I am writing today to talk about a problem that I see frequently in my clinics.  As a board certified Plastic Surgeon it is my obligation to inform my patients to the best of my ability about the procedures that they are considering.  Ethically, I am unwilling to minimize or to ignore the risks associated with the surgeries during my discussions with my patients.  This discussion is a vital component to an informed decision. 

Unfortunately, this doesn’t seem to be the case for all surgeons.  I see a fair number of revision breast augmentation cases in my practice and very frequently I hear, “I thought my breast implants would last forever! My surgeon never told me that I would need another operation!”  This misconception about the “immortality” or implants can be perpetuated by misleading information found on the internet or in advertising, or through the anecdotal experience of a patient’s friend who had undergone the procedure before her. 

I am here to set the story straight.  Implants do not last forever and there can be problems with them.  Unfortunately, the fact of the matter is, many women who undergo a breast augmentation will need a secondary procedure in the future to address some issue with their implants. 

Rupture of either a saline or a silicone implant may occur at some point in time following a breast augmentation.  Removal of the implant is recommended following a rupture, and this is particularly true of silicone implants.  The reason for removal is that the silicone gel can escape from the implant and implant capsule and penetrate into the breast tissue.  Gel that has migrated into the breast tissue may require removal of some of the breast tissue to fully address.  Replacement of implants is common following rupture as many women are unwilling to return to a smaller breast size . 

The development of capsular contracture is another problem that can occur with time.  As this develops, the breasts can become firm, change shape and even become painful.  Significant capsular contracture is another reason that a woman may consider a reoperative procedure following her breast augmentation.  This may prompt you to ask, ”If you have surgery to address capsular contracture, it won’t come back. Right?” Unfortunately, that’s not the case and the risk of recurrent capsular contracture is higher following the secondary surgery.  Furthermore, reoperative procedures do not reduce the risk of needing future surgeries for other reasons. 

Here is an example of patient that underwent a saline breast augmentation 13 years ago.  She presented to my clinic with a complaint that “I woke up this morning and my implant had ruptured.”  She wanted to replace her implants with new implants of similar volume.  On examination there was marked asymmetry of her breasts and she had a ruptured left saline implant.  The right breast had a very mild capsular contracture.  There was a nearly imperceptible inframammary (breast fold) scar.  Here is the preoperative photograph:

During our consultation I spoke with her about removing and replacing her implants into the dual plane.  I performed capsulotomies (incisions in the capsule) on both sides to help open the scar and allow it to remain soft.  I did not remove the capsules on either side because they were mild.  The patient’s original implant volume was not known until the time of surgery as there was no record of her procedure available.  She decided that she would like to use a 325 cc size and this is what I used for her.  The original implant volume turned out to be 300 cc’s.  Here is the postoperative result at 3 months:

This patient was very satisfied with her saline implants and wanted to remain augmented following her rupture.  She was unprepared to return to her pre-augmentation size as she felt more proportional with her implants.  The operation that I performed achieved her goal of restoring the volume lost when her implant ruptured. 

Our websites, www.beauty-surgeon.com and www.drmckane.com have  additional information and before and after photographs of breast augmentation for review.  I invite you to schedule a consultation with me if you would like to learn more about breast augmentation or reoperative surgeries.  Please feel free to contact our office at (713) 661-5255 if you have any questions about this procedure.

-Brice W. McKane, M.D.

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