Breast Implant Revision

Dr. Cohen often sees patients who have had breast surgery done elsewhere and who are dissatisfied with their outcome. The reasons for dissatisfaction can be multiple. Some of the more common ones are:

Capsular contracture. Contracture of the normal capsule that the body creates to envelop any implant (called “capsular contracture”) causes discomfort and misshapes the breast. The treatment involves surgical removal of the capsule and replacement of the implant with a new one. In theory, almost every breast implant can develop this problem sooner or later, and currently there are no known ways of preventing capsular contracture.

Implant rupture. Rupture of a breast implant is immediately obvious to a woman who has saline implants, due to immediate deflation of the breast size. Rupture of a silicone implant can be more difficult to diagnose. The gold standard of diagnosis is a breast MRI. While many implants outlive their guaranteed life span, there are many silicone implants manufactured prior to 1992 that lacked modern quality control and had higher rupture rates compared to today’s implants. This is one of the reasons why in 1992, FDA imposed a moratorium on silicone breast implants in the U.S. that lasted until 2006. In the 14 years between 1992 and 2006, both the research on implant safety and the quality control over silicone implant manufacturing had improved to the point that today, FDA considers breast implants safe.

Implant malposition. Over time, an implant may lose its harmonious relationship with the breast skin and tissues. Some implants may migrate below the natural level of the breast, creating either the “bottomed out” look that makes the nipples appear too high, or the “double-bubble” look that makes it look like there is another breast just below the real breast. Other implants may stay at their original location, but the breast tissue itself may “slide off” the implant over time, creating a “waterfall deformity” appearance. In other instances, an implant may migrate too far toward the side, toward the armpit, or too far toward the cleavage, causing synmastia (a plastic surgery term for “uniboob”). Each individual situation is highly unique, and the surgical plan depends on the nature and extent of the issue as well as the patient’s goals and desires.

Size dissatisfaction. Over time, some women grow dissatisfied with the size of their breasts after breast augmentation. Some women come in wanting to be smaller, and some women want to go bigger. There is no right or wrong answer to these highly unique scenarios, and Dr. Cohen makes sure that the patient’s concerns are addressed exactly to match her desires.

Improperly selected implant. When a woman seeks her first breast augmentation, Dr. Cohen performs an extensive physical exam of the breasts’ anatomic dimensions and tissue quality, carefully recording about a dozen anatomic breast measurements that allow him to make a thorough assessment of what operation and what type of implant will be ideal for this patient. This complex method of 3-dimensional assessment of a breast is something that not all surgeons do when evaluating a patient for a breast augmentation, which occasionally results in implants that are not in harmony with the patient’s native breast and rib cage anatomy. Dr. Cohen has extensive training and experience performing re-operations on women whose implants had not originally been selected to match their unique anatomy, both in cosmetic augmentation as well as breast cancer reconstruction cases. As someone who specializes in plastic surgery of the breast, Dr. Cohen enjoys these challenges and prides himself on his ability to help women who are dissatisfied with the outcomes of their breast implant surgery.