Board Certified Plastic Surgeon, David P. Rapaport, MD offers breast implant revision surgery at his Manhattan, New York plastic surgery facility.  Breast implant revision plastic surgery offers a solution for women who are looking to re-do their breast augmentation.  Patients from NYC and around the world seek his expertise in breast implant revision plastic surgery. Weekly, the plastic surgeon sees patients who are dissatisfied with their augmentation or have developed one or more complications from a breast augmentation (breast implant) surgery performed by another plastic surgeon.
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Actual breast implant revision patients of Dr. Rapaport.

Reasons for Revision

Patients may desire breast implant revision surgery for many reasons. One common reason is that the patient desires either a larger or smaller augmentation. A change in implant size can be easily addressed by revision surgery. Another reason for a revision procedure a problem with breast implant position. Implants may have been placed too high from the beginning, or they may become high over time as a result of capsular contracture. Similarly, implants may be placed too far to the side, or may migrate over time to these positions.

When considering breast implant revision, the first step is to diagnose the problem, which involves determining the cause of the deformity. Dr. Rapaport will make these determinations during a consultation and physical examination. An implant which is too high because it was placed that way at the original surgery can usually be revised with a fairly simple operation. However, if the implant is too high as a result of capsular contracture, then the revision surgery will not be successful over time unless it addresses the contracture and takes steps to prevent the contracture from recurring. Similarly, if an implant has migrated downward on the chest because the patient’s tissues did not provide it with enough support over time, then the revision surgery must provide additional support so the problem will not recur. Sometimes, internal sutures are adequate; sometimes, a supporting layer must be introduced surgically. There are currently a variety of materials available for providing support to a breast implant. These include Alloderm, which is derived from human skin, and Seri, which is a biologically modified silk material.

An undesirable breast implant “feel” may also be a reason for wanting breast implant revision surgery. Saline implants create sharper ripples because the salt water filling them is not as viscous as gel. While a saline implant may provide an excellent augmentation in a woman with adequate breast tissue and body fat, if there is not enough tissue covering the implant, ripples may be felt, and a revision may be desired. Gummy bear implants have become more popular in recent years, partly because they have a much lower incidence of capsular contracture. However, there is a trade off involved. All gummy bear implants feel much firmer than natural breasts, and also do not move as a natural breast would when the woman moves. To prevent the need for future revision surgery patients should understand the properties of different types of implants. Our practice also offers the Ideal Implant, a choice that offers advantages to patients looking for either alternative to saline or silicone implants. Learn more about the Ideal Implant.

Learn more about capsular contracture
There is an approximately 10% incidence of implant rupture within about 10 years of surgery. Saline implants have a somewhat higher risk because the folds of a saline implant are somewhat sharper and more prone to developing microscopic cracks or holes.
When saline breast implants leak, it is usually a very clear event to the patient within days, because the loss of volume and folding up of the implant are usually very apparent. Of course, what is leaking is sterile saline, which is absorbed by the body and involves no risk. When a saline implant deflates and begins folding up inside the body, the pocket which the implant occupied can begin to close. It is for this reason that it is highly advisable to replace a deflated saline implant as soon as possible. This makes the replacement procedure much more simple because there will need to be little, if any, manipulation of the pocket. If the saline implant was placed via the underarm, it is highly likely that it can be replaced through the same underarm incision. In fact, to date, Dr. Rapaport has not needed to use a new incision on the breast for replacing a ruptured saline implant which was inserted via the underarm
Because all modern silicone implants are filled with a fairly thick silicone gel, leakage or rupture of a silicone implant is not always obvious. Generally, a rupture will cause capsular contracture; however, this is certainly not always the case and there is a phenomenon called a “silent rupture,” which is a fairly rare occurrence. In such a case, the only way to diagnose the rupture is with an MRI or very high quality ultrasound. When a silicone rupture is caused by a violent event such as falling off a horse, there can be a visible deformity caused by a change in shape of the implant and silicone breaking through the capsule of tissue which surrounds the implant. Unlike saline implants, which are simple to replace, silicone ruptures require the removal of the gel which has leaked, as well as treating the surrounding capsular tissue if a contracture has also occurred. It is for these reasons that silicone ruptures are almost always treated via a scar under the breast (inframammary).

During the period in the early 1990s when there was a true “scare” in the country surrounding ruptured silicone implants, Dr. Rapaport was an assistant professor at the University of South Florida. A rheumatologist there was very prominent in promoting this scare, and wrote a book claiming that silicone implants cause a variety of problems ranging from depression to lupus. As a result, Dr. Rapaport saw and treated hundreds of patients with implant removal and total capsulectomy. Fortunately, it has now become clear that although ruptured silicone implants create a local cosmetic problem, they DO NOT pose any threat to overall health. The FDA has made it quite clear that there is no evidence of a cause and effect relationship between silicone and any diseases outside the breast.

It is obvious but worth reiterating that the best way to avoid breast implant revision is to have the original surgery performed by a physician who is expert in the field and possesses a large body of experience in breast implant surgery.

If you have questions concerning breast implants revision plastic surgery, or would like to schedule a consultation with the Board Certified Plastic Surgeon, please phone David P. Rapaport’s Manhattan, New York Plastic Surgery office at 212.249.9955 or email the doctor at info@drrapaport.com.

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