Secondary Breast Implant Surgery

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

• Ruptured breast implants
• Capsular contracture (tight scar tissue around implant which causes your breasts to feel hard, to have a change in shape (deformed shape) and/or to be painful)
• Sagging of the breast tissue or implant
• Visibility of the implants
• Weight of the implants
• Change of mind regarding size or shape of implants or regarding having implants in place
• Persistent infection
• Asymmetry between breasts

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

Please see the relevant information booklet or sheet for more detail on individual procedures such as breast augmentation, breast augmentation mastopexy, mastopexy, lipofilling (fat transfer).

Implant exchange

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.

Mastopexy

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.

Implant removal

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.

Investigations

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.

Post-operative course

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.

Recovery

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. 

Complications

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:

• Swelling and bruising. This will peak around day 2 to 3 post surgery and will gradually reduce after that.  Most of the swelling is usually gone by 6 weeks but occasionally lasts longer than expected.  It may be more extensive or last longer than after your original surgery as secondary surgery often takes more time and is more extensive.
• If you have a tendency to bruise or bleed easily or take medications such as aspirin that make you more prone to bleeding, this may be a higher risk for you.  It may be necessary to stop some medications in advance of surgery.  Occasionally there is more bleeding than expected from the incisions or bleeding under the skin forming a haematoma.  A return to theatre may be needed to deal with this.  There is a higher risk of bleeding after capsulectomy surgery than other types of breast surgery.
• Implants that are being replaced because of infection have a higher risk of further infection than those that have never been infected.
• Slow healing. This may be due to one of the problems mentioned in this section such as infection or sometimes some areas are slower to heal than others or due to overdoing it after surgery.  This is usually managed with dressings in the clinic.
• Poor scar formation which may be tender, raised, lumpy, stretched, red or slow to settle. 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.
• No-one is perfectly symmetrical and we all have differences between the two sides of our body.  These differences persist after surgery but are usually small enough that they are not overly visible and do not require any treatment.  With secondary breast surgery, the risk of persistent asymmetry is higher than after the original surgery as it is usually more complex surgery and there are often some physical limitations to what is achievable.
• After surgery, the body naturally produces a certain amount of fluid as part of its reaction to surgery and attempts to heal the area.  Sometimes this fluid can build up underneath the skin after the drains have been removed and require drainage in the clinic or under ultrasound guidance with a fine needle.  This may need to be repeated until it stops being produced.  After capsulectomy, the risk of seroma formation is higher than if no capsule formation or surgery has taken place.
• Reformation of capsular contracture. If you have had a capsular contracture around your breast implants at any stage, you are at higher risk of developing a further capsular contracture in the future compared to those who have had breast implants and never developed capsular contractures.  This has occurred in up to 40% of patients with previous capsular contractures in some clinical studies.  Further surgery (usually at additional cost) is needed to treat a recurrent capsular contracture.
• Adjustment to a reduced breast size. If implants are not replaced or if a smaller implant is used to replace those removed, your breasts will be smaller after surgery. If a breast lift or mastopexy is performed although no significant amount of breast tissue is removed, your breasts may appear smaller due to the tightening and lifting effect of the surgery.
• Loose skin. If implants are removed and not replaced or replaced with smaller implants, you may have loose skin and/or sagging afterwards in your breasts as they will have stretched to accommodate the original implants.  This can be counteracted by having a breast lift or mastopexy.  If skin and breast tissue has been very stretched by large implants, it does not have good elasticity and sagging can recur in the future even after a mastopexy.
• Disappointment with the result. Sometimes after undergoing secondary breast implant surgery, patients are disappointed with the result.  This may be due to one of the problems described above occurring or due to unrealistic expectations of the surgery e.g. mild asymmetries, visible scarring or less than expected improvement of breast size or shape.  It is important that you discuss your expectations in advance of the surgery so that you can understand what to expect from the surgery and so this situation is avoided as much as possible.  (Additional costs may be incurred for further procedures.)

 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.

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