Breast augmentation (breast enlargement) is one of the most popular plastic surgery procedures for many good reasons - it is safe, predictable, can produce an immediate improvement in properly-selected women, and has very high patient satisfaction. However, it is important to appreciate that following breast implant surgery you will almost certainly need further surgery again in the future - to carry out an uplift, to change the implant, or eventually simply to remove the implants. There is no set time limit for revision surgery - some women have had the same implants for decades - but on average, revision surgery takes place ten to fifteen years after the original procedure.
In many cases implant exchange is easier and less invasive than the original surgery, since the pocket for the breast implant already exists. An exception is revision surgery for thick capsule formation ('adverse capsular contracture' or ACC), in which all or most of the capsule is removed and the implant plane may be changed.
There is no 'set piece' for revision breast surgery and your surgical plan will be tailored to your needs. However, a few more common scenarios are:
Change in Size or Shape
One of the most frequent reasons for implant removal and replacement is the woman's desire to change the size of the implants. The majority of women are extremely happy with their new size after breast augmentation, but a number decide years later to increase or decrease their cup size. This might involve implant exchange, plane change, capsulectomy (removal of capsule), capsulotomy (release of the capsule without removing it), capsulorrhaphy (tightening or reshaping the capsule) or a combination of these.
A minority of patients may develop capsular contracture following their breast augmentation. In such cases, the capsule needs to be removed (capsulectomy) and the breast implants replaced, sometimes with a plane change. Sometimes we may decide you would benefit from uplift surgery at the same time.
I have not seen a case of visible implant rippling amongst my patients although I am called upon to address it following previous breast surgery. It can be addressed by a variety of techniques, including changes to the implant, its placement and adjunctive surgical techniques such as fat grafting. I would be happy to formulate a tailor-made plan for you at your consultation.
Before embarking on cosmetic surgery always do your research and find a reliable surgeon with a good local reputation. Developing a rapport with your surgeon is essential. A consultation usually takes at least half an hour and it should be with the surgeon rather than a nurse or patient coordinator. I like to meet twice before surgery so you can ask all the questions you've thought of between meetings.
After the surgery you will be asked to wear a post-surgical bra to support and protect your breasts, and will be given postoperative exercises to start on the day of surgery. In this way, many patients report not needing paracetamol after a few days. You should be able to return to work after one or two weeks depending on the nature of your job.
Anaesthetic: General Anaesthetic
Hospital stay: 1 night
Surgery time: 1.5-2 hrs
Time off work: 1-2 weeks
Reasonably mobile: from Day 1
Washing: Shower after Day 2, bath after 2 weeks
Driving: 1-2 weeks
Exercise: 4-6 weeks
Bras & garments: Surgical bra for 4-6 weeks, non-underwired bra for 2 months.
Full recovery: 4-6 weeks
Smoking: we advise all patients to stop smoking for 2 weeks before and after any surgery
Analgesia (pain relief) - Ibuprofen and paracetamol.
Surgical skin tapes should be left in place for the first week and replaced thereafter.
The hospital or surgeon should be contacted if you develop a temperature, bleeding or rapid swelling.
Wounds will be checked at 1 week, and I usually then see you at 1, 3 and 6 months.
Swelling reduces after a few weeks