Dr. Reagan often performs revision breast surgery on patients operated elsewhere. Many of these patients were never happy with their original result. In some cases, changes occurred over time to yield an unsatisfactory result. Implants, if involved, will likely be replaced (implant exchange). Sometimes the space of the implant needs to be changed (pocket exchange). Often a breast lift (mastopexy) is necessary to get an amazing result.
Patients are extremely satisfied with the use of breast implants. As with the use of any device, there is an inherent lifespan of these products. In addition, there is a fairly well studied complication rate and revision rate which should be clarified with any patient considering such an operation. For women in their late teens and early 20’s, the probability of getting another operation related to their implants is quite high (80%). This includes all factors including complications and the desire to make changes in size or shape, especially after the effects of child-bearing. The chances of revision goes down as the age at time of surgery increases.
Reasons for Revision
Implant Leak/Deflation: Implant leak or deflation rates are thought to be approximately 1% per year. Thus, after 20yrs, approximately 20% of patients have experienced a leak or deflation. In the setting of a saline implant, the saline is absorbed by the body and the implant deflates. In the setting of a silicone implant, the silicone tends to stay within the capsule. The breast may stay soft and thus such a leak may only be detectable by radiographic studies. The makers of silicone implants recommend radiographic surveillance every few years. In the occurrence of a leak or deflation, the recommendation is to remove and possible replace the implant. All implants come with a warranty which can be further discussed at the time of your consultation
Note: It is a misconception that implants need to be replaced every 10yrs !!!!
There exists no support for the notion that implants should be replaced every 10 years. Such a recommendation seems self-serving and exposes the patient to needless risks associated with surgery.
Capsular Contraction: Capsular contraction or contracture, “capsules”, or hardening is one of the more common reasons for breast implant revision. The occurrence is 5-10%. The general consensus is that contracture rates are higher with silicone vs. saline, and subglandular placement vs. submuscular placement. Emerging data suggests that bacteria or “biofilm”may play a causative role in the formation of capsules. With this in mind, attempts to reduce the exposure of the implant to the patients own bacteria seems prudent. Such attempts include the use of delivery devices (Keller Funnels), draping sheets, and the use of the infra-mammary approach to avoid glandular tissue. What is clear is that the formation of a capsular contracture is a complex, multifactorial process.
Malpositioning: The implant can placed improperly at the time of the initial surgery, or the implant can move over time. In either case, the positioning can be improved with a revision surgery. The capsule will either be removed (Capsulectomy), released (Capsulotomy), or repaired (Capsulorrhaphy). The use of form-stable anatomic implants are thought to move less over time and therefore result in less delayed malpositioning. These implants are used widely in Europe and more recently have become available in the United States. Dr. Reagan will discuss the different breast implant options at the time of your consultation.
Use of Alloderm, Strattice, and other Products in Revisionary Breast Implant Surgery
Over the past 10 years a plethora of products have been introduced to assist with breast reconstruction and breast implant revisionary surgery. They have many names such as Acellular Dermal Matrices (ADM), Regenerative Tissue Matrices (RTM), Biologics, and Silk Matrices. Essentially, these products are employed to replace or reinforce soft tissue. Furthermore, these products might reduce certain complications such as scarring or recurrence of defect.
Dr. Reagan is a pioneer in the research of these products and among the first in the world to publish controlled research on their properties (1993- see CV). He has lectured nationally on their uses and continues to implement them when appropriate into his breast implant revisionary surgery.