years after the initial surgery. I have corrected many of these issues for patients, none of which procedures were originally performed by me.

A larger implant was used to replace the ones removed.

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Here both implants are encapsulated and high riding with the breast tissue falling off the bottom of the implant.

A slightly larger implant was used to replace the ones removed.

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Here the left breast is sitting higher and is rounded.

A larger implant was used to replace the ones removed.

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Here the right breast has tightened up and rounded.

A larger implant was used to replace the ones removed.

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Here both breasts have tightened up and rounded.

A larger implant was used to replace the ones removed

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Sometimes the distortion of the breast(s) through  the formation of internal scar tissue can be very obvious. It is more apparent lying down than standing.

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Implant exchange FAQs

What to expect from Capsulectomy / Exchange

Capsulectomy / Exchange surgery makes an immediate and dramatic difference. There may be some discomfort for a few days.

The breast will feel softer and less painful very quickly and they will often look more natural (depending on the pre-operative capsule)

As said above, expect to feel washed out for a few days after the surgery and to tire quickly although you will gradually return to your normal energy levels. The scars may become more visible and lumpy at around 3-4 months after the surgery. This is normal and in most cases the scars settle to form fine, flat, pale scars.

The majority of people who undergo Capsulectomy / Exchange surgery are very pleased with the result and feel it makes a very positive change to their lives.

After Capsulectomy / Exchange

Expect to feel washed out for a few days after the surgery and to tire quickly although you will return to your normal energy levels in a few weeks.

The sutures are all dissolving, but a one week follow-up will be given to make sure everything is OK. I will personally see you at 1, 4 and 12 weeks and 6 and 12 months following surgery and more if required.

You will be given a breast band to wear after the operation this is particularly important at night. Bras that push the breast up should not be worn until at least the first appointment

What can go wrong with Capsulectomy / Exchange

I feel it is important that anyone having surgery with me is aware of the possible negative sides of surgery and understands the small but real risks. The following paragraphs cover what happens when things occasionally don’t go as expected.

Like all surgery there are risks of complications whoever does your surgery. It is important you are aware that many of the problems you may get after your surgery, if they are treated promptly, most have no obvious effect on the final outcome.

It is unlikely your breasts are totally symmetrical before surgery and there may be a small degree of asymmetry after the operation. (If it is a big difference then a surgical correction can be discussed).

All operations have a risk of bleeding. In Capsulectomy / Exchange there is a small risk that there may be bleeding inside the operated breast leading to a collection of blood (haematoma), which needs to be removed under an anaesthetic (less than 5%). Infection is rare and antibiotics are given around the time of surgery to reduce the risk. Infected breast implants can sometimes be rescued but once they are infected there is about a 50% chance treatment with them in wont work and the implant will need to be removed. Some people form bad scars (about 2%) and these can be troubling for a while although often respond to treatment over several months. Swelling of one or both breast may happen due to the accumulation of a seroma (straw coloured fluid). This may happen days or weeks after the surgery and may need further surgery. This is rare.

There may be some numbness of the skin, this will normally get better over a period of time but there is a small risk of small areas of permanent numbness.

As this is a surgical procedure to deal with appearance no guarantee can be given to the final appearance, but if we agree it is an unsatisfactory result correction will be offered at no additional cost.

Risks particular to breast surgery are problems with nipple sensation which may be lost or significantly reduced and breast feeding which may not be possible following the surgery. These problems can be permanent.

Sometime the implant can be felt easily ,or the edge be visible under the skin. This is mostly a problem with very thin people. It is not very common, although after the procedure there is less cover over the implant as the capsule has been removed

Other problems include problems with wound healing under the breast which responds in the main to dressings and has little if any impact on the final result.

Some people are worried about breast cancer or arthritis with breast implants. Screening for breast cancer needs to be done by someone with expertise in breast implants, but the rate of breast cancer in women with implants is lower than in women without implants. The arthritis / silicone question has been answered by a number of very good studies and no relationship or increased risk has been found.

Implants can have problems with the capsule around the implant becoming tight over time and this is more likely if you have already had a capsule. This may lead to the implant wrinkling and being visible as rippling or the implant edge may be visible or able to be felt. It may even be necessary to change the implant and release the tightness. This may take a number of years and affects about 10-15% of modern implants.

Some people may have long term pain or discomfort in the breast area.

There have been 71 reported cases in the world of a type of lymphoma (blood cancer) called Anaplastic Large Cell Lymphoma. Each year about 1 million breast implants are put in around the world. The risk is between 1 and 6 people getting the problem for every 3 million breast implants.

All operations have a small risk of Deep Vein Thrombosis (DVT), chest infection and Pulmonary embolism. Death following elective surgery is exceptionally rare (1:250,000 in fit and well people)

Capsulectomy / Exchange Operation and hospital stay

  • The surgery is performed under general anaesthetic and takes about 2 hours. When you wake up you should be comfortable as local anaesthetic is used in the wounds and you will remain on regular analgesia (painkillers) for several days until you are effectively pain free. There will be dressings on your breasts. After the surgery you will stay in hospital overnight or until it is safe to send you home. Surgical drains are often used to prevent blood collection in the tissues and these are removed once they have settled.

Breast Capsulectomy / Exchange implants Surgery

This involves removing the old implant and all the scar surrounding the implant  (the capsule) and placing a new implant (the same size or larger normally) into the breast. The old scar on the skin is used to get to the implant so there is normally no new visible scar.

All the scar around the implant needs to be removed as research has shown that leaving the capsule behind significantly incrases the risk of the breasts tightening up again.

The amount of breast tissue is slightly less after the surgery so a slightly bigger implant will be required to keep your breasts the same size. You can chose to go larger.

We can have a discussion about round v teardrop implants.

Drains are used and will be removed once they have settled.

Bra, Bands and Arm movement after surgery

Do not wear any type of bra after breast augmentation surgery that might push up on the implants causing them to move upwards.

Wear the band you are given all the time for the first week and then at night until the first clinic appointment.

If you wish to wear something to be more comfortable a camisole or sports bra with no uplift is OK, but be careful. The most common cause or a revision procedure folowing breast augmentation is upward migration of the implant which I think is mostly caused by wearing a bra too early.

The other cause is lifting your arms above your head and tearing out the internal stitching allowing the implant to drop onto the skin causing a double bubble. This should be avoided for two weeks at least

Bras

You will be provided with a surgical bra after the operation

After surgery once the wounds and healed and it is comfortable an underwired bra can be worn. It takes around 3-4 months for the final size to be reached so buying a lot of bras early is not advisable

Implants

There are many different types of implant but many surgeons will use either the round or the anatomical silicone 4th Generation implants. Round implants are circular if you look down on them on a table and anatomical are tear drop shape. The new high cohesive gel implants probably have a life expectancy of 20-30 years. The implants I routinely used are guaranteed for 10 years against failure

 

The Clinic appointment

I will in addition to my routine patient discussion and examination take photos of you with different size implants under a vest top. You will go home with a CD of the photos so you can look at yourself with different size breasts and chose the size you feel works for you and your frame. I then order and use that size implant. This results in almost all my patients having the size of breast they are happy with.

Here are some sample photographs just showing a few sizes

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What to bring to hospital

If you would like, bring a family member or friend. Bring some easy to put on bed wear, preferably with front buttons and your own clothes and toiletries and something to pass the time like books, puzzles or some music . The rooms have televisions and there is free Wi-fi.

What to look out for after you have gone home

Before you come into hospital, you will get a package that contains a set of post-operative instructions and a thermometer.

Watch out for redness, swelling, pain, discharge, opening of the wound, fevers, sweating and shaking. Whatch to see if your temperature is above 37.2C and you feel unwell or it is above 37.6C.

If any of the above are seen or any of the information of the instruction sheet call the numbers on the instruction sheet or the hospital you had your operation.

Things to Avoid

The following are medications or herbal medicines to avoid before surgery.

Please disclose all medications (including self prescribed and herbal and vitamin supplements) during the consultation. The following increase the risk of post operative problems.

Roacutane or other vitamin A skin preparations / aspirin / steroids / warfarin / clopidogrel / Brufen / alka-seltzer / Fish oil / Flagyl / anti-rheumatics-arthritics / blood thinners eg persantin / St John’s Wort / Aloe vera / Cimetidine / Vitamin E (>600mg/day) / Vitamin C (>1000mg/day) / alfalfa / arnica / bromelain / calendula / celery / chamomile / cloves / Evening primrose / garlic / ginger / ginko / goji berries / licorice / meadowsweet / diabetes medication / blood pressure medication / diuretics

Most fruit and pickles have aspirin like chemicals in them so avoid large quantities in the two weeks before surgery.

Please remember that if you have any questions or concerns to ask during one of your consultations. Writing questions down is sometimes helpful.

Driving

Normally you can re-start driving at around 2 weeks. You are fit to drive if you feel you are fit. I recommend you have someone take you to an industrial zone or supermarket car park late at night so you can attempt driving without risk to others. If you find you can drive without problems you are safe to go out on the road

Work

Depending on how physical the work you do is, you can start working from between 1 and 3 weeks.

If in doubt remember you can always ask for advice.

Exercise

At home rest is necessary for one week and any strenuous activity, bending, and lifting etc. is to be avoided. You can shower once your dressings are reduced after your first appointment.

Physical exercise more than a gentle walk should be avoided for the first least 3 weeks and then only undertaken if comfortable. After 3 weeks I allow swimming and cycling and more vigorous walking. After 6 weeks you can, if it is comfortable, return to full activities.