As with any medical device, breast implants are not designed for lifetime use. In fact, the manufacturers recommend a 10-15 year life span. Eventually, your implants will require updating with new implants, either for safety reasons or for aesthetic reasons. Causes for implant exchange vary from patient to patient. Additional pregnancies and/or breastfeeding after primary breast augmentation, significant weight changes requiring a different sized implant or a complication with the device itself – such as deflation (saline implants) or implant rupture (silicone-gel implants). Some women simply become accustomed to their current implant size and desire a greater size. Some women have significant capsular contracture, or scar tissue buildup around their implant that requires removal surgically.
Dr. James Matas, a board-certified plastic surgeon in Orlando, Florida, has extensive experience performing secondary breast surgery. He will ask you about your motivations for further breast surgery, along with assessing your physical and emotional health and reviewing information you provide about previous surgeries, previous pregnancies/breastfeeding, past and current medical conditions, as well as nutritional supplements, herbal remedies and pharmaceutical medications you take.
He will carefully examine your breasts and chest wall, considering the following factors: your current implant size and style of implant used, existing problems you have with implant, amount of breast tissue you have covering your implant, thickness and symmetry of the chest (pectoralis) muscles, position of your nipple areola in relation to the breast tissue, degree of sag, thickness of skin and skin tone. He may specific measurements of your chest area to scientifically determine the proper implant size for secondary breast surgery.
He will recommend the exact procedure, or procedures needed to bring about the desired result, outlining the size, style and placement of the implant, location of the incision, the type of anesthesia, where the surgery will be performed and the risks and possibility of complications. If a woman has a significant sag or looseness of skin since the time of her original surgery, he may also recommend a mastopexy, or breast lift, be done at the same time.
He will advise you to avoid taking aspirin, ibuprofen products, Vitamin E and certain herbal medications before surgery, as these can cause increased bleeding or have undesirable effects with anesthesia. He may also ask you to discontinue upper body workouts in order to reduce muscle strength before surgery. If you require a breast lift, and you are a smoker, he will require that you discontinue smoking one month prior to surgery for proper healing.
Once a surgical plan has been established, you will be provided with the financial details, along with a suggested plan of action should you decide to take the next step towards breast augmentation surgery.
If possible, your incisions from the original implant surgery will be used, so that you don’t require new scars. If the implants are being repositioned under the muscle, then a portion of the pectoralis muscle is cut to allow access beneath it. A pocket is then developed over the rib cage and below the muscle where the new implant will be positioned. If the implants are being repositioned over the muscle, the pocket is developed over the muscle and under the breast tissue.
If the existing pocket has become too large after years of being implanted, he may tighten the pocket so the new implant shifts less. In the case of significant capsular contracture, he will surgically remove the scar tissue.
Once the new implants have been properly positioned, he closes the incision with several layers of sutures and a surgical bra is applied. The procedure itself takes about 2-3 hours and is performed outpatient under general anesthesia.
You will be discharged wearing a supportive, comfortable surgical bra with front closure. Once you get home, you will want to rest for the remainder of the night. There is moderate pain associated with this procedure, but the discomfort can be managed by taking the prescribed pain medication and applying cold compresses. Most women express that their secondary surgery had much less discomfort than their primary surgery. Expect some bruising, mild swelling and sensitivity to physical contact, similar to the first surgery.
Under the muscle placement of the implants may cause more discomfort than over the muscle. Some patients experience a temporary change in nipple sensation, and this is usually resolved within a matter or days or weeks. Most patients return to office work within 5-7 days, although you should avoid any strenuous activities that raise your pulse and blood pressure for at least 2 weeks. Strenuous upper body activities, such as tennis, weightlifting or water-skiing, can be resumed after 6 weeks. Fading of the incisional scar will occur within several months to a year.
We expect you’ll be pleased with the outcome of your secondary surgery, but your reasons for satisfaction will vary according to the problems you had with your original surgery. Since you’ve been accustomed to having implants before, you will more than likely be aware of the new changes that have occurred from the first surgery to the second.
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