Breast Augmentation (BA) is the most common cosmetic surgery procedure in the Western world. Despite advances in both techniques and the prostheses themselves, further surgery will be required at some point. This may be due to implant failure and is increasingly common as the prosthesis ages. Additionally, the breast undergoes changes, particularly with pregnancy, breast-feeding and involution.
Surgery usually takes longer than the primary operation and is associated with more complications. Because of existing scar tissue and the influence of breast implants, outcomes are less predictable.
Where possible, existing scars are used, but secondary surgery is nowadays usually performed through the inframammary crease. There are four variables that you will need to consider and each situation is unique
- Implant – the implant should be replaced in the majority of instances and obviously if ruptured
- Plane – implants placed beneath the breast (‘subglandular’) and may need to be replaced under the muscle (‘submuscular’), particularly with rippling and capsular contracture
- Capsule – this is the natural human response to any foreign body and is scar tissue that is usually soft, thin and flexible. If significantly contracted and distorting the breast it needs to be removed
- Breast – as every woman knows, breasts change with age and gravity. Minor degrees of droop (‘ptosis’) may be addressed with a dual-plane approach or a larger implant. Moderate and severe degrees require an uplift (‘mastopexy’)
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A detailed consultation will assess your particular situation and ensure fitness for surgery. You must not smoke before or after the operation and there is some evidence that capsular contracture is more common in smokers. Importantly, your aims, expectations, alternatives and limitations will be discussed in detail.
Given the variables above, it will be no surprise that a range of options is possible and there are 4 main ones:
- Implant removal only – although the easiest, it usually leaves an empty and drooping breast tissue unless the breast envelope is highly elastic and the prosthesis small
- Implant removal and replacement – often with a slightly larger device to better fill a stretched envelope
- Implant replacement with plane change – generally, from on top to below the muscle. In such cases a larger implant is usually used as the prosthesis appears smaller. There are some additional complications resulting from having 2 pockets in the breast
- Implant replacement with mastopexy – the most challenging breast surgery because of competing forces of skin tightening and volume expansion. This carries the most complications and outcomes not always as predictable as one would like
Whilst you may return to light, daily activities immediately afterwards it is wise to avoid strenuous exertion for a week or two. There will be some discomfort for the first few days, but regular paracetamol is very helpful. Patients normally experience mild to moderate swelling which peaks two or three days after the procedure, then disappears rapidly over the subsequent weeks. Anything more is abnormal. Bruising is rare and the majority with a sedentary occupation are back at work within 2 weeks of the operation.
Wound review is scheduled for 7 days after surgery. Already having a scar, you know that in the great majority it becomes a thin, pale line, but takes 12 – 18 months to completely mature. You should limit sun exposure for the first year, particularly during the most active phase.
Overall healing and recovery time is of the order 4 – 6 weeks.
Any surgery carries some risk, rare with modern techniques, but there is wide natural variability in wound healing. Moreover, secondary surgery takes longer, may have slightly more complications and is less predictable. Complications might arise from the anaesthetic or the surgery. As with all surgery that is for ‘wish’ rather than ‘need’, each individual must ensure that they themselves are happy with the compromises and maintain realistic expectations.