Secondary breast implant surgery is carried out when there is either a problem with your breast implants or a change in your breast shape or size over time or after pregnancy, ageing, weight loss or other body changes. As your breasts have had previous surgery and the breast implants will normally have been in place for some time, this surgery is usually more complicated than your original operation.
Indications for secondary breast implant surgery
Limitations of secondary breast implant surgery
Your breasts have had previous surgery with some scarring as a part of this. There are usually some limitations in what you are suitable for in terms of implant size or style and in the degree of change that is possible to achieve. This depends on the reason you are having secondary breast surgery, the size and shape of your breasts and how able your breast tissue is to support further implants and the changes that you are hoping to achieve with this surgery. This will be discussed with you in more detail and in relation to your particular circumstances during your consultation with Ms Nugent.
There will be situations where Ms Nugent recommends leaving breast implants out for a period of time before replacing them at a second stage or that you no longer have breast implants. This is usually when problems such as infection, recurrent capsular contractures or sagging of the breast tissue persist even after attempts to solve them.
Secondary breast implant procedure
Pre- and post-surgery clinical photographs of your breasts will be taken. Breast implant surgery is usually carried out under general anaesthesia (while you are asleep) as a day case or with an overnight hospital stay. The surgery usually takes between 1 and 3.5 hours depending on the procedure being undertaken. While Ms Nugent does not routinely use drains in breast surgery, she is more likely to do so in secondary breast implant surgery. If possible, they are removed the next morning before you go home. Sometimes it is necessary to leave the drains for longer and you will then be discharged home with the drains in place and an appointment will be made for you to return to the hospital for their removal. You will be asked to wear a support bra for 6 weeks afterwards.
Types of secondary breast implant surgery
An exchange of implant is performed without further surgery. This is usually where only minor problems have occurred or where a patient simply wishes for a different size or style of implant. It can normally be carried out using the original incision.
Capsulectomy with implant exchange or removal
The capsule of scar tissue that has built up around the implant is removed along with the old implants and new implants are placed under the breast if desired. It may be necessary to place new implants in a different plane in relation to the breast e.g. removing implants that have been placed directly under the breast tissue and placing the new implants partially under the pectoralis muscle. This can be helpful in reducing the risk of future capsular contractures. The surgery is usually performed using an incision in the breast crease. It may need to be larger than the incision made to place the original breast implants.
Capsulectomy & implant exchange & mastopexy
In addition to removing the scar tissue around the implant and replacing the implant as described above, a breast lift or mastopexy is performed to lift and improve the breast shape as well. The incision (and therefore the scar) will depend on the extent of mastopexy required.
Implant removal +/- capsulectomy & mastopexy
The breast implants and any significant scar tissue or capsule around them are removed and not replaced. A breast lift or mastopexy is performed to lift and improve the breast shape. The incision (and therefore the scar) will depend on the extent of mastopexy required.
A breast lift or mastopexy can be done over existing breast implants when sagging of breast tissue has occurred over the implants but the implants themselves are not problematic and are of a suitable size and style. This lifts and improves breast shape. The incision (and therefore the scar) will depend on the extent of mastopexy required.
Lipofilling (fat transfer)
Fat transfer can be done from another area of the body e.g. hips or thighs to improve the shape or symmetry of breasts over implants or to hide visible outlines of implants better. It does carry the risk of damaging the implant when fat is being placed around the breast.
Adjustment of implant position
If an implant is sitting too high or low in relation to the other side or the breast itself, it may be necessary to adjust the shape of the breast pocket that the implant is sitting in. It may be recommended that the implant is replaced with a fresh implant in these situations to reduce the risk of infection from exposure of the implant during the adjustments.
Rarely, simple implant removal is all that is needed. This can be done using the original surgical incision and is normally a very straight forward procedure.
In some patients requiring secondary breast implant surgery, Ms Nugent will recommend scans such as ultrasound or MRI scans before surgery. She will also recommend sending tissue or fluid for analysis in some clinical situations. This is usually done at the time of surgery or a scan. If any further treatment is required as a result of this, Ms Nugent will advise you after she receives your results.
It is recommended that ruptured breast implants are reported to the Medicines and Healthcare products Regulatory Agency (MHRA) so that trends or higher than usual rates of problems with breast implants are identified. Ms Nugent will do this on your behalf if indicated.
You will have bruising and swelling in your breasts afterwards which will peak at day 2 to 3 and slowly resolve over the weeks following this. Most of this will go in the next 4 to 6 weeks but swelling can persist for up to six months. You will have a scar, the location and extent of which will be discussed in advance with you and will depend on the exact surgery that you require. Bigger scars may be needed to perform secondary breast implant surgery than those used in your original operation and they may need to be placed in different locations on the breast. It may take 6 to 12 months for the shape of your breasts to fully settle following secondary breast implant surgery particularly after some types of mastopexy.
You will need to wear a support bra for 6 weeks postoperatively. This helps to provide support to your breasts and to keep swelling controlled.
Most people return to work after 1 to 2 weeks depending on the nature of their work. Exercise or strenuous activities need to be avoided for 6 weeks post surgery. Light activities can be resumed within 2 weeks and normal activities are usually unrestricted after 6 weeks.
As with any surgery, there are some complications associated with secondary breast implant surgery. Please see the individual information booklet or sheet for complications relating to breast augmentation, breast augmentation mastopexy, mastopexy, lipofilling (fat transfer). Regarding secondary breast implant surgery specifically, please note the following:
Longevity of procedure
Secondary breast implant surgery is usually very successful. The improvement in your breast shape and/or size is apparent early on although it is 6 to 12 months before the final result can be seen. The results are usually long-lasting.
The natural ageing process of the body continues regardless of surgery and so may over time alter your breast shape or size leading to recurrence of loose skin or sagging of the breast tissue. Significant changes in weight can also affect the longevity of secondary breast implant surgery.